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Fever

Parents know that fevers are very common in children, especially small children. But our biggest concern may be if/when you should call your pediatrician or take your child to the ER.Below is a list of signs and symptoms in addition to fever for when you should contact your doctor.
Keep in mind that fevers do not necessarily need to be treated.  The most important factor in the decision to treat or not to treat a fever is how your child looks, not the height of the fever.If your child is feeling badly and looks ill it would be more appropriate to treat their fever; however, if your child is playful and looks good, it may be best just to watch it closely.

When should I contact the pediatrician when my child has a fever?

Parents should contact their child’s pediatrician if their child has fever with any one of the following signs or symptoms:

  • severe coughing, breathing fast and/or difficulty breathing
  • drooling or your child cannot swallow
  • lethargy or extreme irritability
  • poor fluid intake
  • signs of dehydration (i.e. less urination than usual, dry mouth, minimal tears when crying)
  • continuous vomiting or nonbloody diarrhea
  • any bloody diarrhea
  • persistent abdominal pain, especially if starts around the belly button and moves to their lower right
  • side of the belly
  • red, swollen wound or redness of an area of skin
  • urinary complaints which may indicate a urinary tract infection (e.g., painful urination)
  • petechial rash (small, flat, purple spots that when pressed down on do not blanch, or fade for a second or two) (See Photo called Petechiae)
Also, contact your pediatrician:
  • if your child is under 2 months and has a rectal temperature of 100.4 degrees Fahrenheit or greater (even a slight fever can be a sign of a potentially serious infection in very young infants)
  • if fever persists for more than 48 – 72 hours for mild illnesses (e.g., cold, occasional bouts of vomiting or diarrhea)
  • any time you are uncomfortable with how your child looks
For any of the signs and symptoms listed above, your pediatrician may ask you to bring your child to the office for evaluation or to go directly to the ER.

What can I do to treat my child’s fever at home?

  • Encourage your child to take more fluids, including ice pops, because fever will increase the bodys fluid needs.
  • Dress your child in loose fitting, light clothing.
  • Bathing your child with lukewarm water may help bring down fever. Never use cold water or alcohol to bathe your child.  Cold water will only cool down the skin, not the body temperature.
  • Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) are the two forms of medication for children that may help lower your child’s temperature.
  • Acetaminophen is recommended to be given every 4 hours as needed

*  Ibuprofen is recommended every 6 hours as needed

*  Click on Dosing charts for specific dosing information
  • Never give aspirin to your child with a fever because of the risk of a serious disease known as Reye syndrome.
  • Fevers do not necessarily need to be treated unless your child is feeling badly and looks ill. If your child is playful and looks good, it may be best just to watch it closely.  The most important thing is not the height of the fever but how your child looks.
It is best to ask your pediatrician how he or she recommends treating or not treating fever.

What is a fever?

  • The body normally develops a fever in order to fight against infection by viruses and bacteria, and sometimes is present in other diseases.
  • Babies and children sometimes get a low-grade fever after getting vaccinated.
  • Teething may cause a low-grade fever (less than 100 degrees Fahrenheit or 37.8 degrees Celsius) but cannot by itself be accounted for a higher temperature.
  • Most high fevers are caused by viruses and will go away without treatment for the infection itself.
  • Antibiotics have no effect on viral infections so most causes of fever in children require no antibiotics.
  • Our normal temperature is around 98.6 degrees Fahrenheit, or 37 degrees Celsius. The technical definition of fever is a rectal temperature of 100.4 degrees Fahrenheit, or 38 degrees Celsius.
  • The following is a conversion table for Celsius and Fahrenheit temperatures:

Celsius……………….Fahrenheit

36   C                          96.8  F
37                                98.6
37.2                             98.9
37.4                             99.3
37.6                             99.6
37.8                           100.0
38                              100.4
38.2                           100.7
38.4                           101.1
38.6                           101.4
38.8                           101.8
39                              102.2
39.2                           102.5
39.4                           102.9
39.6                           103.2
39.8                           103.6
40                              104.0
40.2                           104.3
40.4                           104.7
40.6                           105.1
40.8                           105.4
41                              105.8

For an easy way to convert any temperature from one to another, visit http://www.wbuf.noaa.gov/tempfc.htm

  • A rectal temperature is the most accurate way to determine a fever in a child less than three months.
  • Touching a child’s skin is not an accurate way to measure a childs temperature.

How can I take my child’s temperature?


There are several different types of thermometers that can be used to check and monitor your child’s temperature.

   Digital thermometer

  • Can take a temperature in the rectum (100.4 degrees Fahrenheit or 38 degrees Celsius is considered a fever)· recommended for age less than 3 months
  • Can take a temperature by mouth (99.5 degrees Fahrenheit or 37.5 degrees Celsius is considered a fever)· generally not recommended until 4 years of age
  • Can take a temperature under the arm (99.0 degrees Fahrenheit or 37.2 degrees Celsius is considered a fever)· can be used in children over 3 months but probably less
    accurate

Electronic ear thermometers

  • Because this type of thermometer is not as accurate as a digital thermometer, the American Academy of Pediatrics advises against using it for infants younger than 3 months.
  • follow the manufacturers recommendations for any thermometer

Which medication works better for fever in my child, ibuprofen (Motrin) or acetaminophen (Tylenol)?

Research studies have been done to see if there is a difference between ibuprofen and acetaminophen with reducing fever in children:

  • Overall, acetaminophen lowered temperature better in the first 30 minutes after being given; however, both worked the same one hour after being given.
  • Ibuprofen decreased temperature more at 2, 3, 4, and 6 hours after being given.
  • There was no evidence that there was a difference between the two medications with regard to side effects.
  • Acetaminophen does have the benefit that it comes in a suppository form (Feverall), so you may be able to use it if your child is vomiting or is refusing to take any medications by mouth. And acetaminophen can be used in younger children, while ibuprofen is usually limited to children over six months of age.
It is best to ask your pediatrician how he or she recommends treating or not treating fever.

Can I alternate the use of ibuprofen and acetaminophen?

  • There is no consensus among pediatricians on whether or not this is the best way to treat a high or ongoing fever.
  • Research on this topic is limited; however, a recent study was published from Israel this year (2006) in Archives of Pediatric and Adolescent Medicine which evaluated over 400 children 6 months to 3 years of age and found that alternating both medications every 4 hours is safe.The study also concluded that alternating ibuprofen and acetaminophen results in the following:

1. lowers the temperature faster compared to either medication alone

2. lower average temperature

3. less absenteeism from daycare

Note: This question is not fully answered by this study alone.
The doses for both ibuprofen and acetaminophen
used in this study were on the low end of what is
usually recommended and other studies have shown
that higher doses work better.

So, it is still possible that only one of these medications
is really all that is needed to treat fever in our children
if a dose on the higher end of what is usually
recommended is given.

  • The American Academy of Pediatrics has stated that there is no evidence that alternating ibuprofen and acetaminophen achieves faster, safer, or more efficient reduction of fever in children compared to just using one drug.
  • In rare cases, especially if the child is dehydrated, the additive toxic effects of ibuprofen and acetaminophen on the kidneys could possibly lead to kidney problems.
  • By using two different medications, the chance of making an error when giving them increases. Dosing errors can lead to an accidental poisoning.
  • Also, we have to be careful of using over-the-counter meds that may contain acetaminophen or ibuprofen at the same time.
  • If your doctor does recommend to alternate fever reducers, then write down a schedule with the times that you are giving the medicines so that the correct medicine is always given at the correct time.