According to the groundhog, spring should be here, but the winter illnesses keep dragging on, and with those illnesses come fever. Fever is one of the most common reasons why children come to the office for an appointment. It is also a frequent reason why parents or caregivers call for advice, even in the wee hours of the night, fearing an emergency. Many years ago, one of our profession's most prominent pediatricians, Dr. Barton Schmidt, coined the phrase “fever phobia”, and it continues to this day. But fear not! Here are some things to know when dealing with fever.
What is fever?
When an infection or other illness is detected, the brain responds by raising the body's temperature to help fight the condition. Elevating the temperature can slow the growth of many viruses and bacteria and enhance the function of the immune system.
Fever is generally regarded as a temperature above 100.4 F.
How high is too high?
In regards to temperature, we are often asked, “What number do I need to be concerned about?”. For most children, there is no answer to that question. Regardless of the cause, the body's temperature rarely goes above 106 F, and in an otherwise healthy child, fever itself does not cause harm unless it reaches 107 F. The height of the temperature also does not indicate a serious bacterial infection. Viral illnesses are the most common cause of fever in children.
The exception is with an infant under 3 months of age. A rectal temperature of 100.4 F is an important sign of illness. In this circumstance, the baby needs to be evaluated, usually in the emergency room, as soon as possible after the fever is detected.
Children older than this can usually be monitored at home for 24 - 72 hours unless there are other symptoms that should be evaluated, especially if there are concerns about pain, difficulty breathing, or dehydration.
To treat or not to treat?
Because fever itself is not harmful to healthy children, treating it is a matter of judgement. We encourage you to do so if your child is uncomfortable—the particular temperature does not matter. Similarly, it is not necessary for medicine to reduce the temperature to a certain “normal” number. It is only important that the child seems to feel better, either by appearing more alert, less cranky, or more willing to drink fluids.
Children with underlying health conditions, such as those that affect the heart, lungs, brain, or nervous system, should be treated with medication when they have a fever. For those that have had a febrile seizure in the past, it has not been shown that treatment will prevent recurrent seizures. It is, though, a reasonable precaution to take.
Please be aware that it is not necessary to withhold medicine for fever if your child is uncomfortable before coming to the office for an evaluation. Providing accurate information about your child's symptoms is what is important.
What to give?
In the pediatric patient, fever is treated either with acetaminophen (Tylenol) or ibuprofen (Motrin, Advil). Acetaminophen can be given every 4 hours, and ibuprofen products can be given every 6 hours.
The child will have the best response to medication if given a weight-based dose:
Families also often ask about rotating the two medications. While doing so can help to maintain a lower temperature than using either medication by itself, research has not shown any benefit to doing so. Giving more medication, especially more often than a child needs, can increase the risk of toxic effects.
Where is there more information about fever and children's health?
The American Academy of Pediatrics website, HealthyChildren.org, can provide more details about fever, including what to watch for and what to do when your child is ill. Hopefully this can help to prevent any unnecessary fear or concerns the next time your child has a fever.