Every parent has had the experience of waking up in the middle of the night to find their child is hot to the touch, sweaty, and flushed. Often there can be a sudden onset and parents are left asking, should I call the doctor? Get out a thermometer? Give some medication? Go to the Emergency Room?
All kids get fevers, and in the vast majority the cause is a benign illness with the child back to normal in just a few days. It is not unusual for a child to have 3 or 4 febrile illnesses in a year, most clustered in the winter months when cough and colds and flu are prevalent, but can also occur any time of the year with viral “stomach bugs” that can come on suddenly but resolve in 24 hours.
Fever is the body’s way of fighting off infection and illness. An increased temperature mobilizes the immune system to fight off infections which again, thankfully, are rarely serious.
Never the less, fever is a symptom (not a disease) that your child is fighting an illness. When evaluating a child’s fever it is much more important to look at the whole situation, how the child is doing, rather than focusing on just the fever.
Children can feel pretty bad in the first hours of an illness. Even normal colds or short term stomach upsets can cause fevers to spike initially. If your child is up to date on immunizations, and is generally healthy with no unusual chronic disease, giving Tylenol or Motrin for the child’s comfort and evaluating over several hours is appropriate initial treatment in most situations.
If your child is a newborn or infant under the age of 3 months, fever is more concerning. Babies at these ages have not yet had the benefit of their immunizations, and their immune system is not yet completely able to fight off infections. For that reason, at this age if a fever is suspected we recommend taking a rectal temperature to document the problem. Be sure the baby is unwrapped before taking the temperature. Babies who are swaddled or wrapped up in too many clothes can run a temperature that is not really a fever. If a Temperature of over 100.4 is documented after the baby is unwrapped, then it is time to call the doctor.
Older children can tolerate fevers fairly well. The degree of temperature is not as important as other symptoms the child is showing. If the child is interested in playing, doing some eating and drinking, is alert and smiling, showing normal skin color and looks well after you give Tylenol or Ibuprofen to bring the temperature down, you are on pretty safe ground.
There is generally no exact temperature that indicates you should call you doctor. Fevers do not cause brain damage. That myth still persists from the era before immunizations and modern diagnosis. Here are some guidelines of when a fever is important:
1. If your child is 8 weeks of age or less, a rectal temperature is over 100.4 with the child unwrapped.
2. A child undergoing chemotherapy; or with a congenital immune deficiency such as AIDS
3. There is no clear cause and the fever lasts over 3 days
4. A fever associated with bad sore throat or cough with chest discomfort lasting 24-48 hours.
5. A fever with a sore throat that results in difficulty swallowing and drooling because unable to swallow own saliva.
6. A fever with continuous vomiting over 12-18 hours with the symptoms of dry mouth and no urination with refusal to drink
7. A fever with obvious breathing difficulties such as chest retractions and nasal flaring with air hunger.
8. A fever with unusual lethargy or listlessness even after taking fever medication (Tylenol or Ibuprofen)
9. A fever accompanied by stiff neck, headache that is more than a usual tension headache
10. A fever with a specific type of rash: Petechiae (dot like rash that looks like bright red dots that do not blanch when pressed, almost like flat drops of red paint on the skin) or with purplish hemorrhagic rash on the skin that does not blanch when pressed
11. A fever that persists over 104 despite fever medications.
12. A febrile seizure lasting more than 5 minutes
Febrile seizures occur in children, usually less than 3 years of age, when their temperature changes so rapidly the body cannot really catch up, usually in the first hours of an illness. The result is a short episode of shaking with the child rolling the eyes and experiencing a convulsion. While we want to avoid this, simple benign febrile seizures do not cause harm, and do not cause brain damage. Some families have a tendency for febrile convulsions, while most families never have it happen. The best and only way to prevent a simple febrile seizure is with immediate use of fever medications such as Acetaminophen (Tylenol) or Ibuprofen (Motrin, Advil). Racing to the Emergency Room will not prevent a febrile convulsion, only the judicious and rational use of fever medications will help prevent this benign event.
So in summary, while every child will have illnesses with fever, it can be a worry for parents. Fever is instrumental in mobilizing the immune system to fight off disease. “Fever phobia”, which can cause anxiety for parents, is often worse than the fever itself. Never the less, if your child shows worrisome symptoms in addition to the fever (such as those listed above), contact your doctor. The Emergency Room is available after hours if you feel your child is in danger or needs immediate care.
The use of Acetaminophen (Tylenol) or Ibuprofen (Motrin or Advil) often helps a child feel better, and is helpful in treating the symptom of a fever. Below are some dosing guidelines:
Childrens Tylenol Dosing guide: http://www.tylenol.com/children/subchild
There are no dosing instructions for children under two on the label. You must talk to your doctor.
Children's Motrin Dosing guide:http://www.motrin.com/product_links/4?val=overview