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 bodies 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:
The doctors and nurses at Beaufort Pediatrics strive to be available when needed for acute childhood illnesses. The office opens at 8:00 AM Monday through Friday and closes at 7:00 PM with our last appointment at 6:00 PM. We are also open Saturday 9:00 AM until 1:00 PM for urgent care by appointment only.
Between 120-160 children and young people are seen every day in our office, and over 40 appointments are held open each day for same day sick visits. As a result we can usually see every child who needs a same day visit that day, and in fact, we do not close and go home for the evening until we have seen every child that needs to be seen. Such things as ear infections, pain, minor cuts, persistent fevers, persistent coughs, and acute illnesses can be evaluated and treated in a timely manner in our acute care office.
Please note that many of the appointment times for same day problems are available in the morning. Calling early will secure one of those appointments. We realize our parents have work and other responsibilities, and we work hard at seeing everyone on time with a minimum of disruption to family schedules.
At some times of the year, such as during flu season, it does become very difficult, if not impossible, to see everyone who desires to be seen immediately. In that event our nurses can discuss the illness with you, triage the problem, and schedule a time to come in. We appreciate your understanding and patience during the busy seasons.
One of the most difficult decisions for a parent is deciding if their child is sick or injured to the point a visit to the emergency room may be in order.
Emergency Room visits cost 5-10 times more than a visit to your Pediatrician, often results in long waits, and can be very stressful for child and parent.
Emergency Rooms should only be used for immediate problems when a child may be in a life threatening situation, in severe pain, or in a medical situation where immediate care is necessary. Beaufort Memorial Hospital Emergency Room is an excellent facility, staffed by trained Emergency doctors who are expert at trauma, heart attacks, and life threatening illnesses. The Emergency Room does not have a Pediatrician on staff, and should not be used for normal childhood illnesses.
It pays to think ahead of time about the right place to go in the event of an urgent problem. Listed below are some guidelines from the National Institute for Health regarding Emergency Room use:
1. Choking and inability to catch breath. Note this is not congestion from a stuffy nose, but blockage of an airway such as from a foreign body
2. Stopped breathing or turning blue. Call 911
3. Possible poisoning. Call Poison Control Center first at 1-800-222-1222.
4. Severe head injury with continued vomiting, passing out, slurring of speech or change in mental status or behaving abnormally
5. Injury to neck or spine severe enough to consider fracture
6. Severe burn
7. Seizure lasting more than 3-5 minutes
8. Bleeding that cannot be stopped.
Go to an Emergency Room or call 911 for help in such problems as:
1. Trouble breathing with pain in chest that seems more than usual cold or cough
2. Severe allergic reaction with sudden onset Hives with trouble breathing, constriction around the throat, swelling that blocks airways.
3. High fever WITH a headache and stiff painful neck
4. High fever when a child is acting unusually lethargic, confused, slurring speech, can't wake up, or shows other worrisome changes.
5. Suddenly not able to speak, see, walk, or move
6. Heavy bleeding
7. Deep wound
8. Serious burn
9. Probable broken bone, loss of movement, especially if bone pushing through the skin
10. A body part near an injured bone is numb, tingling, weak, cold or pale
11. Unusually severe headache with change in behavior
12. Fast heartbeat that does not slow down with child agitated
13. Mouth is dry, no tears, no wet diapers or urination over 18 hours with refusal to drink.
Beaufort Pediatrics is open extended hours to help our patients avoid using the Emergency Room. We are open 8:00 AM until 7:00 PM Monday through Friday and 8:30 AM until 1:00 PM on Saturday mornings (urgent care only on Saturday).