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When to Worry About a Fever

Posted on Jan 21, 2014 | 29 comments

baby.fever

Nearly every parent has felt their child’s hot, feverish forehead and worried. Is it serious? How high is too high? Should they go to the doctor?

Few symptoms scare parents more than fever, says Palo Alto Medical Foundation pediatrician Cara Barone, M.D.  But it’s important to know when to treat, and when to let nature take its course. Here, Dr. Barone answers parents’ most common questions about fever, and offers tips on how to take your child’s temperature properly.

What causes fever in my child?

Fever is a healthy sign the body is working properly to fight and overcome an infection.  Through a chemical reaction, our bodies elevate our core temperatures in effort to stop bad viruses and bacteria from replicating. The most common sources of infection in children are viruses. Young children can often have seven to 10 viral illnesses with fever each year – especially if they are in daycare or preschool, where viruses spread easily among children. The second most common sources of infection are bacteria. Both types of infections, viral and bacterial, can cause fevers.

We worry most about fevers in very young children – especially infants less than 3 months old – because their immune systems are still developing. This leaves them at risk for severe infections. In preschool age children and beyond, we pediatricians generally don’t worry much about fevers unless they last for four days or more, and cause symptoms such as significant listless/irritability, a bad sore throat, worsening coughing or pain with urination.

How should I take my child’s temperature?

One of the most important skills of parenting is to know how to take a temperature correctly. In babies and children less than 1 year of age, it is important to feel comfortable taking a rectal temperature. This is by far the most accurate method of taking a young child’s temperature. New parents are often frightened to take a rectal temperature. But it doesn’t hurt their baby, and it’s quite simple once you know how to do it.

Lubricate the digital thermometer with petroleum jelly and insert the silver tip of the thermometer into your baby’s rectum about 1/4 – 1/2 of an inch. Hold it gently for one minute, then remove and read the temperature. You can see illustrations showing you how to take a rectal temperature at healthychildren.org. Or, watch this video from Baby Basics.

For children older than 1 year of age, the best and most accurate methods of taking a temperature is either with an oral digital thermometer or a tympanic (ear) thermometer.  Ear thermometers are great for toddlers. They are usually accurate, but can be off if your child has lots of ear wax. You can find illustrations showing how to use an ear thermometer at healthychildren.org.

How high a fever is too high?

In infants less than 2 months of age, a fever is any temperature over 100.4º F. It’s also a concern if your newborn’s temperature is less than 96 F. For an abnormal temperature in your newborn, call your doctor or go to the urgent care clinic or emergency room — your newborn needs to be seen right away.

In babies and children older than 3 months, a fever is a temperature greater than 101.5º F. Call your doctor if your child’s temperature reaches 102.2º F or higher.

Most fevers go away in a couple of days. Call your doctor if the fever lasts four days or more. Call the doctor right away if your feverish child has vomiting or diarrhea, earache, severe abdominal pain, headache, stiff neck, sore throat, trouble breathing, pain when urinating, swollen joints, other localized pain and a purplish/dark rash that does not fade when you press on it. Also call the doctor if your child is listless or refuses to drink fluids.

Should I give my child medicine to lower her fever?

Fever-reducing medicines are not needed for low-grade fevers (99º  to 101º F) unless your child seems uncomfortable or is not drinking well. Once children’s fevers rise above 101.5º F, they generally feel miserable, and fever-reducing medicines will help them feel better. Children may be more likely to drink fluids properly after they have had fever-reducing medicines.

It is important to make sure you are giving your child the correct dose of medicine. Too little medicine won’t be effective, but too much could be dangerous. Follow the instructions on the label carefully and only use the cup or syringe that came with that medicine. (Never use a household teaspoon. They vary in size, so your dose may be wrong.)

Two types of fever medicine are safe for children: Acetaminophen (sold as Tylenol) and ibuprofen (sold as Motrin and Advil). Tylenol is the only fever-reducing medicine approved by the FDA for babies younger than 6 months old. Motrin has a few advantages over Tylenol for children older than 6 months of age: It lasts between six and eight hours; it can reduce swelling from teething and ear infections with its anti-inflammatory properties; and it may be a better choice for children who have asthma or recurrent wheezing.

It’s a good idea to print out the correct dosing for these medicines. Or bookmark the pages for easy reference:

Tylenol for children (acetaminophen) dosing chart
Motrin and Advil for children (ibuprofen) dosing chart

Remember, fevers are a sign of a healthy immune system. If your child has a low fever and no other worrisome symptoms, provide plenty of fluids, rest and love. The fever should go away in ta few days.

Barone-Cara-2013-webCara Barone, M.D. , is a pediatrician at the Palo Alto Medical Foundation.

Please note that we are unable to respond to personal medical questions through the comments feature below. For information about personalized health care, or if you need help in choosing a PAMF physician, please visit Becoming a PAMF Patient (http://www.pamf.org/findadoctor) or call 1-888-398-5677. If you are a PAMF patient, you can email your doctor securely via our My Health Online program. Thank you

29 Comments

  1. It really helped a lot. Thank you.

    San

    • Thank you very much! Very helpful!

  2. Thank you so much for this! :)

    • You are welcome, Lisa. Glad you enjoyed the article and thank you for visiting our blog.

  3. My son has had a fever in the 104 range for 5 days now. Ive taken him to his pediatrician and they’ve ran all sorts of tests and found nothing. What could possibly be wrong with him why he continues to have such high fevers

    • Hi Levonya,
      This is a community blog and does not provide personalized medical advice. If you have a personal medical question for you or your family, please contact your doctor directly to discuss. If you or your child are a PAMF patient, you can also email your doctor securely via our My Health Online program with any questions. Thank you for visiting our blog and best wishes.

    • My daughter is going through the same thing Levonya, though it was low grade for 5 wks, now its been 103. Initially labs clear, rerunning some and did a few more. Hope you got answers.

  4. Thanks for everthing it is really useful for us..and for the thermometer it is very important to have one at home

    • Kunal,

      Glad to hear you enjoyed the article and tips. Best wishes!

  5. my six month baby fever 103 which medicine should be given

    • Hi Sunil,

      This is a community blog and does not provide personalized medical advice. If you have a personal medical question or concern for you or a family member, please contact your doctor directly to discuss – or if it is a medical emergency, seek immediate medical attention. (If you are a PAMF patient, you can also email your doctor securely via our My Health Online program with your questions.) Thank you for visiting our blog and best wishes.

  6. This was very helpful information. Thank you very much.

    • Isabel,
      Glad to hear you found the information helpful. Well wishes!

  7. Is there a way to see if a fever is hospital needed if you do not have a thermometer?? Hypothetically

    • Brittany,

      There is no way to measure a temperature accurately without the use of a thermometer. Feeling a child’s forehead or body are not an accurate reflection of core temperature. The only way we can decide if a fever is hospital worthy is to actually measure it.

      – Dr. Barone

  8. The link for the tylenol chart is linking to the ibuprofen chart. Im using an ipad. It seems like both lines are one link rather than 2 separate ones.

    • Hi Liz,
      The link for the Tylenol (acetaminophen) chart is working now. Thanks for letting us know and you can also view the chart here: http://ow.ly/DTlPm

  9. Thank you for this article I work in the medical field and sometimes even when you work with it everyday when it’s your own kids it can get scary this article has really helped me through this tough time. Thank you again.

    • Hi Amy,

      Thanks for your comment and glad to hear you found this post useful. Thank you for visiting our blog!

  10. OMG thank you so much for this vital information that you’ve shared …I’m a 1st time mom and every little thing that happens to my son when he gets sick I tend to think the unthinkable…thank you!😊

    • Thanks for your feedback, Katrina. We’re glad to hear you found the article helpful and thank you for visiting our blog.

  11. Hey my little boy is 3 and he has had a fever since 5:00 yesterday morning. At first it was 103.7 and has stayed around 102.1-102.7 all night and even now. He was been given medicine but it has not broken his temp at all. will not get below 102.1. any suggestions on what I should do? Should I take him to the doctor or just wait it out?

    • Hi Samantha,
      This is a community blog and does not provide personalized medical advice. If you have a personal medical question, please contact your doctor (or your child’s doctor) directly to discuss – or seek medical attention if there is an emergency. Thank you for visiting our blog and best wishes.

  12. My daughter 19 months old is running fever for 7 days, it goes around 101 when we give her
    Mortrin

    She looks very active eats well and drinks as usual am worried what is wrong going on with her, is it safe to give mortun for 7 starchy days?

    We will be taking her to blood test tomorrow

    • This is a community blog and does not provide personalized medical advice. If you have a personal medical question or concern for you or a family member, please contact your doctor directly to discuss – or if it is a medical emergency, seek immediate medical attention. (If you are a PAMF patient, you can also email your doctor securely via our My Health Online program with your questions.) Thank you for visiting our blog and best wishes.

  13. Is there any risk to not giving fever reducing medicines with high fevers? Is there a risk with febrile seizures?

    • Sabrianne,

      Febrile seizures occur in about 30% of children, mostly in the age ranges of ages 1-5 years old. Most commonly, the seizure occurs as the fever is rising, not at the height of the fever. Most febrile seizures occur with viral infections, do not cause any other medical problems and resolve on their own—although they certainly can be quite scary to parents. So the answer to your question is “No”, meaning there is no increased risk of a febrile seizure with a high fever in a young child. But that being said, most children (and grown ups) feel miserable when they have a temperature greater than 102 degrees and therefore giving a fever reducing medicine will certainly help your child to feel better.

      – Dr. Barone

  14. Great Article!
    My baby got his 5 month shots at Dr’s Office. Eventhough he was playful and he seemed not bothered, he felt a little hot. This was the first time I felt the need to tech his temp. with his rectal themometer. Surely enough it blinked red, beeped and read “fever” the results were 100.4. (Greatest themometer ever!) I was debating on meds, I rather let nature do its thing and not interrupt the body’s defense mechanism. I was scared at first. After reading this article I felt so relieved and glad that it was ok to follow my instincts.
    ThanK You Dr.Barone for taking the time to write this wonderful article!

    • Hi Maria,
      We’re glad to hear you found the information in this article helpful. Thank you for visiting our blog and best wishes to you and your child.

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