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Fever and Children

Posted on Mar 13, 2012

Pediatrician Nancy Barnett Zises, M.D., Palo Alto Medical Foundation

None of us want our children to be sick, but it’s important to remember that fever can be our friend. The American Academy of Pediatrics describes fever as “a positive sign that the body is fighting infection.” In this blog post, Nancy Barnett Zises, M.D. a pediatrician at the Palo Alto Medical Foundation, answers commonly asked questions about fever in children.

What temperature constitutes a fever?

Normal temperatures in children can be over 100 F (37.8 C). The definition of fever varies based on the age of a child. If your child is under 3 months old, a fever is any temperature over 100.4 F (38 C). If your child is over 3 months old, the definition of a fever is any temperature over 101 F (38.3 C).

What should I do if I think my child has a fever?

First, take your child’s temperature. For infants under 6 months old, the only accurate method is a rectal thermometer. There are many thermometers on the market, including some that resemble pacifiers or that you rub on the child’s forehead, but for this age group the only medically accurate thermometer is rectal.

Some children older than 6 months can cooperate during an oral thermometer reading. For those who can’t sit still long enough, the most accurate method is still rectal. Other options for this age group are thermometers that measure the child’s temperature in the ear or under the armpit. If you choose an armpit thermometer, make sure that the child hasn’t been bundled up to the point that he or she is sweaty, because this can cause an inaccurately high temperature reading.

By age 4 or 5, most kids will cooperate when having their temperatures taken orally. Be sure to use a digital thermometer as opposed to a mercury thermometer to avoid exposing your child to mercury, a known toxin. It’s also important to wait a few minutes after your child eats or drinks hot or cold foods or drinks, or after your child has a warm bath, to avoid a false reading. After you’ve taken your child’s temperature, clean the thermometer with rubbing alcohol or wash it in warm, soapy water.

If my child does have a fever, should I call the doctor?

There are no hard guidelines about when you should call the doctor regarding your child’s fever. As a parent, you should watch how your child is acting and use common sense. However, here are some general guidelines that may help with your decision:

  • If your child has a fever and is difficult to wake up, you should always call the doctor.
  • If your child is 3 months of age or younger, it’s best to call the doctor if he or she has a fever, just to be on the safe side.
  • If your child is between 3 months and 6 months old, call your doctor if his or her temperature is 101 F (38.3 C) or higher and if there are no other symptoms indicating the source of the fever. For example, if your child has a stuffy nose or cough that would suggest a virus is the cause of the fever, it’s not necessary to see the doctor. However, if the fever lasts longer than three or four day with these symptoms, call the doctor.
  • For a child of any age, call the doctor if the fever persists daily for more than four or five days.

 What other symptoms warrant calling the doctor?

If your child has any of these symptoms along with a fever, it’s important to call the pediatrician right away:

  • Persistent vomiting or diarrhea
  • Earache or pulling at ears
  • Severe headache
  • Stiff neck
  • Severe sore throat
  • Unresponsiveness or limpness
  • Trouble breathing
  • Sore or swollen joints
  • Pain when urinating, or urinating more than usual
  • Refusal to drink liquids

Should I treat my child’s fever with over-the-counter medications?

If your child has a fever, you can make your child more comfortable with over-the-counter fever and pain reducers. You don’t need to talk to a doctor before making this decision.

Common children’s fever reducers include acetaminophen (Tylenol) and ibuprofen (Motrin or Advil). You should only give ibuprofen to children 6 months of age or older. Be sure to read the instructions or talk to your doctor about the correct dosage and frequency of treatment for your child. Never give aspirin to your child or teen because of the risk of Reye syndrome, a rare, but very serious disease.

Just because your child has a fever, however, doesn’t mean you have to control it with medication. If the fever doesn’t seem to be bothering your child, he or she may not need a fever reducer at all. If your child has a fever and is sleeping, there’s no need to wake the child to administer fever-reducing medication.

Is there anything else I can do to help my child feel better?

There are several things you can do at home in addition to medication to sooth your child’s symptoms:

  • Provide plenty of fluids to prevent dehydration. Try water, juice, broth and popsicles.
  • Ensure that your child gets plenty of rest.
  • Keep the room temperature at a comfortable 70 to 74 F.
  • If your child feels warm, remove excess clothing.
  • If your child has the chills, provide a blanket to keep him or her comfortable.

If you have a child, the chances are good that he or she will have a fever sometime during the year. I hope the tips in this article help you navigate through these times quickly and relatively painlessly so you can enjoy more healthy and comfortable time with your family.

Nancy Barnett  Zises, M.D., a board-certified pediatrician at the Palo Alto Medical Foundation, contributed this blog post.