The Child With a Fever

All parents at some time will have a child who develops a fever. Fever is the number one reason for visits to the pediatrician's office, and fever accounts for about 20 percent of patient visits in many pediatric practices.

Contrary to popular belief, the degree of fever does not reflect the seriousness of the child's illness. Some children with a temperature of 102 degrees F remain cheerful and continue eating while other children will feel quite ill when their temperature is 100 degrees F.

What is a fever?

A fever is usually a healthy child's response to an illness. By raising the body temperature, a child's immune system can defend against invading organisms by increasing the release of white blood cells and other specialized disease-fighting immune cells.

Fever itself is a symptom, which alerts us that some form of illness is present. Normal body temperature is 98.6 degrees F although it often varies throughout the course of a normal day from a low of 97 degrees F early in the morning to a high of 100 degrees F in the early evening.

A child's temperature is considered to be a fever when:

• Oral temperature is greater than 100 degrees F



• Rectal temperature is greater than 100.4 degrees F



• Axillary or armpit temperature is greater than 99 degrees F

When is a fever in a child serious?

Any fever in an infant younger than 6 months of age requires special attention. Consult with your pediatrician or health care provider if you encounter a fever in a child at this age.

Although a fever may cause anxiety in the parents of a child, elevated temperatures themselves are not dangerous to an otherwise healthy child. You should not ignore a fever, however, because some of the illnesses that cause a fever can be serious.

Many children's fevers are because of viral illnesses that can be treated at home. At times, your physician may wish to examine your child if a fever is present to rule out the possibility of a serious infection and perhaps to prescribe an antibiotic. Some common bacterial infections that can cause a fever include middle ear infections, throat infections and infections of the respiratory tract.

Most fevers in children last between one and three days, with temperatures ranging from 101 degrees F to 104 degrees F. A fever often does not cause discomfort until it reaches about 102 degrees F, at which time you may notice flushing of the skin, shivering, sweating, increased thirst or rapid breathing. Flushed skin is often a sign that the fever has peaked. Shivering usually indicates the fever is rising. Sweating means the fever is breaking or starting to come down.

At times a child with a fever may become delirious or lethargic. A small percentage of children who develop fevers suffer a febrile seizure, or convulsion. Although this is alarming, most febrile seizures are of short duration and do not cause any long-term ill effects. During a febrile seizure, you may notice the child's eyes rolling back toward the head and the arms and legs may begin to twitch and jerk.

Seek help immediately for a fever in a child when:

• The child is 6 months or younger.



• The child is crying and cannot be consoled.



• The child is lethargic or is difficult to wake up.



• The child has a stiff neck.



• The child is having trouble breathing.



• The child is having excessive drooling and difficulty swallowing.



• The child suffers a seizure or convulsion.



• The child develops a purplish spotty body rash.

Less urgent reasons to consult your health care provider for a fever in a child include:

• The child complains of an earache or has drainage coming from the ear.



• Vomiting and diarrhea accompany the fever.



• The child complains of abdominal pain.



• A cough or runny nose that is not improving after several days and accompanies the fever.



• The child complains of burning or pain when urinating.



• The fever seems to be returning after having been gone for 24 hours.



• The child does not "seem right," and the illness seems to be worsening.

Treating fevers in children

In most instances, you will be treating your child's fever from home. Have a thermometer and medication on hand. Acetaminophen (Tylenol®) and ibuprofen (Motrin®) are the two most commonly prescribed fever-reducing drugs. The doses for these medications vary according to your child's age and weight. Take note that Tylenol can be purchased as drops, liquid or chewable tablets. The concentration of this drug varies with the preparation. For example, infant drops are stronger than the liquid. So be sure to read the label before administering it to a child. Always check with your pharmacist or health care provider if you are unsure of the correct dosage because overdosing with these medications can cause serious or fatal side effects. Although fever-reducing drugs may make your child feel more comfortable, reducing a fever will generally not shorten the course of an illness.

Tips for treating fevers in children

Offer extra fluids throughout the day. Children with a fever require extra fluid to prevent dehydration. Water, fruit juices and ice pops are usually well tolerated.

Unless instructed to wake a child to check the temperature, let your child sleep. Children with a fever require more rest and checking the temperature once or twice a day is usually enough.

If the temperature remains higher than 104 degrees F after a fever-reducing medicine has been given, you may put the child in a tub of lukewarm water. Never use rubbing alcohol or cold water. Bathe the child for 15 to 20 minutes. If the child begins to shiver in the tub, raise the temperature of the bath water by adding warm water. Never leave a child alone in the bathtub.

Keep your child lightly dressed and covered with light blankets even if your child is shivering. Bundling the child in heavy blankets will only raise the body temperature.

Do not give aspirin to a child with a fever. Using aspirin in children with viral illnesses has been linked with a potentially fatal disorder called Reye's syndrome.

External Source American Academy of Family Physicians (www.familydoctor.org)

This article was reviewed and updated June 2007.

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