Fever is the number one reason that children are taken to hospital emergency rooms. This is not surprising. Fevers are frequent in childhood, and they are often frightening to both parent and child. What follows is a set of questions and answers written to address that fear and to help parents know what to do when their child is hot.
Q: WHAT IS A FEVER?
A: A fever is a body temperature that is higher than normal ( 98.6 F or 37 C) as measured by a thermometer in Fahrenheit or Centrigrade degrees. Although they can help children to fight infections, fevers can also be uncomfortable and worrisome-depending on how high they climb and how old the child happens to be.
Q: HOW WILL I KNOW THAT MY CHILD HAS A FEVER?
A: Children with fever will feel hot and show certain changes in their behavior depending on their age. Newborns will be either fussier or sleepier than usual-or both; they will refuse the breast or bottle; and they are apt to have fewer, drier diapers than normal. Older babies and toddlers will be cranky, “clingy”, and less energetic than usual. They will have no appetite but will seem especially thirsty. Finally, toddlers will either be quite listless and sleepy or very irritable and have difficulty falling asleep. Older children, over age 2, will be whiny and tired, will ask for drinks, and sometimes will complain of having chills or “hurting all over.” If you note any of these changes in your child, no matter how old he is, it is smart to take his temperature.
Q: HOW DO I TAKE A TEMPERATURE?
A: There are so many different kinds of thermometer readily available for purchase at drug stores that it can be confusing to know which is best and for what age child. It might be smart to check with your pediatrician about her favorites especially since she knows your family well. Having said that, there are some tricks to choosing thermometers and to taking temperatures, as noted below:
o Best for Babies: A Rectal Temp
o Rinse your thermometer with cool water and then put petroleum jelly on the tip;
o With the baby on his tummy, put the thermometer into his rectum about one inch;
o Keep one hand on his back and the other holding the thermometer in place until it beeps.
o Expect your baby to cry but know that you are not hurting him; it is uncomfortable for him but not painful.
o Best for Preschoolers: An Axillary Temp
o Place the thermometer tip in your child’s armpit and hold his arm next to his body until the beep.
o Axillary temps are usually about a degree cooler than rectal.
o Best for Big Kids: An Oral Temp
o Keep your child from drinking anything hot or cold for 20 minutes;
o Rinse the oral thermometer in cold water;
o Place its tip under your child’s tongue until the beep.
If you take your child’s temperature and then decide to call the doctor, make sure to explain what kind of thermometer you used. This will eliminate some of the confusion that sometimes arises about the reliability or meaning of a temperature reading. Also, please note that ear, pacifier and band-aid strip thermometers are not considered reliable for home use. Temporal artery thermometers are being developed, are expensive, and are still considered controversial.
Q: HOW CAN I HELP MY CHILD FEEL BETTER?
A: Fevers do not need to be treated, but children do. If your child is uncomfortable with his fever-feeling achy or having chills-then there are several tips to help him feel better.
o Give him medicine.
o Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) are highly recommended. Avoid aspirin, cold or cough medicine.
o Because Advil, Motrin and Tylenol come in many forms (like liquids or chewables) and many strengths, check with the pharmacist about the best choice and dose for your child. Generic medicines are fine and cheaper than “brands.”
o Rectal suppositories are very helpful if your child is vomiting. Your pharmacist will have these behind his counter.
o Ibuprofen should not be used in children younger than 6 months or in dehydrated children.
o Give him a bath after giving him medicine as above.
o This is suggested for children with very high fevers and/or previous seizures with fever.
o The bath should be its usual warmth or slightly cooler, not frigid. Your child is not a polar bear!
o Do not add alcohol to the bath: alcohol can cause coma.
o Water evaporating from the skin cools your child. Gently wet (and rewet) his back and head with a washcloth to bring down his fever as he plays.
o Keep him cool.
o Dress him in a t-shirt or summer pajamas.
o Take the extra blankets off his bed.
o Make sure his room is cool.
o Give him extra drinks
o Fever increases your child’s need for liquid.
o He is getting enough to drink if he urinates normally (wets his diapers well) and has lots of tears.
Many parents respond to their child’s complaint that he feels cold by bundling him up, forgetting that his primary problem is fever. But he is already too hot! If your child has a fever, it is better to pretend that it is a hot summer day: water play, cool clothes and cool drinks will help bring down his fever.
Q: WHEN SHOULD I WORRY ABOUT A FEVER?
A: There are excellent pediatric guidelines about fever and when to worry as noted below. Call your pediatrician if:
o Your child’s fever is over 100.4ºF (38ºC) and he is less than 3 months old;
o Your child’s fever is over 102ºF (39ºC) and he is less than 2 years old;
o Your child’s fever is over 104ºF (40ºC) and he is over 2 years old.
If you are worried about your child-even if his fever is lower than that listed above–please err on the side of calling for advice. Trust your instinct.
Q: WHEN SHOULD I CALL THE DOCTOR?
A: In addition to calling the pediatrician because your child has a fever in the “worrisome” range described above, it is necessary to call if your child has:
o Even a low- grade fever if he has a chronic disease like sickle cell anemia, diabetes, cystic fibrosis, neutropenia, or if he is on steroids;
o Severe pain anywhere, a stiff neck, persistent vomiting or diarrhea, or a new purplish rash;
o Difficulty breathing or blue nail beds or lips;
o A seizure (rhythmic motion of his extremities that you cannot stop);
o Unusual sleepiness or fussiness even after his fever goes down;
o An illness without fever for a few days and then a new fever;
o “Just something wrong” that worries you, especially if he is a newborn.
Q: WHAT WILL THE DOCTOR DO? WILL SHE GIVE ANTIBIOTICS?
A: Of course what the doctor will do depends to some extent on what your child has in addition to his fever. If your child has a worrisome fever for his age, the doctor will talk to you both and examine your child. She will consider ordering tests (like blood work or a urine culture). She may hospitalize him if your child is either very young or appears very sick.
The doctor will give your child antibiotics if she has diagnosed a bacterial infection like strep throat or pneumonia. She will not give him antibiotics for viral infections like colds or the flu. The fact that a child has a fever does not mean that he should be treated with antibiotics!
Q: WHEN MAY MY CHILD RETURN TO DAYCARE OR SCHOOL?
A: Most children with fever do not feel well, and many of them are contagious. Your child should not go back to daycare or school until:
o He has had no fever for 24 hours after stopping acetaminophen or ibuprofen.
o He is acting like himself again.
If you are unsure about when your child may return to school, check with your pediatrician. She will give you excellent advice based on experience with your child.
Fevers and childhood go together like peanut butter and jelly– except that no one likes fevers. Because everyone eventually gets them, it is best to be prepared. Have an appropriate thermometer and medicine on hand so that, if your child gets his first fever in the middle of the night, you will be ready to offer the comfort and care he needs.
The purpose of this article is to educate. While every effort has been made to ensure its accuracy, its content should not be construed as definitive medical advice and is not a substitute for the professional judgment of your child’s health care provider in diagnosing and treating illness. Because each child’s health care needs are unique and because medical knowledge is always evolving, please consult a qualified health care professional to obtain the most current recommendations appropriate to your child’s medical care. Neither the author nor the publisher shall be liable for any outcome or damages resulting from reliance upon the content of this publication.
MOTRIN® is a registered trademark of Johnson & Johnson. TYLENOL® is a registered trademark of The Tylenol Company. ADVIL® is a registered trademark of Wyeth. No association, affiliation or endorsement of this article or its contents by the referenced companies is intended or implied.