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For most kids, take your child to the pediatrician if:
- Your child is unusually fussy, sleepy, cranky, or quiet
- Your child appears very sick
- You are unable to lower your child's fever or your child develops other serious symptoms
- The fever goes away for more than 24 hours and then returns
- Your child has a fever for more than 72 hours
- Your child is younger than 3 months with a rectal temperature above 100.1° F
- Your child is 3 to 6 months with a rectal temperature above 101° F
- Your child is 6 to 12 months with a rectal temperature above 103° F
- Your child has fever and ear or sore throat pain
- Your child has fever and a skin rash
- Your child has fever and cries inconsolably
- Your child has fever and a history of febrile seizures
Take your child to the ER if you notice any of these symptoms with fever:
- A stiff neck (unable to touch chin to chest)
- Trouble breathing
- Your child has a seizure (arms and legs jerk uncontrollably)
- Your child is difficult to awaken
WHAT IS THE CAUSE OF FEVER?
Fever is a symptom, not a disease. It is the body's normal response to infections. Fever helps fight infections by turning on the body's immune system. Most fevers (100 to 104°F, or 37.8 to 40°C) that children get are helpful, not harmful. Most are caused by viral illnesses such as colds or the flu. Some are caused by bacterial illnesses such as Strep throat or bladder infections. Teething does not cause fever.
HOW LONG WILL IT LAST?
Most fevers with viral illnesses last for 2 to 3 days. In general, the height of the fever doesn't relate to the seriousness of the illness. How sick your child acts is what counts. Fever does not cause any permanent harm. Brain damage occurs only if the body temperature is over 108°F (42°C). Fortunately, the brain's thermostat keeps untreated fevers well below this level.
While all children get fevers, only 4% develop a brief seizure from the fever. This type of seizure is generally harmless, but a child who has a febrile seizure should always be checked by a healthcare provider. If your child has had high fevers without seizures, your child is probably not going to have one.
HOW CAN I TAKE CARE OF MY CHILD?
EXTRA FLUIDS AND LESS CLOTHING
Encourage your child to drink extra fluids. Popsicles and cold drinks are helpful. Body fluids are lost during fevers because of sweating.
Clothing should be kept to a minimum because most heat is lost through the skin. Do not bundle up your child; it may cause a higher fever. During the time your child feels cold or is shivering (the chills), give him a light blanket.
If the fever is 100 to 102°F this is the only treatment needed. Fever medicines are rarely needed. Fevers of this level don’t cause discomfort, but they do help the body fight the infection.
MEDICINES TO REDUCE FEVER
Remember that fever is helping your child fight the infection. Fevers only need to be treated with medicine if they cause discomfort. That usually means fevers above 102°F (39°C).
These medicines start working in about 30 minutes, and 2 hours after they are given, these drugs will reduce the fever 2°F to 3°F (1°C to 1.5°C). Medicines do not bring the temperature down to normal unless the temperature was not very high before the medicine was given. Repeated dosages of the drugs will be necessary because the fever will go up and down until the illness runs its course. If your child is sleeping, don't awaken him for medicines.
Acetaminophen: Children older than 3 months of age can be given acetaminophen (Tylenol). Give the correct dosage for your child's weight every 4 to 6 hours. Never give more than 5 doses in any 24 hours.
Ibuprofen: Ibuprofen (Advil, Motrin) is approved for infants over 6 months of age. One advantage ibuprofen has over acetaminophen is a longer lasting effect (6 to 8 hours instead of 4 to 6 hours). Give the correct dosage for your child's weight every 6 to 8 hours.
Caution: The dropper that comes with one product should not be used with other brands.
Caution: Do not use acetaminophen and ibuprofen together unless recommended by your child’s healthcare provider. Mainly, it’s unnecessary and can be confusing.
Avoid aspirin: Doctors recommend that children (through age 21 years) not take aspirin for fevers. Aspirin taken during a viral infection, such as chickenpox or flu, has been linked to a severe illness called Reye's syndrome. If you have teens, warn them to avoid aspirin.
Sponging is usually not necessary to reduce fever. Never sponge your child without giving him acetaminophen or ibuprofen first. Sponge your child only if the fever is over 104°F (40°C), and hasn’t come down when you take the temperature again 30 minutes after your child has taken acetaminophen or ibuprofen.
If you do sponge your child, sponge him in lukewarm water (85 to 90°F, or 29 to 32°C). Sponging works much faster than immersion, so sit your child in 2 inches of water and keep wetting the skin surface. Cooling comes from evaporation of water. If your child shivers, raise the water temperature or stop sponging until the acetaminophen or ibuprofen takes effect. Don't expect to get the temperature down below 101°F (38.3°C). Don't add rubbing alcohol to the water; it can be breathed in and cause a coma.
Written by Barton D. Schmitt, MD, author of “My Child Is Sick,” American Academy of Pediatrics Books.
Pediatric Advisor 2014.1 published by RelayHealth.
Pediatric Advisor 2014.1 Index
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