Fever

Pediatric HouseCalls Online

DEFINITION

• Rectal temperature above 100.4°F (38.0°C).
• Oral temperature above 99.5°F (37.5°C).
• Axillary (armpit) temperature above 99.0°F (37.2°C).
• Pacifier temperature above 100°F (38.0°C)  New digital electronic ones are accurate.
• Ear (tympanic) temperature above 100.4°F(38.0 C) (Note: Not reliable for under 6 months old.)
• Temporal artery (TA) temperature above 100.4 F (38.0 C) (Note: more reliable than tympanic thermometers, but not to be used for children under 6 months old)
• Use this guideline if fever is your child's only symptom

Causes

• Main cause: colds and other viral infections.
• Fever may be the only symptom for the first 12-24 hours (i.e. viral fevers). The onset of symptoms (runny nose, cough, diarrhea, etc.) are often delayed. In the case of Roseola, fever may be the only symptom for 2 or 3 days.
• The cause of the fever often can't be determined during the first 24 hours.
• Bacterial infections (e.g.,  Strep throat or urinary tract infections) also cause fever
• Teething does not cause fever

Return to School

• Your child can return to day care or school after the fever is gone and your child feels well enough to participate in normal activities.

See More Appropriate Topic (instead of this one) If

• Other symptom is present with the fever, see that topic (e.g., COLDS, COUGH, SORE THROAT, EARACHE, SINUS PAIN, DIARRHEA, VOMITING, RASH - WIDESPREAD AND CAUSE UNKNOWN).

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WHEN TO CALL YOUR DOCTOR

Call 911 Now (your child may need an ambulance) If

• Not moving or very weak.
• Unresponsive or difficult to awaken.
• Difficulty breathing with bluish lips.
• Purple or blood-colored spots or dots on skin

Call Your Doctor Now (night or day) If

• Your child looks or acts very sick.
• Any difficulty breathing.
• Great difficulty swallowing fluids or saliva.
• Child is confused (delirious) or has stiff neck or bulging soft spot.
• Had a seizure with the fever.
• Age under 12 weeks with fever above 100.4°F (38°C) rectally. (Caution: Do NOT give your baby any fever medicine before being seen.)
• Fever above 105°F (40.6°C) at any age.
• Very irritable (e.g., inconsolable crying or cries when touched or moved).
• Won't move an arm or leg normally.
• Signs of dehydration (very dry mouth, no urine in more than 8 hours, etc.).
• Burning or pain with urination.
• Chronic disease or medication that causes decreased immunity.

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

• You think your child needs to be seen.
• Age 3-6 months with fever.
• Age 6-24 months with fever present over 24 hours but no other symptoms (e.g., no cold, cough, diarrhea, etc.).
• Fever repeatedly above 104° F (40° C) despite fever medicine
• Fever present for more than 3 days 

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns.

Parent Care at Home If

• Fever with no other symptoms AND you don't think your child needs to be seen.

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HOME CARE ADVICE FOR FEVER

1. Reassurance:  Presence of a fever means your child has an infection, usually caused by a virus. Most fevers are good for children and help the body fight infection.  Use the following definitions to help put your child's level of fever into perspective:
   • 100°-102°F (37.8° - 39°C)   Low grade fevers: beneficial, desirable range
   • 102°-104°F (39 - 40°C)      Mild fever:  still beneficial
   • Over 104°F (40°C)         Moderate fever: causes discomfort, but harmless
   • Over 105°F (40.6°C)      High fever:  higher risk of bacterial infections
   • Over 106°F (41.1°C)      Very high fever:  important to bring it down
   • Over 108°F (42.3°C)      Dangerous fever:  fever itself can harm brain 
2. Treatment for All Fevers:  Extra Fluids and Less Clothing
   • Give cold fluids orally in unlimited amounts (reason: good hydration replaces sweat and improves heat loss via skin).
   • Dress in 1 layer of light weight clothing and sleep with 1 light blanket (avoid bundling).  (Caution: overheated infants can't undress themselves.)
   • For fevers 100°-102°F (37.8° - 39°C), this is the only treatment needed (fever medicines are unnecessary).
3. Fever Medicine:  
   • Give acetaminophen (e.g. Tylenol) or ibuprofen (e.g. Advil) for fevers above 102°F (39°C), if your child is uncomfortable. See the dosage charts.
   • The goal of fever therapy is to bring the temperature down to a comfortable level. Remember, the fever medicine usually lowers the fever by 2° to 3°F (1 - 1.5°C)
   • Avoid aspirin (Reason: risk of Reye's syndrome, a rare but severe brain disease).
   • Avoid alternating acetaminophen and ibuprofen (Reason: unnecessary and risk of overdosage)
4. Sponging:  
   • Note: Sponging is optional for high fevers, not required.
   • Indication: May sponge for (1) fever above 104°F (40°C) AND (2) doesn't come down with acetaminophen (e.g. Tylenol) or ibuprofen (always give fever medicine first) AND (3) causes discomfort.
   • How to sponge:  Use lukewarm water (85°-90°F) (29.4° - 32.2°C). Do not use rubbing alcohol. Sponge for 20-30 minutes.
   • If your child shivers or becomes cold, stop sponging or increase the water temperature. 
5. Contagiousness:  Your child can return to day care or school after the fever is gone and your child feels well enough to participate in normal activities.
6. Expected Course of Fever:  Most fevers associated with viral illnesses fluctuate between 101° and 104°F (38.4° and 40°C) and last for 2 or 3 days.
7. Call Your Doctor If:
   • Fever goes above 105° F (40.6° C) or repeatedly above 104°F (40° C).
   • Any fever occurs if under 12 weeks old
   • Fever without a cause persists over 24 hours. (if age less than 2 years)
   • Fever persists over 3 days 
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

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