Pediatrics
Fever

Definition

  • A higher body temperature than normal. Fever is a healthy way in which the body fights infection.

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Facts

  • The main concern is how sick your child is acting. That is much more important than the height of the fever. High fevers are not usually dangerous. The height of the fever does not tell us the seriousness of the infection.

  • Temperature strips on the forehead are inaccurate.

  • Ear thermometers are not very reliable in children less than 6 months, or for temperatures over 102° F.

  • High fevers do not cause brain damage unless greater than 107° F or associated with diseases that affect the brain, like meningitis (an infection of the fluid that covers the brain and spinal cord).

  • Do not give Tylenol to infants less than 2 months with a fever. If you are concerned your baby less than 3 months feels warm, take a rectal temperature. Call your doctor immediately if above normal (>100.4° F).

  • Breathing rates and heart rates are increased with a fever.

  • Seizures associated with fevers only occur in about 3 to 5 percent of the population and these are called febrile seizures. They are generally harmless. See febrile seizures below.

  • Teething does not cause a significant fever (not >100.4° F).

  • A common viral infection called roseola affects infants from 6 months to about 3 years. There is a fever for two to three days and then as the fever goes away, a rash develops. The rash is flat and pink or slightly raised dots. It looks like an intense heat rash. It is mostly on the neck and body and lasts one to two days. Once the fever is gone for 24 hours, the child is not contagious. There is no specific treatment for the rash. About 10 percent of viruses cause fever and rash.

  • External sources of heat can be dangerous. Internal sources of fever (e.g. viral fevers) are not. Heat illness occurs because of excess heat exposure. There is a range of severity of this disease. Mild symptoms can include muscle cramps, stomachache and headache. Heat stroke is a life-threatening emergency, recognized by temperatures over 106° F (41° C), confusion and is usually brought on by vigorous exercise in the heat.
Repeat temperature in one hour if between 100° F and 100.5° F:
  • Overbundled, quite common in babies under 3 months; unwrap and repeat temperature.

  • Recent exercise.

  • Eaten hot foods before an oral temperature.
Give acetaminophen or ibuprofen
  • Received DPT (Dipththeria-Pertussis-Tetanus) injection in last 24 hours.

  • Received MMR (measles-Mumps-Rubella) or varivax (chickenpox vaccine) in the last 7 to 21 days.

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Home care

Acetaminophen. Tylenol, Liquiprin, Tempra, Panadol, Anacin-3 and generic store brands are all acetaminophen products. Paracetamol is generally the form of acetaminophen sold in other countries. They may be used to make a child more comfortable, but they do not treat the underlying illness. They may be given every four to six hours. Within one to two hours after given, the fever is usually down by 2 to 3° F. The temperature does not always return to normal. Again, how sick your child is acting is more important than if the fever comes down to normal or not. If your child is resting comfortably, there is no need to wake him to give acetaminophen, unless he is prone to febrile seizures.

Ibuprofen. Children's Motrin and Motrin oral drops, Advil and generic ibuprofen products are available over the counter. One advantage of ibuprofen is the longer-lasting effect of six to eight hours of fever reduction. Some children who are not responding well to acetaminophen may respond better to ibuprofen.

Aspirin. Aspirin is generally not recommended in pediatrics. This is because of the past association linking Reye's syndrome to aspirin usage in children with chicken pox or influenza.

Less clothing. Children should not be over-bundled while having a fever as this tends to raise the temperature more. Dress with a minimum of clothes and use a light blanket if they are having chills. Sometimes, an overbundled infant may have a slight elevation of temperature. If you suspect this, undress and retake the temperature in about one hour

Sponging. Sponge baths are usually not necessary for low-grade fevers. Sponging may cause shivering and may be uncomfortable. Sponge baths may be useful with heatstroke, confusion associated with high fevers or in children who are prone to febrile seizures. Never use alcohol or ice in the bath. Stop if the child is shivering or raise the water temperature. Lukewarm washcloths or sponges rubbed briskly over the skin with the child in two inches of water is the best technique.

Acting sick. How your child is acting is more important than how high the fever is running. The terms lethargy and listless or acting sick can mean different things to different people. To tell how sick the child is acting when they have a fever, give an appropriate dose of acetaminophen or ibuprofen (see chart below) and see how the child is acting about one to two hours after the dose. Many parents who call us find out they have not given enough acetaminophen or ibuprofen. The fever may not necessarily return to normal, but is often lower. Keep in mind that some children can be seriously ill without any fever.

A baby or child is probably not seriously ill if:

  • A baby will coo, make eye contact, smile or reach for an object.

  • A toddler will pay attention to activities, smile, walk around to get things.

  • An older child will engage in quiet activities like coloring or reading.
A child may be seriously ill if despite reducing the fever:
  • A baby is not making eye contact, continuously cries and cannot be comforted.

  • A toddler refuses to play, cries inconsolably, moans, appears very weak, turns away and stares repeatedly, or is very hard to awaken if sleeping.

  • An older child refuses to talk and won't interact or is unable to get out of bed.

  • Keeps dropping off to sleep without periods of activity; remember sick children do tend to sleep more.
Febrile seizures. These are usually harmless and occur most often from 5 months to 5 years, although they may after 6 years of age. There is often a family member who had febrile seizures as a child. They occur in about 3 percent to 5 percent of the population. Typically, the seizure occurs when the fever is rapidly increasing. They are typically brief, lasting only three to five minutes. They may occur with any type of infection that causes a fever. Any first febrile seizure should be evaluated by a physician. The possibility of meningitis or other serious illness needs to be ruled out. Because a child has a history of febrile seizures does not mean they will go on to have epilepsy as an adult. These brief febrile seizures do not cause brain damage. The treatment involves controlling the fever aggressively with acetaminophen or ibuprofen. Some children with complicated, frequent or prolonged febrile seizures need prescription anti-seizure medicines.
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When to call your doctor

Immediately call for advice if:

  • The child is less than 2 months old.

  • Constant crying, irritable, inconsolable and acting sick (if possible, decide an hour after acetaminophen or ibuprofen).

  • Drooling more than usual and difficulty swallowing.

  • Stiff neck or headache out of proportion to fever.

  • Purple spots on the skin - may be large or pinpoint, these do not fade with pressure.

  • Difficulty breathing, unless it is due to a stuffy nose.

  • Difficult to arouse, confused or delirious.

  • Having his/her first febrile seizure.
Call during office hours (Moday through Friday, 8 a.m. to 5 p.m.) if:
  • Fever lasts more than four days.

  • Associated symptoms such as an earache, sore throat, urinary burning or frequency, persistent cough.

  • Fever is more than 104° F, especially if child is less than 2 years old.
Tips on giving medicines correctly
  • Best if dosed by weight, not age.

  • Always measure with a dropper, dosage cup or other accurate measuring device. Kitchen teaspoons used for eating are not accurate.

  • Acetaminophen or ibuprofen may be given with other medicines, like antibiotics or over-the-counter cold medicines. Just make sure the over-the-counter cold medicine does not already contain acetaminophen or ibuprofen, otherwise you could be giving your child a double dose.

  • Liquid medicines may be mixed in with soft foods or liquids. Chewables may be crushed and added to the food. Mix the medicines with a small amount of food or drink, so you can be sure the child takes it all.

  • One teaspoon = 5 ml. or cc (milliliters or cubic centimeters).

  • Additional Tips

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Temperature equivalents

CELSIUSFAHRENHEIT
36.697.8
37.0 NORMAL98.6
37.699.6
38.0100.4
38.6101.4
39.0102.2
39.6103.2
40.0104.0
40.6105.1
41.0105.8

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Acetaminophen and Ibuprofen dosage charts

  • Acetaminophen (Tylenol) for fever or pain
Do NOT give acetaminophen to a baby less than 2 months old unless directed by your doctor. Fever (temperature of 101° or 38° C) in any baby less than 2 months old may be a sign of serious illness, and you should call your doctor immediately.

Weight

Age

Infant Suspension & Drops

Children's Suspension & Elixir

Children's Chewable Tablets

Jr. Strength Chewable Tablets/ Caplets

  

80 mg/0.8ml

160 mg/5ml

80 mg each

160 mg each

  

dropperful

teaspoon

tablet

tablet/caplet

6-11 lbs.

2-3 months

½

   

12-17 lbs.

4-11 months

1

½

  

18-23 lbs.

12-23 months

1½

¾

  

24-35 lbs.

2-3 years

2

1

2

 

36-47 lbs.

4-5 years

 

1½

3

 

48-59 lbs.

6-8 years

 

2

4

2

60-71 lbs.

9-10 years

 

2½

5

2½

72-95 lbs.

11 years

 

3

6

3

95 lbs.& over

12 years

   

4

  • Ibuprofen (Advil or Motrin) for fever, pain or swelling
Acetaminophen and ibuprofen work differently, so it is acceptable to give both or only one medicine. One medicine is not better than the other; some children do better with acetaminophen while others react better to ibuprofen.

Advil/Motrin is available as infant drops (50mg/1.25ml) or children's liquid (100 mg/teaspoon=100 mg/5ml)

Weight

Age

Infant Suspension & Drops

Children's Suspension & Elixir

Children's Chewable Tablets

Jr. Strength Chewable Tablets/Caplets

  

50mg/1.25ml

100 mg/5ml

50 mg each

100mg each

  

dropperful

teaspoon

tablet

tablet/caplet

12-17 lbs.

6-11 months

1

½

  

18-23 lbs.

12-23 months

1½

¾

  

24-35 lbs.

2-3 years

2

1

2

 

36-47 lbs.

4-5 years

 

1½

3

 

48-59 lbs.

6-8 years

 

2

4

2

60-71 lbs.

9-10 years

 

2½

5

2½

72-95 lbs.

11 years

 

3

6

3

95 lbs. & over

12 years

   

4

Please remember that this advice is for educational purposes and should only be used as a guide.
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