Health Tips & Articles

Fever in Children

by Darlene Stone Adair, APRN-BC

A fever in a child can be confusing and sometimes even scary. Here are some important things to remember:

  • Fever is defined as a body temperature over 100.4° F (38.0° C) as measured with a thermometer.
  • The most common cause of fever is infection. Most of these infections are caused by a virus, such as those that cause a cold, and will be handled effectively by the body’s own immune system. Viral illnesses DO NOT respond to treatment with antibiotics, and antibiotic prescriptions are not warranted in such cases.
  • Fever in infants under 3 months of age can represent a serious infection, so fever in such children should result in an urgent visit with a health care provider. These infants should NOT be given acetaminophen (Tylenol) or ibuprofen (Motrin) for their fever.
  • Aspirin should NEVER be used in children under 18 years of age for fever as it can increase the risk for Reye syndrome, a rare but serious illness that leads to brain and liver swelling in children.

How to measure for a fever? A variety of thermometers are available, from standard oral thermometers to the newer temporal artery scanners. You may use any of these devices, but an inexpensive digital thermometer is generally all you need.

For infants and young children, a rectal thermometer is most accurate. In older children, an oral temperature is most accurate if the child is able to cooperate. Feeling a child’s forehead or observing that a child’s cheeks are flushed is NOT an accurate way to assess body temperature.

If obtaining a rectal temperature, dab petroleum jelly (Vaseline) onto the silver tip of the thermometer and gently insert it into the anus until the silver tip is not visible. Hold it in place until a reading is obtained.

If using an oral thermometer, wait until at least thirty minutes after your child has had anything hot or cold to eat or drink. Wash and rinse the thermometer with soap and water before use and then insert the thermometer so that it can be held in the pocket at the underside of the tongue (rather than by the teeth). 

What should you do with a feverish child? Ask yourself how your child is acting. Are they more lethargic or sleepy than normal? How long have they had the fever? Are they taking fluids? Have you given the correct dose of acetaminophen or ibuprofen? A well-looking and normal-acting child with a fever of under 104.0° F (40.0° C) of less than three days duration who has no physical complaints can generally be simply monitored.

When should you call the pediatrician? Call your health care provider for an appointment if your feverish child:

  • Acts or appears abnormally,
  • Is refusing fluids,
  • Has repeated or bloody vomiting or diarrhea or shows signs of dehydration (such as chapped lips, a dry mouth, or a lack of tear or urine production)
  • Has an unexplained rash, limb pain, difficulty breathing, or urinary complaints
  • Has a stiff neck or a severe headache
  • Has had a seizure
  • Has a fever that is not decreasing in response to acetaminophen or ibuprofen,
  • Has had a fever for more than 3 days, or
  • Has a fever that is greater than 104.0° F (40.0° C).

Children who have chronic medical problems or who are behind on the recommended schedule of immunizations should be seen sooner as they are often at a higher risk for severe infections.

Children can get a fever after immunizations, but acetaminophen can help. If the injection site is red or warm, a cool cloth may also be applied.

In conclusion, the majority of fevers in children are no great cause for alarm. If your child seems ill, you should call us to make an appointment with your child’s health care provider, but, if you can keep your cool, usually your child will, too!

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