Know the ABC's of Fever in Children

By Julia Patsell, Nurse Practitioner, Wilkerson Pediatric ClinicDecember 11, 2014

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FORT LEE, Va. (Dec. 11, 2014) -- One third of all children arriving at an emergency room will have fever as their primary symptom. Most parents have probably experienced waking up in the middle of the night to find their child flushed and sweaty with a forehead that is hot to the touch. Many parents may suspect a fever but are unsure of what to do next.

It is important to remember that in healthy children mild fevers usually don't indicate anything serious. It can be frightening when a child's temperature goes up. However, knowing some basic facts about fevers and how to manage them can help alleviate some of this anxiety.

Fever occurs when the body's internal "thermostat" raises the body temperature above its normal level of 98.6 F. The body's thermostat is found in the brain. It knows what temperature your body should be and works to keep it that way.

Most people's body temperature changes during the course of the day. It's usually a little lower in the morning and a little higher in the evening. Children who have been heavily bundled in blankets or running around playing can feel quite hot.

Fever is defined by a temperature of 100.5 F or higher, but the way the temperature is measured also must be taken into account. Rectal temperatures are the standard in infants, but axillary temperatures (taken under the arm) or oral temperatures are appropriate for older children. A standard digital thermometer is a reliable and accurate tool for taking temperatures. A decent thermometer can be purchased for around $5 and should be kept with the first aid kit for the family.

It's important to remember that fever by itself is not an illness -- it's usually a symptom of an underlying problem:

Infection: Most fevers are due to viruses that can cause other symptoms as well. A child can experience congestion, cough and runny nose with their fever when they have a cold or nausea, vomiting, and diarrhea with their fever when they have a stomach virus. The fever helps the body fight these infections by raising the body temperature greater than 100 F, the temperature at which many viruses and even bacteria will begin to die off. Most people know they need to cook food properly and to wash dishes in hot water to keep food resources safe for consumption. The same principle works within our bodies -- the elevated temperature literally helps to cook the virus or bacteria to kill it off.

Overdressing: Babies, especially infants, may get fevers if they're over-bundled or in a hot environment. It is important to avoid overdressing infants. Follow your own feelings on this; if you are chilly or hot, the same probably applies to the child and you should dress them accordingly. However, because fevers in newborns can indicate a serious infection, any infant less than 3 months of age should be immediately evaluated to determine the cause of the fever.

Immunizations: Babies and kids sometimes get a low-grade fever after getting shots. This usually is a good thing because it indicates the immunization is working as it should and has triggered the child's body to make thousands of protective antibodies to fend off serious illnesses.

Follow the instructions on information sheets given out at the time of the vaccines for guidance.

Teething: Although teething may cause a slight rise in temperature, it's probably not the cause if a child's temperature is higher than 101 F.

What to do if your child has a fever:

Temperatures are lower than 100.5 F often don't require medication unless they're uncomfortable. Parents can continue to give fluids, ice chips or offer a popsicle while monitoring the child closely. It is important to consider a child's overall condition. If he or she has a low-grade fever and appears uncomfortable, it is OK to give a dose of Tylenol or Ibuprofen at a lower temperature. If a child has a fever but is still playful and taking fluids well, it is OK to simply monitor him or her.

There's one important exception to this rule: If you have an infant 3 months or younger with a rectal temperature of 100.4 F or higher, call your doctor or immediately go to the emergency department. Even a slight fever can be a sign of a potentially serious infection in very young infants. For children 3 months to 3 years old with a fever of 102 F or higher, call your doctor for assistance.

For older kids, take behavior and activity level into account. If an older child is eating, drinking and sleeping well and is playful when awake, he or she is probably OK even if they have a low-grade fever. However, if an older child is not acting right, refusing to eat or drink and appears miserable, they should be evaluated regardless of what their temperature is doing.

For a fever greater than 102 F, give the child a dose of Tylenol or ibuprofen based upon weight and age. It is safe to use the weight-based dosages listed on the bottle. For high fevers slow to respond to medication, you can give a warm water bath. Never use cold water, ice or alcohol as this may drop their temperature too quickly and can lead to febrile seizures.

Call for an appointment with your primary care provider. Be sure to continue to treat the fever before this appointment. Keep a list of temperatures taken during the course of the child's illness and when they were given fever medicine. Primary-care givers do not need to see that children are hot at the clinic to treat them.

Give plenty of fluids. Clear liquids like Pedialyte for infants and popsicles, Jello, chicken noodle soup or sports drinks are appropriate for older children. It is OK if your child has a decreased appetite as long as he or she is taking in plenty of fluids with calories.

Never give aspirin to children. This puts the child at risk for Reye's syndrome, which can be fatal.

Any child with a fever who appears weak, very sick, is complaining of a headache with a stiff neck, has difficulty breathing, is dehydrated or has a change in consciousness should be seen immediately.

As always, if your instincts are telling you that something more serious is going on, respond accordingly and seek immediate medical treatment.