Fever – normal response to a variety of conditions, the most common of which is infection. Fever occurs when the body’s temperature is elevated as a result of the body’s thermostat being reset to a higher-than-usual temperature.

Nearly every child will develop a fever at some point. The challenge for parents is to know when to be concerned.

A Fever means a temperature above 100.4ºF (38ºC). You might get slightly different numbers depending on how you take your child’s temperature – oral (mouth), axillary (armpit), ear, forehead, or rectal.

Fever causes:

Infection is the most common cause of fever in children. Common viral and bacterial illnesses are the most likely illnesses to cause fever. These include: Colds, Gastroenteritis, Ear infections, Croup Bronchiolitis and Urinary tract infections. Bundling a child who is less than three months old in too many clothes or blankets can increase the child’s temperature slightly.

How do I measure my child’s temperature?

The best way to measure a child’s temperature depends upon several factors. In all children, a rectal temperature is the most accurate. However, it is possible to accurately measure the temperature in the mouth (for children older than four or five years) when the proper technique is used.

Evaluation recommended: A health care provider should be consulted in the following situations:

Infants who are less than three months of age who have a rectal temperature of 100.4°F (38°C) or greater, regardless of how the infant appears (eg, even well-appearing young infants should be evaluated). These patients should not receive fever medication (eg, acetaminophen. Children who are three months to three years who have a rectal temperature of 100.4°F (38°C) or greater for more than three days or who appear ill (eg, fussy, clingy, refusing to drink fluids).

Children who are 3 to 36 months who have a rectal temperature of 102°F (38.9°C) or greater.

Children of any age whose oral, rectal, tympanic membrane, or forehead temperature is 104°F (40°C) or greater or whose axillary temperature is 103°F (39.4°C) or greater.

Children of any age who have a febrile seizure. Febrile seizures are convulsions that occur when a child (between six months and six years of age) has a temperature greater than 100.4° F (38°C).

Children of any age who have recurrent fevers for more than seven days, even if the fevers last only a few hours.

Children of any age who have a fever and have a chronic medical problem such as heart disease, cancer, lupus, or sickle cell anemia.

Children who have a fever as well as a new skin rash.

Treatment is recommended if a child has an underlying medical problem, including diseases of the heart, lung, brain, or nervous system. In children who have had febrile seizures in the past, treatment of fever has not been shown to prevent seizures but is still a reasonable
precaution.

Treatment of fever may be helpful if the child is uncomfortable, although it is not necessary.

Treatment not required — In most cases, it is not necessary to treat a child’s fever. A child older than three months who has a rectal temperature less than 102°F (38.9°C) and who is otherwise healthy and acting normally does not require treatment for fever.

Parents who are unsure if their child’s fever needs treatment should contact the child’s health care provider and have them evaluated.

Fever Treatment Options

The most effective way to treat fever is to use a medication such as acetaminophen Tylenol or ibuprofen. These treatments can reduce the child’s discomfort and lower the child’s temperature by 2 to 3°F (1 to 1.5°C). Aspirin is not recommended for children under age 18 years due to concerns that it can cause a rare but serious illness known as Reye syndrome.

Acetaminophen may be given every four to six hours as needed but should not be given more than five times in a 24-hour period. Acetaminophen should not be used in children younger than three months of age without consultation with a health care provider.

Ibuprofen may be given every six hours. Ibuprofen should not be used in children younger than six months of age. The dose of ibuprofen should be calculated based upon the child’s weight.

Giving combinations of acetaminophen and ibuprofen or alternating acetaminophen and
ibuprofen increases the chance of giving the wrong dose of one or the other of the medications and is not recommended routinely.

Fever-reducing medications should only be given as needed and discontinued once
bothersome symptoms have resolved.

Increase fluids — Having fever can increase a child’s risk of becoming dehydrated. To reduce this risk, parents should encourage their child to drink an adequate amount of fluids. Children with fever may not feel hungry, and it is not necessary to force them to eat. However, fluids such as milk (cow’s or breast), formula, and water should be offered frequently. Older children may eat flavored gelatin, soup, or frozen popsicles. If the child is unwilling or unable to drink fluids for more than a few hours, the parent should consult the child’s health care provider.

Rest — Having a fever causes most children to feel tired and achy. During this time, parents should encourage their child to rest as much as the child wants. It is not necessary to force the child to sleep or rest if he or she begins to feel better. Children may return to school or other activities when the temperature has been normal for 24 hours.

Sponging and baths — Sponging is not as effective as medications for fever and generally is not recommended. Alcohol should not be used for sponging because of the risk of toxicity if it is absorbed through the skin.