I Got The Fever…

By Guest Blogger, Dr. Sameena Evers
Dilworth Pediatrics

I think having a young child with a fever is one of the scariest experiences for new parents and it happens to us all at some point. There are, however, a lot of misconceptions as to the definition of fever, what it means, and how to treat it. I’ll try to address these issues in this article.

First of all, what is a fever and how do you measure it? We all know that fever refers to an elevated body temperature but I think many people don’t know how to accurately measure this in a child. Also, it is important to recognize that everyone has daily fluctuations in their body temperature throughout the day with a temperature of 98.6 degrees, plus or minus on degree defined as normal. For babies, checking the temperature rectally is the ONLY good way to get a reading (I promise you, your baby really doesn’t care about the whole rectal thing; I know it is a freaky concept to a lot of parents, though). Once your child is a bit older (closer to age 2), checking them with a thermometer placed in the armpit so that it is tightly surrounded by skin is the best way to get an accurate measurement of body temperature until your child can hold a thermometer under the tongue well.

There are a lot of new gadgets in the thermometer world such as a device you put in the ear, a pacifier, and a strip on the forehead. None of these products is nearly as accurate as the old cheap standby you can get at the local drugstore and not worth wasting your money on. Throw them away if you have one of these at home!! Many calls we receive in the office are due to false readings from these instruments.

The number on the thermometer representing fever is defined a bit differently in my mind based on the age of a child. In the newborn period, until about 2 months of age, fever is a temperature above 100.4 degrees and is a true medical emergency. If your child has a fever at this young age you need to take them into the doctor’s office or the emergency room immediately. Be prepared for your child to potentially spend a few nights in the hospital and have several tests done on blood, urine, and spinal fluid to check for serious infection. Fortunately, this is a rare occurrence but one every parent should be aware of.

Once your child is out of the newborn period, fever alone is much less likely to be a major medical concern. I usually define fever in an older baby/child as a temperature of 101 degrees or higher. It is important to remember that fever is a healthy response of the immune system to fight off infection. Young children often run fevers as high as 104 when battling common childhood viruses. While your child runs fever for two to three days and coughs for the next 1-2 weeks, you may suffer from the identical viral illness with a little sniffle and head cold for a few days. A young child’s immune system has not been exposed to many illnesses before and does not have the antibody memory that older folks have to help fight off the infection. The elevated temperature may actually help kill off some of the infectious agents and aid in the recovery process. It is quite common during many illnesses for a temperature to be close to normal for most of the day and then elevate to a fever in the afternoon and evening as our natural diurnal cycle fluctuates.

Fever by itself is not a concern; more important is how your child looks and behaves overall. Most of the time a child with fever doesn’t look like they are at the top of their game. She may appear flushed, have a racing heart rate, and breathe in a fast, shallow manner. She may also complain about body aches and seem exhausted. These are all normal responses to an elevated body temperature and no cause for alarm. It is important to keep your child well hydrated during a fever as your body naturally burns off some fluid with all of the excess heat generated. If your child is having persistent breathing problems, seems dehydrated, or is not responding to you appropriately you should seek medical attention. Most kids with a fever and obvious cold symptoms do not need to see their doctor unless the fever lasts
more than three days or you have other concerns.

There are two other situations related to fever that should warrant a visit to your doctor. The first is a child with cold symptoms for a few days who spikes a fever for the first time several days into the illness. This may indicate an ear infection or pneumonia secondary to the initial cold and should be checked out. The other scenario would be a child under the age of one who has a fever and no runny nose, cough or other obvious symptoms of illness associated with the fever. This may be a sign of a bladder infection in an infant and should be evaluated by your doctor.

As mentioned earlier, fever may actually be beneficial in fighting off infection and therefore does not necessarily need to be treated. Some medical experts advocate no treatment at all. However, there are safe medications that can be used as symptomatic treatment and I think it is wise to use them judiciously when your child seems truly uncomfortable. Acetaminophen (Tylenol) is a good medication for fever relief in infants and children. Ibuprofen (Motrin, Advil) is another safe medication although you should wait to use this one until your child is at least 6 months old. Both medication dosages are based on the weight of your child. You should also note that these products are sold as an “infant” version and a “child” version with varying strengths and recommended dosages.

Ibuprofen and acetaminophen are two completely different types of medication from a pharmacological standpoint although they produce similar effects in the relief of pain and fever in our bodies. Acetaminophen can be given every 4 hours and ibuprofen can be given every 6 hours. Both medications can be dangerous if overdosed, especially if given over several days, so it is important to follow directions for the amounts and timing closely. I am not a big fan of alternating these medications back and forth every 3-4 hours because I think it is all too easy to have multiple caregivers, exhausted from taking care of a sick child, make a simple mistake and overdose by accident. My usual recommendation for treatment of a persistent, bothersome fever is acetaminophen for daytime symptom relief and a dose of ibuprofen at bedtime (it lasts longer and we need all the sleep we can get!).

I hope this helps a bit as we all try to make it through the winter season and the many associated febrile illnesses which are inevitable this time of year. Here’s to wishing for some more 70 degree days in the near future!

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