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Sonja Brownlee, MD.
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Last Updated 1/2010

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Fever

What is a Fever?

• Rectal temperature higher than 100.4 F (38.0 C).
• Ear (tympanic) temperature higher than 100.4 F (38.0 C) in rectal mode or 99.5 F (37.5 C) in oral mode. (Note:  This temperature is not reliable in children younger than 6 months old).
• Oral (or electronic pacifier) temperature higher than 100 F (37.8 C).
• Axillary (armpit) temperature higher than 99.0 F (37.2 C).  (The armpit should be dry)

• Rectal temperatures are the most accurate.
• Oral, electronic pacifier, or tympanic temperatures are also accurate if done properly.
• Armpit temperatures are the least accurate but are better than no measurement.
• Birth to 5 years:  take a rectal temperature (An armpit or electronic pacifier temperature is adequate for screening.)
• Older than 5 years:  take an oral temperature.

 Are Some Fevers "Normal"?

Temperatures normally fluctuate during the day:  98.7-100 F (37-37.8 C).  Mild elevation (100.4-101.3 F) can be caused by exercise, excessive clothing, a hot bath, hot weather, or teething.  Warm food or drink can also raise the oral temperature.  If you think one of these has caused an elevated temperature, take the temperature again in a half hour.

 Fever Phobia:

Fever is a sign of illness, not a disease.  It usually causes no discomfort until it reaches 102-103 F (38.9-39.5 C).Even without treatment, fevers rarely go higher than 104-105 F (40-40.6 C).

Fever will not lead to brain damage or death.  A fever above 108 F can only occur when there is a hyperthermic insult which can happen when a child is left in a closed, hot car or with dehydration (heat stroke).

Fevers with Infections:

Fever is the body's natural way of fighting infection.  It stimulates the immune system, and bacteria and viruses do not grow well in elevated temperatures.

When your child is ill, s/he may not run a fever continuously, but may spike up and down.  Fevers need to be treated only if they cause discomfort.  Usually this means an oral temperature >102 F (38.9 C).  Acetaminophen or Ibuprofen may not bring a temperature down to normal, but as long as it decreases the fever by 1-2 F within an hour, it is working.  Fevers that don=t respond to fever medicine are not necessarily related to a more serious infection; nor does a high fever necessarily mean a more serious infection.  How sick your child acts is what counts. 

When to call the doctor:

Fever itself will not harm your child and does not necessarily require treatment.  But you should call your pediatrician if:

• Your child is under 3 months of age and has a rectal temperature of 100.4 F (38 C) or higher.
• Your child is lethargic or is irritable or is crying almost constantly, inconsolably.
• Your child cries if you touch or move him/her.  Your child has a stiff neck.
• Your child also has symptoms such as sore throat, ear pain, abdominal pain, or pain when urinating.
• Your child recently started drooling because of not swallowing.
• Your child is having trouble breathing (even after clearing out the nose), whether or not s/he has a fever.
• Your child is drinking less fluid than usual and has had fewer than 4 wet diapers in the past 24 hours or less than 2 urinations during waking hours.
• You are worried that your child is less active than normal.
• Fever has been present for longer than 3 days.
• Fever was gone for over 24 hours and then returned.
• Your child had a convulsion.

Emergent conditions (call 911):

• Your child is limp and unable to move.
• Your child is unconscious or very difficult to awaken.
• Your child has purple spots or dots on the skin.

 Febrile Seizures:

Only 4% of children have febrile seizures and there is usually a family history of febrile seizures.  A child is not more likely to have a febrile seizure if the fever goes high.  These children can have seizures even with "low" fevers.  It is how quickly the temperature changes that usually triggers the seizure.  Febrile seizures are usually harmless, however, your child does need to be seen if it occurs. 

 Treatment of Fevers:

Extra fluids and less clothing:

A fever can put your child at risk of dehydration.  Encourage extra fluids (water and dilute juices), but do not force them.  Popsicles or iced drinks are helpful.  Do not use pedialyte unless your child is also vomiting or has diarrhea.  Your child should have at least 4 wet diapers per 24 hours or at least 2 urinations during waking hours.

Clothing should be kept to a minimum because most heat is lost through the skin.  Be especially careful with infants as they cannot undress themselves if they become too hot.  Do not try to “sweat the fever out".  If your child feels cold or is shivering, use a light blanket.

Sponging is usually not necessary, and usually just adds to your child's discomfort.

If you do sponge your child, give a fever medication first.  Use tepid or lukewarm water - not cool or cold.  Never use rubbing alcohol:  it can cause a coma or seizure.  Do not immerse your child in water or leave wet cloths on your child.  The heat is lost through evaporation.  Stop sponging if your child begins to shiver, feels cold, or feels discomfort. 

Fever Medications: