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Sonja Brownlee, Md, FAAP
Pediatrician

1825 Pinion Road, Suite E
Elko, Nevada  89801
775-778-6762          Fax: 775-778-6767

Office Hours

8:30 am - 4:30 pm, Monday through Thursday

8:30 am - 12:00 pm Friday (Staff Only)

Copyright 2011,
Sonja Brownlee, MD.
All rights reserved.
Site created by
Joanne Asch.
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Last Updated 11/2011

 

The information contained on this web site is not a substitute for direct examination and treatment by a physician. If any of this material is unclear or confusing, or if you have additional questions or concerns, please call the office at 778-6762. 

Disclaimer:Sonja Brownlee,M.D. cannot endorse all links presented on the website as they may link to unrelated third-party websites.

 

FEVER

What is a Fever?

  • Rectal temperature higher than 100.4˚F (38.0˚C)  (most accurate method)
  • Temporal artery temperature higher than: (also very accurate if done correctly)
    • 100.7°F (38.1°C) for a baby aged 0-2 months
    • 100.3°F (37.9°C) for a child aged 3 months to under 4 years old
    • 100.1°F (37.8°C) for anyone 4 years of age or older
  • Oral (or electronic pacifier) temperature higher than 100˚F (37.8˚C)
    • Drinking, coughing, talking, or mouth breathing can affect the accuracy of an oral temperature.
  • Ear (tympanic) temperature higher than 100.4˚F (38.0˚C) in rectal mode or 99.5˚F (37.5˚C) in oral mode.
    • This temperature is not reliable in children younger than 6 months old.
    • Ear wax can affect the accuracy of an ear temperature.
  • Axillary (armpit) temperature higher than 99˚F (37.2˚C). 
    • Moist skin and skin blood flow changes with a fever can affect the accuracy of an axillary temperature.

Are some Fevers “Normal”?
 -- Temperatures normally fluctuate during the day:  98.7°-100°F (37°-37.8°C). 
 -- Mild elevations 100.4°-101.3°F (38.0°-38.5°C) 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 after correcting the circumstance.

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 treatments, fevers rarely go higher than 104-105°F (40°-40.6°C).
  • A fever above 108°F can only occur when there is a hyperthermic insult: 
    • A child left in a closed, hot car
    • Exercising on a hot day without drinking enough fluids causing dehydration (heat stroke): 

Fevers with Infections:
 -- Fever is the body’s natural way of fighting infection; it stimulates the immune system.  Also, 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 over 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 degrees within an hour, it is working. 
-- Fevers that don’t respond to fever medicines 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.

Febrile Seizures:
Only 4% of children have febrile seizures and there is usually a family history.  It is not just a high temperature that triggers a seizure, but how quickly the temperature changes – whether up or down.  Febrile seizures are usually harmless, however, your child does need to be seen if it occurs.

When to call the doctor:

  • Your child is under 3 months of age and has a rectal temperature of 100.4˚F (38.0˚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 his/her 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 72 hours (3 days).
  • Fever was gone for over 24 hours and then returned.
  • Your child had a convulsion (seizure).

Emergent conditions (call 911):

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

 

Treatment of Fevers

Extra fluids and less clothing

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

Sponging or baths are 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:  Acetaminophen (2 months + older) or Ibuprofen (over 6 months).  Never use aspirin.

  • For fevers higher than 102˚F (38.9˚C) and preferably only if your child is also uncomfortable.
  • At the correct dosage and frequency.  Do not exceed the maximum dose in 24 hours.
  • During waking hours.  Do not awaken your child from sleep to give fever medications.
  • Alternating acetaminophen and ibuprofen should only be done if instructed to do so by a physician.  It is done only in specific cases.  It carries an increased risk of poisoning due to dosing medicines incorrectly.
  • Do not use a dropper from one brand to give another brand.  Always check the mg. amount per dropper or ml or tsp.
  • Avoid aspirin.  It has been linked to Reye’s Syndrome (a severe encephalitis-like illness) when given to children with Chicken Pox or Influenza (cold, cough, sore throat symptoms).

 

Acetaminophen (Tylenol or another brand):  How much to give?  Use child’s weight, not age

Give every 4 to 6 hours, as needed, no more than 5 times in 24 hours (unless directed to do so by your physician).

 

Child’s Weight

 

Child’s

Age

 

Infant Drops

80 mg per 0.8 ml

 

Children’s Liquid

160 mg in 5 ml (1 tsp)
Kitchen spoons are not accurate.

 

Children’s

Tablets

80 mg in each tab

 

Junior

Strength

160 mg in each tab

 

6-11 lbs

 

0 - 3 mos

 

0.4 ml =   40 mg

 

1.25 ml  (1/4 tsp) =  40 mg

 

 

 

12-17 lbs

 

4 - 11 mos

 

0.8 ml =   80 mg

 

2.50 ml  (1/2 tsp) =  80 mg

 

 

 

18-23 lbs

 

12 - 23 mos

 

1.2 ml = 120 mg

 

3.75 ml (3/4 tsp) = 120 mg

 

 

 

24-35 lbs

 

2 - 3 yrs

 

1.6 ml = 160 mg

 

5 ml (1 tsp)  = 160 mg

 

2 tabs = 160 mg

 

 

36-47 lbs

 

4 - 5 yrs

 

 

7.5 ml (1½ tsp) = 240 mg

 

3 tabs = 240 mg

 

 

48-59 lbs

 

6 - 8 yrs

 

 

10 ml (2 tsp)  = 320 mg

 

4 tabs = 320 mg

 

2 tabs    = 320 mg

 

60-71 lbs

 

9 -10 yrs

 

 

12.5 ml (2½ tsp) = 400 mg

 

5 tabs = 400 mg

 

2½ tabs = 400 mg

 

72-95 lbs

 

11 yrs

 

 

15 ml (3 tsp)  = 480 mg

 

6 tabs = 480 mg

 

3 tabs    = 480 mg

 

Ibuprofen (Advil, Motrin, or another brand):  How much to give?  Use child’s weight, not age

Give every 6 to 8 hours, as needed, no more than 4 times in 24 hours (unless directed to do so by your physician).

 

Child’s Weight

 

Child’s

Age

 

Infant Drops

50 mg per 1.25 ml

 

Children’s Liquid

100 mg in 5 ml (1 tsp)
Kitchen spoons are not accurate.

 

Children’s

Tablets

50 mg in each tab

 

Junior

Strength

100 mg in each tab

 

Under 12 lbs

 

0-5 mos

 

 

 

 

 

12-17 lbs

 

6 - 11 mos

 

1.25 ml  =  50 mg

 

2.50 ml  (1/2 tsp)  = 50 mg

 

 

 

18-23 lbs

 

12 - 23 mos

 

1.875 ml = 75 mg

 

3.75 ml  (3/4 tsp)  = 75 mg

 

 

 

24-35 lbs

 

2 - 3 yrs

 

2.5 ml   = 100 mg

 

5 ml (1 tsp)   = 100 mg

 

2 tabs = 100 mg

 

 

36-47 lbs

 

4 - 5 yrs

 

 

7.5 ml (1½ tsp) = 150 mg

 

3 tabs = 150 mg

 

 

48-59 lbs

 

6 - 8 yrs

 

 

10 ml (2 tsp)   = 200 mg

 

4 tabs = 200 mg

 

2 tabs    = 200 mg

 

60-71 lbs

 

9 - 10 yrs

 

 

12.5 ml (2½ tsp) = 250 mg

 

5 tabs = 250 mg

 

2½ tabs = 250 mg

 

72-95 lbs

 

11 yrs

 

 

15 ml (3 tsp)    = 300 mg

 

6 tabs = 3000 mg

 

3 tabs    = 300 mg