FEVER

Diagnostic Findings

Your child has fever if his

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Rectal temperature is over 100.4° F (37.0° C)

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Oral  temperature is over 99.5° F (37.5° C)

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Axillary (armpit) temperature is over 98.6° F (37° C)

The body's average temperature when it is measured orally is 98.6°F  (37° C), but it normally fluctuates during the day.  Mild elevation (100.4° to 101.3° F or  38° to 38.5° C) can be caused by exercise, excessive clothing, a hot bath or hot weather.  Warm food or drink can also raise the oral temperature.  If you suspect such an effect on the temperature of  your child, take his  temperature again in one-half hour.

Cause

Fever is a symptom, not a disease.  Fever is the body's normal response to infections and plays a role in fighting them.  Fever turns on the body's immune system.  The usual fevers (100° to 104° F [37.8° to 40° C]) that all children get are not harmful. Most are caused by viral illnesses; some are caused by bacterial illnesses.  Teething does not cause significant fever.

Expected Course

     Most fevers with viral illnesses range between 101° and 104° F  (38.3° to 40° C) and last for 2 to 3 days.  In general, the height of the fever doesn't relate to the seriousness of the illness.  How sick your child acts is what counts.  Fever causes no permanent harm until it reaches 107° F (41.7° C).  Fortunately, the brain's thermostat keeps untreated fevers below this level.Although all children get fevers, only 4% develop a brief febrile convulsion.  Since this type of seizure is generally harmless, it is not worth worrying about, especially if your child has had high fevers without seizures.

HOME CARE

Acetaminophen products for Reducing Fever:

     Children older than 2 months of age can be given any one of the acetaminophen products.  Tylenol, Anacin-3, Liquiprin, Panadol, and Tempra all have the same dosage.

     Remember that fever is helping your child fight the infection.  Use drugs only if the fever is over 102° F (39° C) and preferably only if your child is also uncomfortable.  Give the correct dosage for your child's age every 4 to 6 hours, but no more often.

     One to two hours after they are given, these drugs will reduce the fever  2° to 3° F.  Medicines do not bring the temperature down to normal unless the temperature was not very elevated before the medicine was given.  Repeated dosage of the drugs will be necessary because the fever will go up and down until the illness runs its course.  If your child is sleeping, don't awaken him for medicines.

Caution:   The dropper that comes with one product should not be used with other brands.

Brand

Concentration

Age and Dosage

2-4 Months

5-11 Months

12-23 Months

2 to 3 Years

4-5 Years

6-8 Years

9-11 Years

12 Years

& Older

Acetaminophen

Drops

80 mg/0.8 ml

0.4 ml

0.8 ml

1.2 ml

1.6 ml

2.4 ml

Acetaminophen Syrup

160mg/5 ml

1/2 tsp

3/4 tsp

1 tsp

1 1/2 tsp

2 tsp

2 1/2 tsp

4 tsp

Chewable acetaminophen

80 mg tablets

1 1/2 tablets

2 tablets

3 tablets

4 tablets

5-6 tablets

8 tablets

Adult acetaminophen

325 mg

1 tablet

1-1 1/2 tablets

2 tablets

Liquid Ibuprofen:  

     Liquid ibuprofen was approved by the Food and Drug Administration (FDA) in 1989 for treating fever in children 6 moths to 12 years old.  (Ibuprofen pills, a non prescription product, have been used for many years to treat menstrual cramps and sports injuries.)

     Ibuprofen and acetaminophen are similar in their abilities to lower fever, and their safety records are similar.  One advantage the ibuprofen  has over acetaminophen is a longer-lasting effect (6 to 8 hours instead of 4 to 6 hours).  However, acetaminophen is still the drug of choice for controlling fever in most conditions.  Children with special problems requiring a longer period of fever may do better with ibuprofen.

Cautions about Aspirin:

     The American Academy of Pediatrics has recommended  that children (through 21 years of age) not take aspirin if they have chickenpox or influenza (any cold, cough, or sore throat symptoms).  This recommendation is based on several studies that have linked aspirin to Reye's syndrome, a severe encephalitis-like illness.  Most pediatricians have stopped using aspirin for fevers associated with any illness.

On the other hand, aspirin may be a better drug for relief for muscle and bone pains.  For such pains not caused by flu use the same dosage of aspirin as given above for acetaminophen.

CAUTION:  A hidden source of aspirin that is commonly overlooked is Pepto-Bismol.  Don't give your child Pepto-Bismol if he has a fever.

Sponging:

     Sponging is usually not necessary to reduce fever.  Never sponge your child without giving him acetaminophen first.  Sponge immediately only in emergencies such as heatstroke, delirium, a seizure from fever, or any fever over 106° F (41.1° C).  In other cases, sponge your child only if the fever is over 104° F (40° C),the fever stays that high 1/2 hour after the child has taken acetaminophen and your child is still uncomfortable.  Until acetaminophen has taken effect ( by resetting the body's  thermostat), sponging will just cause shivering, which is the body's attempt to raise the temperature.

     If you do sponge your child, sponge him in lukewarm water (85° to 90° F ([29° to 32° C]). (Use slightly cooler for emergencies.)  Sponging works much faster than immersion, so sit your child in 2 inches of water and keep wetting the skin's surface.  If your child shivers, raise the water temperature or wait for the acetaminophen to take effect.  Don't expect to get the temperature below 101°F  (38.3° C).  Don't add rubbing alcohol to the water; it can cause a coma if inhaled.

Extra Fluids:

Encourage your child to drink extra fluids but do not force him to drink.  Popsicles and iced drinks are helpful.  Body fluids are lost during fevers because of sweating.

Less Clothing:

Bundling can be dangerous.  Clothing should be kept to a minimum because most heat is lost through the skin.  Do not bundle your child; it will cause a higher fever.  During the time your child feels cold or is shivering (the chills), give him a light blanket.

CALL OUR OFFICE

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Your child is less than 2 months old.

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The fever is over 105° F (40.6° C).

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Your child is crying inconsolably.

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Your child is difficult to awaken.

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Your child's neck is stiff.

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Any purple spots are present on the skin.

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Breathing is difficult and no better after you clear their nose.

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Your child is unable to swallow anything and drooling saliva.

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Your child looks or acts very sick (if possible, check your child's appearance 1 hour after your child has taken acetaminophen.

Within 24 Hours

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Your child is  2 to 4 months old (unless the fever is due to a recent vaccine injection).

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The fever is between 104° and 105° F (40° to 40.6° C); especially if your child is less than 2 years old.

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Burning or pain occurs with urination.

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Your child has had a fever more than 24 hours without an obvious cause or location of infection.

During Regular  Hours if:

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Your child has had a fever more than 72 hours.

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The fever went away for more than 24 hours and then returned.

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Your child has a history of febrile seizures.

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You have other concerns or questions.