Few symptoms cause as much confusion and concern as fevers do. Dr. Katherine Vaughn, PKIDs’ medical director, answers questions about this worrisome symptom (check with your child’s doctor to determine what course of action is best for your child):
Why do Fevers Occur?
A fever is a resetting of the body’s thermostat to a higher temperature. This usually occurs in response to an infection, although other conditions can cause fever as well. Fever is an indicator that the immune system is working.
What is a Fever?
We all tend to think of 98.6 as a “normal” temperature, and anything above as a fever. In fact, temperature varies from person to person, and will also fluctuate by about a degree in any given person over the course of a day. We typically run about a degree lower in the morning compared to the evening. A temperature of over 100.4 is considered a fever.
How should a Temperature Be Taken?
Rectal temperature is considered the “gold standard”, and it’s most important to obtain in this way in an infant under 3 months of age. An axillary or ear (tympanic) temperature can be obtained in older infants and children. Forehead and pacifier thermometers are not as reliable a measure of temperature.
When Do I Worry About a Fever?
Always notify your doctor if an infant 3 months of age or younger has a rectal temp of over 100.4. The fever itself isn’t harmful, but babies this age can be quite ill without showing other signs, and will likely need to be seen.
For children over 3 months of age, it’s less likely they will be seriously ill and not have other signs and symptoms. A child’s behavior and activity level are more important clues to the severity of illness. A 6 month old who is playing and happy with a temperature of 103 would be less concerning than a 9 month old with a 101 temp who is listless and lethargic. A fever has to be quite high (generally felt to be greater than 106) for the fever itself to be harmful.
Other symptoms, such as rash, trouble breathing, lethargy, or other indications of a sick-looking child should prompt a call to your physician or visit to the ER. Fevers over 104 degrees, or any fever lasting more than 3 days should prompt a call to your physician to help assess for the need for a visit.
When Should a Fever Be Treated?
The main reason to treat a fever is for comfort. A happy child with a fever does not have to be treated. However, as temperatures rise over 101, many children become uncomfortable, with headache, body aches, increased heart rate, etc.
Treatment can be with acetominophen or ibuprofen at the appropriate doses. Never give your child aspirin for fever. It has been linked to a condition called Reyes’ syndrome.
Lukewarm sponge baths can also be used, as well as offering plenty of fluids. Don’t worry if your child doesn’t want to eat much for a few days, as long as they’re drinking.
Avoid alcohol sponging (it will raise the temperature) or cold water baths (increases discomfort).
- “The temperature came down a few degrees and my child feels better, but the temperature still isn’t normal. My child must be really sick.” A child’s response to acetominophen or ibuprofen (in terms of degrees a fever decreases) is not an indicator of severity of illness. We don’t expect the temperature to come down to normal. Remember, treating the fever is done mainly for the child’s comfort, but it doesn’t make the illness get better any sooner.
- “Fever can cause brain damage.” A temperature probably has to be over 106 to cause problems like this, and in a normally healthy person, that doesn’t happen.
- “What about febrile (fever) seizures? They can occur at temperatures less than 106.” True. Febrile seizures are frightening. They occur in 3-4 percent of children, usually between 6 months and 5 years of age. They are typically brief and don’t cause any lasting problems. Always notify your child’s doctor if they have a febrile seizure.
Take Home Message
Fevers are rarely harmful. In a child under 3 months of age, call your doctor for any temperature over 100.4 . In older children, you can feel more comfortable evaluating the child, giving medicine to bring the fever down if they are uncomfortable, and calling the doctor if you’re concerned about how they are looking or acting.