BY LINDA STEVENSON, PhD, RN, FNP-C, PEDIAQ Chief Nursing Officer
Most parents have experienced their child awakening from a nap or late at night, all hot, sweaty, and flushed. You take their temperature and they have a fever. Now what!! How high is too high? Is it really a fever or were they just bundled up in too many blankets, they didn’t seem sick when they went to bed. Fever can be scary!
Fever is believed to be the body’s way of fighting off illness. It is fighting the viruses and bacteria that cause infections. Because germs don’t like heat your child’s body increases the temperature to fight off any infection. A fever is usually considered any temperature over 100.4F.
Temperatures can vary by age of the child and with the time of the day. Temperatures rise during the day. You may notice that late afternoon is when your child usually spikes a fever. Normal temperature is considered to be 98.6F, but a toddler can have a temperature of 99F and it can be normal. Older children may have a normal temperature lower than 98.6F.
High temperatures can indicate a serious illness in children over age 12 but not always in younger children. Infants who are over dressed or bundled with blankets can have an increased temperature. Always unbundle the infant, wait 30 minutes and retake the temperature. Any infant with a temperature greater than 100.4F you should call their pediatrician, particularly if they are less than 3 months of age.
When your child has a fever always look at how they are acting. Are they drinking okay? Are they playing when the fever goes down and behaving normally? Or are they not drinking, lethargic and not behaving normally? Children with a fever may breathe faster than usual and have a faster heart rate. This is expected but if they seem to be working hard at breathing then they need to be seen by their pediatrician.
Fevers of less than 5 days in a child with relatively normal behavior and drinking well are not concerning. From over 3 months to 3 years children can have a fever up to 102F and it not be concerning. Children can have a fever one day and be back to normal the next. Low-grade fevers, less than 101F can occur after immunizations and it is considered normal if it lasts only a couple of days.
When do you call your pediatrician if your child has a fever?
- If your infant is under 3 months of age and has a temperature of 100.4F or greater
- If your child’s fever lasts more than 5 days
- If your child’s fever does not respond to acetaminophen or ibuprofen
- If the temperature is over 104F
- If your child is not acting normally, or not drinking or urinating
- If your child has a seizure with the fever
- If your child was immunized and the fever is over 102F or the fever continues for over 48 hours
- If your child is working hard at breathing and this does not improve when the fever decreases
Some of the medical literature discusses the fact that fever of 102F or below does not need to be treated unless your child has a medical issue such as heart disease/defect, seizure disorder, etc. But it is hard to see your child feeling so uncomfortable when they have a fever. There is no research that says giving fever reducers to a child alters the immune response so it is ok to give acetaminophen or ibuprofen to help your child feel better. Based on how your child is behaving you can give them acetaminophen every 4 to 6 hours or ibuprofen every 6 hours. The dose should be based on your child’s weight. Remember infants under 6 months should not receive ibuprofen and never give children of any age Aspirin unless specifically ordered by your pediatrician.
Keep your child’s room cool. Dress your child in light clothing and do not over bundle infants. Increase fluids when your child has a fever due to the increased risk of dehydration. Children usually do not want to eat normally when ill, but as long as they are drinking enough to keep their mouth moist, have good tears and are wetting their diapers 4 to 6 times a day or using the toilet every 6 hours they will be okay not eating well for a couple of days.
When in doubt over what to do for your child’s fever, you should call your pediatrician.