FEVER

SYMPTOM DEFINITION

• Rectal temperature above 100.4 F (38.0 C)
• Oral temperature above 99.5 F (37.5 C)
• Axillary (armpit) temperature above 99.0 F (37.2 C)
• Pacifier temperature above 100 F (38.0 C) (New digital electronic ones are accurate)
• Ear (tympanic) temperature above 100.4 F (38.0 C)(Note: Not reliable for under 6 months old.)
• Temporal artery (TA) temperature above 100.4 F (38.0 C) (Note: more reliable than tympanic thermometers, but not to be used for children under 6 months old)
• Use this guideline if fever is your child's only symptom

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Causes

• Main cause: colds and other viral infections
• Fever may be the only symptom for the first 12-24 hours (i.e., viral fevers). The onset of symptoms (runny nose, cough, diarrhea, etc.) are often delayed. In the case of Roseola, fever may be the only symptom for 2 or 3 days.
• The cause of the fever often can't be determined during the first 24 hours.
• Bacterial infections (e.g.,  Strep throat or urinary tract infections) also cause fever
• Teething does not cause fever

Return to School

• Your child can return to day care or school after the fever is gone and your child feels well enough to participate in normal activities.

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See More Appropriate Topic (instead of this one) If

• Other symptom is present with the fever, see that topic (e.g., COLDS, COUGH, SORE THROAT, EARACHE, SINUS PAIN, DIARRHEA, VOMITING, RASHES, WIDESPREAD AND CAUSE UNKNOWN).
• Fever onset within 48 hours of receiving vaccine, see IMMUNIZATION REACTIONS
• Fever onset 6-12 days after measles vaccine OR 17-28 days after chickenpox vaccine, see IMMUNIZATION REACTIONS

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WHEN TO CALL YOUR DOCTOR

Call 911 now (your child may need an ambulance)if:

• Not moving or very weak.
• Unresponsive or difficult to awaken.
• Difficulty breathing with bluish lips.
• Rash with purple (blood-colored) spots or dots.

Call your doctor now (night or day) if:

• Your child looks or acts very sick.
• Not alert when awake.
• Any difficulty breathing.
• Great difficulty swallowing fluids or saliva.
• Child is confused or has stiff neck or bulging soft spot.
• Had a seizure with a fever.
• Age less than 12 weeks with fever above 100.4°F (38°C) rectally.
  (Caution: Do not give these babies any fever medicine before being seen.)
• Fever above 105°F (40.6°C) at any age.
• Very irritable (e.g., inconsolable crying or cries when touched or moved).
• Won't move an arm or leg normally.
• Signs of dehydration (very dry mouth, no urine in more than 8 hours, etc.).
• Burning or pain with urination
• Chronic disease (e.g., sickle cell disease) or medication (e.g., chemotherapy) that causes decreased immunity.

Call your doctor within 24 hours (between 9am and 4pm) if:

• You think your child needs to be seen.
• Age 3-6 months with fever.
• Age 6-24 months with fever present for more than 24 hours but no other symptoms (e.g., no cold, cough, diarrhea, etc.).
• Fever repeatedly above 104 F (40 C) degrees despite fever medicine
• Fever lasts for more than 3 days (72 hours).

Call your doctor during weekday office hours if:

• You have other questions or concerns.

Parent care at home if:

• Fever with no other symptoms AND you don't think your child needs to be seen.

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HOME CARE ADVICE

1. Reassurance: Presence of a fever means your child has an infection, usually caused by a virus. Most fevers are good for children and help the body fight infection. Use the following definitions to help put your child's level of fever into perspective:
   • 100 -102 F (37.8 - 39 C) Low grade fevers: beneficial, desirable range
   • 102 -104 F (39 - 40 C)  Mild fever: still beneficial
   • Over 104 F (40 C) Moderate fever: causes discomfort, but harmless
   • Over 105 F (40.6 C) High fever: higher risk of bacterial infections
   • Over 106 F (41.1 C)  Very high fever: important to bring it down
   • Over 108 F (42.3 C) Dangerous fever: fever itself can harm brain
2. Treatment for All Fevers:Extra Fluids and Less Clothing
   • Give cold fluids orally in unlimited amounts (reason: good hydration replaces sweat and improves heat loss via skin).
   • Dress in 1 layer of light weight clothing and sleep with 1 light blanket (avoid bundling).  (Caution: overheated infants can't undress themselves.)
   • For fevers 100-102 F (37.8 - 39 C), this is the only treatment needed (fever medicines are unnecessary).
3. Fever Medication:
   • Give acetaminophen (e.g., Tylenol) or ibuprofen (e.g., Advil) for fevers above 102 F (39 C), if your child is uncomfortable. See the dosage charts.
   • The goal of fever therapy is to bring the temperature down to a comfortable level. Remember, the fever medicine usually lowers the fever by 2 to 3 F (1 - 1.5 C).
   • Avoid aspirin (Reason: risk of Reye's syndrome, a rare but serious brain disease).
   • Avoid alternating acetaminophen and ibuprofen (Reason: unnecessary and risk of overdosage)
4. Sponging:
   • Note: Sponging is optional for high fevers, not required.
   • Indication: May sponge for (1) fever above 104 F (40 C) AND (2) doesn't come down with acetaminophen (e.g., Tylenol) or ibuprofen (always give fever medicine first) AND (3) causes discomfort.
   • How to sponge: Use lukewarm water (85 - 90 F) (29.4 - 32.2 C). Do not use rubbing alcohol. Sponge for 20-30 minutes.
   • If your child shivers or becomes cold, stop sponging or increase the water temperature.
5. Contagiousness: Your child can return to day care or school after the fever is gone and your child feels well enough to participate in normal activities.
6. Expected Course of Fever:Most fevers associated with viral illnesses fluctuate between 101 and 104 F (38.4 and 40 C) and last for 2 or 3 days.
7. Call Your Doctor If:
• Fever goes above 105 F (40.6 C) or repeatedly above 104 F (40 C)
• Any fever occurs if under 12 weeks old
• Fever without a cause persists over 24 hours (if age less than 2 years)
• Fever persists over 3 days (72 hours)
• Your child becomes worse

And remember, contact your doctor if your child becomes worse or develops any of the "Call Your Doctor" symptoms.

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REFERENCES

1. AAP Committee on Quality Improvement: Subcommittee on Urinary Tract Infection. Practice parameter: The diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatrics. 1999;103:843-852.
2. Birmingham PK, Tobin MJ, Henthorn TK, et al. Twenty-four hour pharmacokinetics of rectal acetaminophen in children: an old drug with new recommendations. Anesthesiology. 1997;87:244-252.
3. Bonadio WA. The history and physical assessments of the febrile infant. Pediatr Clin North Am. 1998;45(1):65-77.
4. Crocetti MT, Serwint JR. Fever: separating fact from fiction. Contemp Pediatr. 2005;22(1):34-42.
5. Finklestein JA, Christiansen CL, Richard Platt. Fever in pediatric primary care: Occurrence, management and outcomes. Pediatrics. 2000;105:260-266.
6. Graneto JW et al. Maternal screening of childhood fever by palpation. Pediatr Emerg Care. 1996;12(3):183-184.
7. Greenes DS and Fleisher GR. Accuracy of a noninvasive temporal artery thermometer for use in infants. Arch Pediatr Adolesc Med. 2001;155:376-381.
8. Ishimine P. Fever without source in children 0 to 36 months of age. Pediatr Clin North Am. 2006;53(2):167-194.
9. Mayoral CE, Marino RV, Rosenfeld W, Greensher J. Alternating antipyretics: Is this an alternative? Pediatrics. 2000;105:1009-1012.
10. McCarthy PL. Fever. Pediatr Rev. 1998;19:401-407.
11. Newman TB, Bernzweig JA, Takayama JI, Finch SA, Wasserman RC, Pantell RH. Urine testing and urinary tract infections in febrile infants seen in office settings. Arch Pediatr Adolesc Med. 2002;156:44-54.
12. Press S, Quinn BJ. The pacifier thermometer. Arch Pediatr Adolesc Med. 1997;151:551-554.
13. Rideout ME, First LR. Fever: measuring and managing a sizzling symptom. Contemp Pediatr. 2001;18(5):42-50.
14. Roberts KB. Young febrile infants. JAMA. 2004;291(10):1261-1262.
15. Sarrell EM, Wielunsky E, Cohen HA. Antipyretic treatment in young children with fever. Arch Pediatr Adolesc Med. 2006;160:197-202.
16. Scolnik D et al. Comparison of oral versus normal and high-dose rectal acetaminophen in the treatment of febrile children. Pediatrics. 2002;110:553-556.
17. Shann F. Comparison of rectal, axillary and forehead temperatures. Arch Pediatr Adolesc Med. 1996;150: 74-78.
18. Tal Y, Even L, Kugelman A, et al. The clinical significance of rigors in febrile children. Eur J Pediatr. 1997; 156:457-459.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

See Other Topics:

• Colds
• Cough
• Diarrhea
• Earache
• Rashes, Widespread and Cause Unknown
• Sinus Pain and Congestion
• Sore Throat
• Vomiting

View Anatomic Index of Topics

SelfCareNet, Inc. Copyright © 2000-2007 Barton Schmitt, M.D. FAAP

Reviewed 7/2007

Revised 8/2007