- A fever is a body temperature higher than a normal temperature of 98.6° F.
- Fever is a healthy way in which the body fights infection.
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- Fevers are most worrisome in children less than 3 months of age. At this age, a child with a rectal temperature of 100.4° F or greater should be seen by a doctor immediately.
- When a child has a fever, the main concern is how sick your child seems. This is much more important than the height of the fever. High fevers are not usually dangerous. The height of the fever alone does not indicate the seriousness of the infection.
- Temperature strips on the forehead are inaccurate.
- Ear thermometers are not very reliable in children less than 6 months of age, or for temperatures over 102° F.
- High fevers do not cause brain damage unless greater than 107° F or associated with diseases that affect the brain, like meningitis (an infection of the fluid that covers the brain and spinal cord).
- Do not give Tylenol to infants younger than 2 months of age with a fever without notifying your doctor's office first. If your baby is less than 3 months of age, and you are concerned that he or she feels warm, take a rectal temperature, which is definitely the most accurate method for infants. Call your doctor immediately if the temperature is 100.4° F or greater. If your baby is bundled, this can cause an elevated temperature. Unwrap your baby and retake the temperature in a half hour.
- Breathing rates and heart rates are increased with a fever.
- Seizures associated with fevers only occur in about 3 to 5 percent of the population and these are called febrile seizures. They are generally harmless. See febrile seizures below.
- Teething does not cause a significant fever (not greater than 100.4° F).
- A common viral infection called roseola affects infants from 6 months to about 3 years of age. There is a fever for two to three days and then as the fever goes away, a rash develops. The rash is flat and pink or slightly raised dots. It looks like an intense heat rash. It is mostly on the neck and body and lasts one to two days. Once the fever is gone for 24 hours, the child is not contagious. There is no specific treatment for the rash. About 10 percent of viruses cause fever and rash.
- Fevers are usually caused by viruses or bacteria. Viruses are the most common cause of fever in childhood.
- External sources of heat can be dangerous. Heat illness occurs because of excess heat exposure. There is a range of severity of this disease. Mild symptoms can include muscle cramps, stomachache and headache. Heat stroke is a life-threatening emergency associated with temperatures over 106° F (41° C) and confusion, and is usually brought on by vigorous exercise in the heat.
- Received DPT (Dipththeria-Pertussis-Tetanus) injection in last 24 hours
- Received MMR (Measles-Mumps-Rubella) or varivax (chickenpox vaccine) in the last 7 to 21 days
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1) Fever reducing medications
Fever medicines help to bring a fever down and make a child more comfortable. They do NOT treat the underlying illness. We do NOT advise alternating between Tylenol and Motrin when your child has a fever. Pick one of the medicines to use that you think works better for your child. See dosage charts below. Once they have contacted their doctor, many parents find out they have not given their child enough acetaminophen or ibuprofen.
Tylenol, Liquiprin, Tempra, Panadol, Anacin-3 and generic store brands are all acetaminophen products. Paracetamol is generally the form of acetaminophen sold in other countries. These products may be used to make a child more comfortable, but they do not treat the underlying illness. They may be given every four to six hours. Within one to two hours after taking the medicine, the fever is usually down by 2 to 3° F. The temperature does not always return to normal. Again, how sick your child seems is more important than whether or not the fever comes down to normal. If your child is resting comfortably, there is no need to wake him or her to give acetaminophen, unless your child is prone to febrile seizures.
Children's Motrin and Motrin oral drops, Advil and generic ibuprofen products are available over the counter. One advantage of ibuprofen is the longer-lasting effect of six to eight hours of fever reduction. Some children who are not responding well to acetaminophen may respond better to ibuprofen.
Aspirin is generally not recommended for children. This is because of the past association linking Reye's syndrome to aspirin usage in children with chicken pox or influenza.
- Give a dosage according to your child's weight, not age.
- Always measure the medicine with a dropper, dosage cup or other accurate measuring device. Kitchen teaspoons used for cooking are not accurate.
- Acetaminophen or ibuprofen may be given with other medicines, such as antibiotics or over-the-counter cold medicines. Make sure the over-the-counter cold medicine does not already contain acetaminophen or ibuprofen, otherwise you could be giving your child a double dose. Do not give over-the-counter cold medicine to your child younger than 2 months of age unless instructed to do so by your doctor.
- Liquid medicines may be mixed in with soft foods or liquids. Chewables may be crushed and added to food, such as pudding, yogurt, applesauce and peanut butter. Mix the medicines with a small amount of food or drink, so you can be sure the child takes it all.
- One teaspoon = 5 ml. or cc (milliliters or cubic centimeters).
2) Less clothing
Children should not be over-bundled when they have a fever, as this tends to raise their temperature. Dress infants in a minimum of clothes and use a light blanket if they have chills. Sometimes, an over bundled infant may have a slight elevation of temperature. If you suspect this, undress and retake their temperature in about one hour.
Sponge baths are usually not necessary for low-grade fevers. Sponging may cause shivering and may be uncomfortable. Sponge baths may be useful with heatstroke, confusion associated with high fevers, or in children who are prone to febrile seizures. Never use alcohol or ice in the bath. Stop or raise the water temperature if the child is shivering. Lukewarm washcloths or sponges rubbed briskly over the skin with the child in two inches of water is the best technique.
4) Degree of sickness
How sick your child seems is more important than how high the fever is running. To assess how sick a child is when he or she has a fever, give an appropriate dose of acetaminophen or ibuprofen (see chart below), and see how he or she is behaving about one to two hours after the dose. The fever may not necessarily return to normal but is often lower. Keep in mind that some children can be seriously ill without any fever.
The behaviors listed below probably indicate that a baby or child is not seriously ill.
- A baby will coo, make eye contact, smile or reach for an object.
- A toddler will pay attention to activities, smile, walk around to get things.
- An older child will engage in quiet activities like coloring or reading.
The behaviors listed below may indicate a serious illness despite fever reduction.
- A baby is not making eye contact, continuously cries and cannot be comforted.
- A toddler refuses to play, cries inconsolably, moans, appears very weak, turns away and stares repeatedly, or is very hard to awaken if sleeping.
- An older child refuses to talk and won't interact or is unable to get out of bed.
- The child keeps falling asleep without periods of activity; remember, sick children do tend to sleep more.
5) Promote liquids and rest
We all need to sleep more whenever our bodies fight an infection. Liquids are important because we sweat more when we have fevers. Children are more prone to dehydration compared to adults. Signs of dehydration in children include:
- No urine output in 8 to 12 hours
- Dry cracked lips and/or mouth
- No tears when crying
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When to call your doctor
Immediately call for advice if:
- Your child is younger than 3 months old and has a temperature of 100.4° F or greater.
- Your child is constantly crying, irritable, inconsolable and behaving sick. (If possible, decide if your child is sick an hour after giving him or her acetaminophen or ibuprofen.)
- Your child is drooling more than usual and having difficulty swallowing.
- Your child has a stiff neck or headache and fever.
- Your child has purple spots on the skin that are large or pinpoint, and do not fade with pressure.
- Your child has difficulty breathing, unless it is due to a stuffy nose.
- Your child is difficult to arouse, confused or delirious.
- Your child is having his or her first febrile seizure.
- Fever lasts more than four days
- Other symptoms include an earache, sore throat, urinary burning or frequency or persistent cough
- Fever is more than 100.4° F, especially if the child is younger than 2 years old
These are usually harmless and occur most often from 5 months to 5 years of age, although they may occur after 6 years of age. There is often a family member who had febrile seizures as a child. They occur in about 3 percent to 5 percent of the population. Typically, the seizure occurs when the fever is rapidly increasing. They are typically brief, lasting only three to five minutes. They may happen with any type of infection that causes a fever. These brief febrile seizures do not cause brain damage. Any first febrile seizure should be evaluated by a physician to rule out the possibility of meningitis or other serious illness. Because a child has a history of febrile seizures does not mean he or she will have epilepsy as an adult. The treatment involves controlling the fever aggressively with acetaminophen or ibuprofen. Some children with complicated, frequent or prolonged febrile seizures require prescription anti-seizure medicines.
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