Fever: Preventing Fever Fear

By: Caroline MacElroy, MSN, CPNP

“My child has a fever, what do I do?,” is our most commonly asked question from parents. Fevers are a warning sign to parents there is something going on in your child’s body, but it does not always mean it’s time to panic.

Let’s start first by addressing what causes a fever. Average body temperature is 98.6°F, and can fluctuate during the day based on age, activity, and other factors. A fever occurs when your body temperature is greater than 100.4°F. Fevers are caused by your body fighting off an infection, either a virus or bacteria, which can be beneficial to help your body eradicate the infection.

What is the best way to check your child’s temperature? Armpit, ears, and forehead temperatures are easier to measure, but they are not as accurate as oral or rectal temperatures. Use caution when checking rectal temperatures because if not done correctly localized trauma may occur. The height of the temperature is less important than how sick your child seems to you. It is best to be consistent with the method that you are checking your child’s temperature. Here’s best way to check an oral temperature in a child older than 4 years of age:

  • Make sure they have not eaten or drank anything hot or cold in over 30 minutes

  • Place the tip of the thermometer under your child’s tongue towards the back. Ask your child to hold the thermometer with his or her lips, not teeth.

  • Have your child keep his or her lips sealed around the thermometer. This usually takes 1 minute for digital thermometers.

When should you call or see your pediatrician?

  • If your child is younger than 3 months and has a temperature higher than 100.4°F, even if they are acting like themselves. Do not give fever reducing medication to an infant less than 3 months unless your doctor or nurse tells you to.

  • If your child has had a fever for greater than 5 days.

  • If your child is not acting like himself or herself within an hour of giving a fever reducing medication. Especially if your child is refusing to drink or difficult to rouse. Fevers can lead to dehydration, so if your infant or child has less than 3 wet diapers or voids in a day that is cause for concern.

  • If your child has a fever as well as a new skin rash.

  • A fever that increases after 30 minutes of giving the correct dose of fever reducing medication. Also a fever that does not go down 1°F to 2°F within an hour after giving a fever reducing medication.

  • If you think your child had a febrile seizure, which is a scary side effect in 2-4% of children under 5 years of age. If your child has twitching movements or seems like they are “passing out,” then put your child on his or her side. Do not put anything in his or her mouth. Call 911 if the seizures lasts greater than 5 minutes. Call your pediatrician if the seizures lasts less than 5 minutes. Febrile seizures usually occur due to how quickly a fever rises not how high the fever gets.

  • There is no upper limit to how high a fever can get, but call for a fever of 104°F or higher

What is the best way to treat a fever? The best thing to do is treat how your child feels or looks. If they look miserable and not interested in drinking fluids, it’s best to treat the fever with Acetaminophen or Ibuprofen. However, if your child is acting like themselves or playing, it is appropriate to not medicate and let the fever do its job. You can find appropriate dosing for Acetaminophen or Ibuprofen by clicking this link. Encouraging fluids and rest can help your child to feel better. You will want to unbundle your child or infant. You can even try a lukewarm bath, not cold. Your child is no longer considered contagious once they are fever free for 24 hours without a fever reducing medication. If you have any questions regarding your child’s fever or medication doses please call our office.