Milestone Pediatrics

20400 Observation Drive, suite 205 Germantown, MD 20876 301-972-9559

Parent Information About Fever

  1. Fever Management
  2. Myths About Fever
  3. Taking Your Child's Temperature
  4. Home Care For Fever
  5. Dosing Chart For Acetaminophen (Tylenol) And Ibuprofen (Motrin Or Advil)

I - Fever Management

There is much information available about fever and its management. This information should never replace information obtained from your physician. Rather, it should be used in addition to what you learn from your doctor.

Fever is defined as:

  • Rectal temp over 100.4F (38.0C)
  • Oral temp over 99.5F (37.5C)
  • Armpit temp over 99.0F (37.2C)
  • Ear temp over 100.4F (if thermometer is in rectal mode)

Children with the following problems should be seen immediately in the office or in an emergency facility:

  • Any newborn less than one month of age who acts sick
  • Any infant less than 3 months of age with fever over 100.4F rectally
  • Fever over 105F
  • Will not move an arm or leg normally
  • Difficulty breathing after cleaning out the nose
  • Signs of dehydration (no tears with crying, very dry mouth, no urine for more than 8 hrs

Children should be seen on the day you called our office if these conditions exist:

  • Fever over 102F in a 3-6 month old infant
  • A 3-6 month old who acts sick but has a fever
  • Children 3-24 months with fever beyond 24 hours and no obvious cause such as a cold, cough, sore throat or diarrhea
  • Burning or pain with urination

Call our office immediately for the following syptoms:

  • If your child is limp, weak, or not moving.
  • If your child is unresponsive or difficult to awaken

Sponging

Sponging may be tried for fever over 104F that is not coming down with fever reducer. Sponging is also used if the fever is causing discomfort.

HOW TO SPONGE: Use lukewarm water (do not use rubbing alcohol). Always give fever reducer first. Sponge for 30-40 minutes. Warm water should cover the top of the thighs, so most of the trunk and upper extremities are exposed to the air and are available for brisk sponging.

Should shivering occur, increase water temperature if possible or stop sponging. Note that sponging is NOT required for high fever - it is optional.

EXPECTED COURSE OF FEVER: Most fevers associated with viral illness fluctuate between 102-104F and last for two or three days.

CALL BACK ANYTIME IF:

  • Your child looks very sick one hour after giving Tylenol, Motrin or Advil HAS BEEN GIVEN
  • Fever goes above 105F
  • Fever lasts beyond three days

II - Myths About Fever

Myth: All fevers are bad for children.
Fact: Fevers turn on the body's immune system. Fevers are one of the body's protective mechanisms. Most fevers are good for children and help the body fight illness that produces fever.

Myth: Fevers cause brain damage, especially fevers of 104F or higher.
Fact: Fevers do not cause brain damage. Only body temperatures over 108F can cause brain damage. Fevers only go this high due to high environmental temperatures (ex. Being confined in a closed car).

Myth: Anyone can have a convulsion with fever.
Fact: Only 4% of children have febrile seizures. Children who are prone to febrile seizures may have one during the first 24 hours of the febrile illness.

Myth: Febrile seizures are harmful.
Fact: Simple febrile seizures are scary to watch and usually stop within 5 minutes. However, they cause no permanent harm.

Myth: All fevers need to be treated with fever medicine.
Fact: Fevers only need to be treated if they cause discomfort. Discomfort may occur with fevers over 102-103F.

Myth: Without treatment fevers will keep going higher.
Fact: Fevers generally top out at 105 or 106F or lower, due to the brain's thermostat.

Myth: With treatment, fevers will come down to normal.
Fact: With treatment, fevers come down 2 or 3 degrees.

Myth: If the fever doesn't come down, the cause is serious.
Fact: Fevers that do not respond to fever medicine can be caused by trivial or serious infections. It does not relate to the seriousness of the infection.

Myth: The exact number of the temperature is very important.
Fact: How your child looks is what is important.

Myth: "I don't use a thermometer. I can tell by touch if my child has a fever."
Fact: When this observation was put to the test of clinical research, here is what we learned: Experienced mothers were wrong 50% of the time in diagnosing low grade fevers (101-102F) by touch.

Myth: Teething causes fevers.
Fact: Teething is not related to fevers. During the first two years of life, many teeth come in. During these two years, it is common for toddlers to develop fevers from viral infections, like colds and coughs, at least 4-8 times. Naturally the two events, teething and infections, may occur at the same time, but they are not related. When teeth come in, your child may have mild discomfort for a few days and not feel like eating. It is wrong and may be harmful to blame fevers and fussiness on teething. The reason for the fever may be an ear infection, urinary infection, or other serious infection.


III - Taking Your Child's Temperature

Rectal Temperature

Rectal temperature is the "Gold Standard." This is the preferred method. Use a digital or mercury thermometer. We will show you how to use one during your next visit. It is really easy.

Digital Thermometers: Follow the directions on the package insert.

Mercury (glass) Thermometers: Shake mercury level down below 98F. Lubricate bulb with Vaseline. Lie your child across your lap. Gently insert the bulb no more than one inch into the anus. Firmly grasp cheeks closed with holding the stem of the thermometer where it enters the body. Remove thermometer after one minute. Record value where mercury column ends.

We consider a reading of 100.4F or above a fever when the temperature is taken rectally.

Oral Temperature

Oral thermometers may be used for children 6 years of age and older.

Digital Thermometers: Follow the directions on the package insert.

Mercury(glass) Thermometers: - Note: Readings will be inaccurate if your child has had fluids to drink within the previous 15 minutes from when you took the temperature. Shake mercury level down below 98F. Insert thermometer under the tongue. The child's mouth should be closed with the lips, NOT THE TEETH, and firmly grasping the thermometer. Remove from the mouth after one minute. Read the highest level of mercury column.

We consider a reading of 99.3F or above a fever when the temperature is taken orally.

Armpit Temperature

We recommend against using armpit readings. False normal readings may be obtained.

Ear Temperature

Generally, readings in children over 6 months of age are reliable. Follow directions on package insert.


VI - Home Care Advice for Fever

Be calm. Your child probably has an early virus infection. Most fevers are good for children and help the body fight infection. Use the following definitions to help put the child's level of fever into perspective.

100-102F: low grade and beneficial
102-104F: moderate grade fever and beneficial
104F and over: high fever and causes discomfort but harmless
105F and over: high fever and some risk of bacterial infections
107F and higher: the degree of fever itself may be harmful

TREATMENT OF ALL FEVERS

Extra fluids and less clothing

Fever Medicine: Give Tylenol, Motrin, or Advil for fever above 102F if your child is uncomfortable. The goal of fever treatment is to bring the temperature down to a level where your child is showing no visible signs of discomfort. Fever medicine usually lowers the temperature two or three degrees. Follow the dosing charts below. DO NOT USE ASPIRIN (RISK OF REYE'S SYNDROME).


V - Dosing Chart