Fever

Fever alarms parents more than any other sign of illness. This is understandable since fever usually causes your child to feel bad and could be the early signs of an infection. Often it is difficult to determine the nature and seriousness of an infection when the fever first begins. Observing a child for a short time may yield other symptoms such as rash, cough, vomiting, or sore throat.

Fever occurs when the body’s immune system is active. The immune system may be active due to inflammation or as part of the body’s infection-fighting process. Fever is helpful because it hinders the progress of an infection as most viruses and bacteria are unable to live or multiply at high temperatures.

Average body temperature is 98.6°F measured under the tongue. However, body temperature varies between 97-100.3°F over the course of a given day, whether a person is well or sick. If the temperature stays at or higher than 100.4°F for more than a few hours, fever is present.

Measuring the temperature accurately is important

For infants, it is necessary to take temperatures rectally; for toddlers, one can take it under the arm and in children over 4 years old, under the tongue is recommended. Ear and forehead thermometers have become more and more popular. While typically effective screening tools, they tend to be less accurate then the methods previously mentioned. 

When to call the doctor if your child has a fever

The question of when to notify the doctor of a fever depends on the age of the child.

In infants less than two months old, you should call our office with any fever > 100.4°F.

For older infants, any fever > 102°F should also prompt a call to our office during normal office hours.

For older children, we would recommend calling our office if they have a temperature of 102°F for more than 48 hours, or a temperature of 105°F at any time.

What to expect when your child has a fever

In general, you can learn a lot more about how ill your child is by looking at them, rather than looking at the number on the thermometer. A child’s behavior provides the best clue of how serious an illness is. Fevers drain children of energy. This makes them more cranky, clingy and sleepy than usual. Once they have been given fever-reducing medicine, however, they should be able to show interest in toys and family. Most children lose their appetites when sick, but they should still drink liquids well.

Managing a fever in infants and young children

The most common reason for newborns and young infants to have an elevated temperature is absorbing warmth from their environment, whether being cuddled closely by a loved one or wrapped/swaddled in blankets. If your infant feels warm, undress them to their diaper and allow them to cool to ambient air for 5-10 minutes. If your infant still feels warm, check a rectal temperature. Call us immediately at (804) 282-4205 if your infant is 2 months old or younger and has a rectal temperature of 100.4°F or greater. Do not give Tylenol.

For older infants and children of all other ages, focus on the comfort level of your child. If your child has a fever but is staying hydrated, breathing comfortably and acting normally, you do not need to do anything or give fever reducer. Give your child plenty of fluids. This will make him feel better, help him lower the fever and prevent dehydration.

Giving medication for fever

Acetaminophen (common brand Tylenol) is the medication of choice, if needed, for fever in children. Ibuprofen (common names Motrin or Advil) is unsafe for infants under 6 months old because it can harm their immature kidneys. Additionally, ibuprofen is harder on the stomach and is more likely to make your child vomit if they have a poor appeite and empty stomach from feeling sick. Aspirin should NOT be used in children due to the risk of Reye Syndrome.

  • Doses of acetaminophen can be given every 4 hours as needed for comfort.
  • Do not exceed more than 5 doses of acetaminophen in 24 hours.
  • Check labels of any other medicines you are giving for the active ingredient “acetaminophen”, especially cough/cold preparations.
  • Use the enclosed dropper, measuring cup or a device used for measuring medicines, do not use a household spoon to measure the medicine.
  • The most accurate way to dose any medication for children is according to weight. Use age-based dosing only if a weight is not available.

Acetaminophen (Tylenol) Dose Chart

Ibuprofen (Motrin, Advil) Dosing Chart