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Fever in children: When should you worry?

Kara Murphy
Feb. 15, 2018

That number on the thermometer keeps climbing. Your child's a wreck — you even more so. Do you give him more Tylenol? A cool bath? Or is it time to call the doctor?

Take a deep breath, says pediatrician Dr. Barton D. Schmitt, M.D., FAAP, the author of "My Child Is Sick" and creator of KidsDoc, the American Academy of Pediatrics' iPhone app for parents. Fever in children is scary, but it's actually a positive sign that the body is fighting back, he says. Fever is "showing your immune system is turned on, and the body is working to overcome the infection," he says. "If you have an infection, you want to have a fever."

Here's everything you need to know about treating fevers in children:

What should you do if a child has a fever?

"I tell parents not to pay as much attention to the fever as to the child and the symptoms," says Dr. David Wolfson, M.D., FAAP, the medical director of Children's Community Pediatrics, an affiliate of Children's Hospital of Pittsburgh of UPMC. "It's much more important to understand why your child has a fever than to worry about the fever itself."

Schmitt agrees. "Don't look at the thermometer. Look at your child," he says. "I've seen serious infections with just low-grade fevers that needed immediate medical attention. But I've also seen viruses with 105 degree temperatures that didn't need a doctor intervention."

How should you monitor his temperature?

Take your child's temperature as much as makes you feel comfortable. You don't need to take a temperature on a set schedule, and don't wake a sleeping child, Schmitt says.

The American Academy of Pediatrics (AAP) recommends always using a digital thermometer, and taking a temperature rectally gives the most accurate reading. Any temperature over 100.4 degrees taken rectally is considered a fever. Temperatures can also be taken orally or in a variety of other ways.

How can you make your child more comfortable?

"It's reasonable to use medication like ibuprofen or acetaminophen if a child isn't feeling well," Wolfson says. But if a child isn't complaining, reconsider, both he and Schmitt say.

"When a temperature is between 100 and 102, it shows the body is protecting itself," Schmitt says. "You shouldn't mess around with Mother Nature." In fact, studies have shown that flu patients whose fevers weren't treated were sick fewer days than those who were treated. However, a fever over 102 should be treated with medicine, Dr. Schmitt says.

What you shouldn't do is put a child with a fever in a cool bath, or, conversely, dress them especially warm to try to "sweat" the fever out of her, both experts say. Those solutions "are probably causing more harm than good," Wolfson explains. A cold bath could give an already sick child more chills, while making a child warmer could worsen dehydration.

When should you see a doctor?

The AAP guidelines direct parents to call a doctor right away if your child has a fever, and:

  • It rises above 104 degrees repeatedly
  • Looks very ill, is unusually drowsy or is very fussy
  • Has been in a very hot place (such as an overheated car)
  • Has symptoms such as a stiff neck, severe headache, sore throat or ear pain, an unexplained rash, or repeated vomiting or diarrhea
  • Has immune system problems
  • Has had a seizure
  • Is younger than 3 months and has a rectal temperature of 100.4F or higher
  • Your child still "acts sick" once his fever is brought down
  • Your child seems to be getting worse
  • The fever persists for more than 24 hours in a child younger than 2 years
  • The fever persists for more than 3 days in a child 2 years of age or older

You know your child better than anyone, Schmitt says. "It's all about looking at your child and how sick he is," he notes. "If you see something that worries you, that seems off — then immediately call your doctor."

Wolfson agrees. "We always want parents to call if they're worried," he says.
 

Kara Murphy is a freelance writer in Erie, Pennsylvania. She has two children, ages 3 and 5.

* This article is for general informational purposes only. It is not intended nor implied to be providing medical advice and is not a substitute for such advice. The reader should always consult a health care provider concerning any medical condition or treatment plan. Neither Care.com nor the author assumes any responsibility or liability with respect to use of any information contained herein.

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