Childhood Fever

Fever is a response by the body to illness, disease or injury.

A child is considered to have a fever when their temperature is at or above the following:

• 100.4 °F measured rectally
• 99.5 °F measured orally
• 99 °F measured in the arm pit (axillary)

Children & infants may develop very high fevers with even minor viral illnesses, but more serious causes should always be considered as serious complications could occur.

Febrile seizures can occur in some children, especially when the fever rises quickly. Although scary to watch they are generally over quickly, do not cause permanent harm, and do not signal that your child has epilepsy. All children that have a seizure for the first time should be brought immediately to a physician, urgent care center or emergency rooom.

Possible Causes of Childhood Fever

Common causes of childhood fever include:

• Ear & Sinus Infections
• Sore Throat & Strep Throat
• Colds & Other Respiratory Viruses
• RSV infection
• Bronchitis
• Urinary Tract Infection
• Stomach Virus or Diarrhea
• Infectious Mononucleosis
• Serious infections like meningitis, skin infections, appendicitis, pneumonia, bone infections
• Other serious illnesses such as leukemia, cancer, and inflammatory disorders.

A low grade fever (generally not more than 100° F may be seen when a child is teething and for several days after a child receives some immunizations.

Home Care

The degree of temperature elevation does not necessarily indicate how serious the problem is. A minor infection can cause a high fever and some more seriuous illnesses can cause a mild temperature elevation. Some serious infections can cause a drop in body teperature.

The illness is probably not serious if your child:

• Is alert as usual and appears happy and smiling
• Is eating, drinking and urinating normally
• Is interested in playing with their toys and others
• Their breathing appears normal
• Their skin color is normal
• They look well when their fever comes down to normal

You generally try and lower the fever to make your child more comfortable.

Here are some general guidelines for giving your child medicine to lower their fever:

• Call your doctor first before giving medicines to any child under 3 months of age.
• Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) can help to reduce fever. Sometimes your doctor will advise you to use both types of medicine. Giving these medications every 4-6 hours can prevent the fever from going higher between doses.
• YOU SHOULD NOT use ibuprofen in children younger than 6 months old.
• YOU SHOULD NOT give aspirin to children unless your child's doctor tells you to do so.
• These should be given as directed by your doctor or the package instructions. It is important to know your childs weight to correctly give these medications.

Other suggestions when trying to lower your child's fever:

• Room temperature should be comfortable, not very cold or hot. A fan to circulate air is good, but should not blow directly on your child.
• Light clothing and bedding is OK. Remove excess clothing and blankets.
• DO NOT over cloth or wrap your child too much, even if they appear to have chills.
• A lukewarm or sponge bath may be helpful. You SHOULD NOT use cold baths, ice or alcohol rubs.

What should your child eat and drink?

• They should drink plenty of fluids. Water, soup, popsicles, and jello are all good. Too much fruit juice and sports drinks should generally be avoided.
• They should generally eat the foods they like, but only in the amount they are comfortable eating. Fluids are more important for a few days than forcing your child to eat.

When should your child be examined?

You should speak to your doctor or have your child examined if:

• Your child has a fever of 102.2 °F or higher
• Your child is younger than 3 months old
• Your child's fever lasts longer than 24 - 48 hours
• Is older and has a fever for longer than 48 - 72 hours
• Has symptoms that suggest an illness, needing treatment, such as a cough, earache, or sore throat, or pain on urinating
• Has fevers that come and go for over a week, even if low grade
• Has another serious medical illness, such as HIV, previous spleen removal, previous bone marrow transplant, cancer or leukemia, diabetes, cystic fibrosis, sickle cell anemia, or a heart problem
• Is taking chemotherapy, steroids, or other immunosuppresant medications
• Has had a recent immunization
• Has a new rash or bruises appear on their skin
• Has recently traveled outside the United States to a third world country

You should call 911 if your child has a fever and:

• Is not conscious, is confused, or cannot be awakened easily
• Is unable to walk
• Complains of a bad headache or stiff neck or has pain when bending their neck
• Has blue or grey lips tongue, or nails
• Has problems breathing, even after their nose is cleared
• Has a seizure
• Refuses to move their arm or leg

What to Expect When Your Child is Examined

The doctor will perform a complete physical examination, looking for the cause of the fever. They will especially be looking to make sure there is not a more serious illness

They may perform some tests to help determine the exact cause of the fever. These tests may include the following:

• Blood tests such as a CBC (Complete Blood Count), Blood Chemistries, viral or flu testing
• Urinalysis
• Chest X-Ray
• Other testing as needed depending on the exact symptoms and findings on examination.

Treatment will depend on the diagnosis of the cause of the fever, and symptoms. Depending on the cause and severity treatment could include various medications, antibiotics, fluids, or hospital admission , if needed.