Should I Worry About Fever?

There isn’t a day in clinic or a night on call that I don’t field questions from concerned parents about fever. What’s a fever? When I do I worry? Should I come in? What should I do? And the list goes on and on. Here are a few guidelines.

In pediatrics, fever is defined as a temperature of 100.4°F or 38.0°C. This is best measured rectally, meaning in a child’s bottom (for further instruction, see article Taking A Temperature). Fever on its own is not inherently dangerous. In fact, it is the body’s natural defense against infection. The reason we treat a fever is to make a child more comfortable.

The degree of the fever does not correlate to the seriousness of the infection. As a pediatrician, I do not get more worried over a 104°F fever than I do over a 101°F fever. For example, Roseola, a very benign viral infection, is well known to have high spiking fevers prior to breaking out in an impressive red rash. On the other hand, a case of life threatening meningitis may only present with a low grade fever of 100.8°F. The important questions to ask are how does your child look and act? Is he running around the room or lying lethargic on the couch? Is he still drinking enough to prevent dehydration?

Your child must be seen urgently (and in an emergency room if it is after hours) if signs and symptoms include severe headache, stiff neck, severe abdominal pain, difficulty breathing, rapid breathing, frequent vomiting, or extreme sleepiness/lethargy/irritability (by the way, this list is not exhaustive). The other caveat is if your child is 2 months or younger, then he or she must be seen urgently because fever can be the only sign of a serious infection in an infant this young. Your child should be seen during regular clinic hours if the fever has lasted longer than 3 days, there is associated ear pain, sore throat, persistent rash, or cough.

As for what to do once your child has a fever, these are all comfort measures. There are medications to try, such as acetaminophen and ibuprofen (see medication section for dosing). Please note that you should not use acetaminophen in infants less than 2 months of age (as previously mentioned, infants this young must be seen) and ibuprofen in infants less than 6 months of age (not FDA approved). Decrease the amount of clothing your child is wearing (a onesie or tee is about right). You can also try a tepid bath. Avoid a cold bath as this will cause chilling. Increase the amounts of fluids your child is drinking. He or she will be utilizing extra fluid through sweating. A cool wash cloth on your child’s head and armpits can also help.

As always, if you have questions, concerns, or your parent instinct is telling you there is something seriously wrong, call your pediatrician’s office.