Fever is the body’s natural response to infection and may be quite helpful in fighting the infection. Fever is defined as a rectal temperature over 100.5°F, an oral temperature over 100°F, or an axillary (under arm) temperature over 100°F. The body’s average temperature of 98.6° may normally fluctuate from 97° in the morning to a high of 100° F in the evening. Exercise, excessive clothing, hot weather, and warm drink may cause mild elevations of temperature. For this reason, low-grade temperatures should be retaken one hour later to verify their existence.

For children under three years, the most accurate method of temperature measurement is rectally. Axillary measurements can give general estimates of body temperature. Oral measurements are practical beginning at three years of age. Ear thermometers are useful with older children, but are inaccurate with children under 6 months and difficult to properly use under 2 years of age.

Most childhood fevers are caused by viral infections that require no treatment and last from one to three days. Other causes of fever include infections of the ears, sinuses, throat, urinary tract, lungs and skin. In general, the height of the fever and the effectiveness of fever medication in lowering the temperature are not related to the seriousness of the infection. What is more important is the child’s appearance and general disposition during the illness. Many children with viral infections tolerate temperatures as high as 103° F without any significant change in activity – this is a favorable sign that the condition is not serious. Other children with temperature elevations may be particularly irritable, excessively sleepy, or may complain of pain in a certain part of their body. These children will require a medical evaluation to determine the cause of their fever.

Since fever is not harmful to the body, it need only to be treated if a child is experiencing some discomfort as a result. Low-grade fever is usually well tolerated, but fever of 102°F or higher may cause a child to feel poorly. The following measures will help reduce the fever.

  1. Lightly clothe the child to allow the body to lose its excess heat.
  2. Encourage the drinking of cool liquids and eating of Popsicles as tolerated.
  3. If the child is uncomfortable, give a fever medication: acetaminophen (Tempra, Tylenol) or ibuprofen (Advil, Motrin). If the fever is greater than 101°, use acetaminophen, and if greater that 102.5° use ibuprofen. For fever persistently above 103°, doses of acetaminophen and ibuprofen may be given together. Antibiotics and over-the-counter medications may be given along with fever medications.
  4. Sponge baths to reduce fever are usually not necessary. Exceptions would be emergencies such as heat stroke, delirium from fever, a seizure from fever or fever over 106°. Do not sponge with alcohol or ice water. Place the child in about two inches of lukewarm bath water and sponge the water slowly over the head, shoulders, chest, and back. The child’s body temperature will slowly fall, but don’t expect the fever to drop below 101°.

Although fever aids the body’s defenses in fighting infection and is not harmful to the body, an occasional child may have a seizure with high fever. These seizures are generally of short duration (less than five minutes) and result in no brain damage. They are generally caused by a rapid rise in body temperature, and therefore are not easily prevented. If your child does experience a seizure, lay him on the floor on his side away from any objects that he might strike with his arms or legs during the seizure. Don’t try to force anything into your child’s mouth since tongue swallowing is not possible. An immediate examination by a physician is recommended.

Each of the following conditions will require consultation with a pediatrician or the office staff:

  1. Fever above 101° rectally in a child less than four months of age.
  2. Fever lasting longer than three days. Fever caused by most viral infections usually resolves within three days.
  3. Fever associated with a stiff neck, severe headaches, or excessive drowsiness.
  4. Fever with pain in a specific part of the body such as an earache, sore throat, neck pain, or painful urination.
  5. Fever with the sudden appearance of a skin rash.

Posted in: Pediatric Topics