Fever Facts

Understanding Fevers

Fever - an increase in body temperature - is one of the body's normal defenses against attack from an infection or another disease. It is therefore a symptom, not a disease itself. A part of the brain that acts as the body's thermostat controls body temperature by balancing hot and cold signals throughout the body. Factors that influence body temperature are infections; vaccines and medications; and injury. Body temperature increases also occur with exercise, excessive clothing, a hot bath, or hot weather. Fever may actually play a role in fighting infections and shortening their course by turning on the body's immune system, thereby increasing the release and activity of white blood cells and other germ-killing substances. The usual fevers (100°to 104°F) that all children get are not harmful. Most are caused by viruses and may last 3 to 5 days. In general, the height of a fever doesn't relate to the seriousness of the illness. How sick your child acts is what counts, and that should determine whether he or she needs a doctor's attention.

Fever Fears

My Child Will Have A Convulsion (Seizure)

Only a small percent of children have a seizure caused by a fever. These usually occur in children between 6 months and 6 years of age. It is not only the height of the fever but also how rapidly the temperature rises that puts a child at risk for a seizure. Although these seizures are frightening for parents, they usually are without serious long-term consequences. If you think your child has had a seizure during a fever, you should call your doctor immediately. If your child has had a seizure from a fever, your doctor will discuss strategies to help you avoid future sudden high fevers.

Fever Is A Sign Of Meningitis

Meningitis can cause a high fever, but meningitis is very rare. The vast majority of high fevers are caused by common childhood illnesses that are not dangerous.

Treatment of Fevers

Remember that fever is helping your child fight infection, so use fever medications only if the fever is in the moderate range (over 102°F) and your child is uncomfortable. In general, fever medications are overused, and, as with all medications, there is a risk of dangerous side effects from giving them too frequently. Simply undressing the child and offering a cool drink can reduce mild fevers. If fever medications are to be used, be sure to give the correct dosage for your child's weight and within the appropriate time interval. The table included in this brochure provides all the information you will need about medication dosing.

Fever medications usually work within about an hour after they are given and will reduce a fever by 1.5 to 2°F. Don't expect the medication to bring the temperature down to normal unless the fever was low-grade to begin with. Repeated doses may be needed to manage fever fluctuations as the illness runs its course, which may take several days. If your child is sleeping comfortably, it is not necessary to awaken him to administer a fever medication. If the fever is high enough to require medicine, your child will usually awaken on his own.

Remember that the response, or lack of response, of the fever to fever medication tells us little about the severity of the infection that caused it. If your child is smiling, playing, and drinking adequate fluids, you usually do not need to worry about the fever.

Acetaminophen Products (Tylenol, Tempra)

Children two months of age and older can be given one of the acetaminophen products for fever. Give the correct dosage for your child's weight every 4 hours but not more frequently. Remember that these products are made in several different strengths (infant's and children's) and formulations (liquid and tablets), so be sure to choose the appropriate product for your child's age. For assistance in determining the correct dosage, see the dosing instructions on the product or consult your doctor.

Ibuprofen Products (Motrin and Advil)

Children six months of age and older can be given one of the ibuprofen products. Like acetaminophen products, ibuprofen comes in several strengths and formulations, so be sure to choose the appropriate product for your child's age. As with acetaminophen, ibuprofen should be used only if the fever is over 102°F and your child is uncomfortable. Ibuprofen is longer acting than acetaminophen and should be given every 6 to 8 hours but not more frequently. Again, see the table included in this brochure for assistance with dosing.

Cautions about Asprin

The American Academy of Pediatrics has advised that all children (through 21 years of age) not take aspirin products. This recommendation is based on several studies that have linked aspirin to Reye's Syndrome, a rare but serious disease affecting the brain and liver following viral infections. Most pediatricians have stopped using aspirin for fevers associated with any illness.

Sponging

Although helpful, sponging (artificially cooling the skin surface) is usually not necessary to reduce fever. Never sponge your child without first giving a fever medication. Sponge immediately only in emergencies such as heat stroke, delirium (acting very confused) from fever, a seizure from fever, or any fever greater than 106°F. In other cases, sponge your child only if the fever is over 103°F, the fever has stayed that high when you take the child's temperature 45 minutes after giving medication, or your child is uncomfortable from the fever. Until the medication has taken effect (by resetting the body's thermostat), sponging will only cause shivering, which is the body's attempt to raise the temperature. If you choose to sponge your child, use lukewarm (85-90°F) water. Sponging works much faster than immersion, so seat your child in about two inches of lukewarm water and wet the skin surface continually over about 20 minutes. If your child shivers, warm the water slightly, or wait for the fever medication to take effect. Your goal should be to reduce the fever by a few degrees, not to eliminate it entirely. Never use rubbing alcohol either alone or in the sponging water. The skin can absorb it, and it can cause coma if inhaled. And please remember never to leave your child unattended in the tub.

Extra Fluids

Because body fluids are lost due to sweating during fevers, encourage your child to take some extra fluids to replace those losses, but do not force him to drink. Your child may especially prefer popsicles or iced drinks during the fever.

Less Clothing (Bundling Can Be Dangerous)

Since most body heat is eliminated through the skin surface, your child's clothing should be kept to a minimum during a fever. Bundling a child can cause a higher fever; be especially careful with infants who cannot shed extra layers if they become overheated. During a fever, dressing the child in a single layer should be adequate. If at any time your child feels cold or develops shivering ("the chills"), offer a light blanket or a warm drink.

How to Measure Body Temperature

Obtaining an accurate measurement of your child's temperature with a thermometer requires some practice. If you have questions about this procedure, ask your pediatrician or office nurse to demonstrate how it is done and to observe you taking your child's temperature. A rectal measurement is the most desirable and the most accurate, especially in an infant, because it reflects the body's central ("core") temperature. Oral temperatures are also reasonably accurate if performed properly. Axillary (underarm) temperatures are the least accurate, but better than no measurement at all.

Types of Thermometers

1. Digital:

These record temperatures with a heat sensor that runs on a small battery. They measure quickly, usually in less than 30 seconds, and can be used for rectal, oral, or axillary readings. They usually "beep" when the measurement is complete, and then display the temperature in numbers on a small screen. These thermometers are inexpensive and are recommended as the most reliable by pediatricians.

2. Glass:

These come in two versions, rectal (with a round tip) and oral (with a thinner tip) although they can be used interchangeably if well-cleaned, and can also be used under the arm. They are the least expensive type of thermometer but also the slowest (usually requiring two to three minutes for a measurement) and the most difficult to read. Mercury thermometers should not be used. We encourage parents to remove mercury thermometers from their homes to prevent accidental exposure to this toxin.

3. Ear Thermometers:

These are infrared devices that read the temperature of the eardrum, which provides a measurement that is as sensitive as a rectal temperature. Although they are the fastest reading thermometers (less than two seconds), they are expensive and often inaccurate and therefore unreliable.