Fever (and medicine dosages)
Description
A fever means the body temperature is above normal. Your child
has a fever if his:
- Rectal temperature
is over 100.4°F (38.0°C).
- Oral temperature
is over 99.5°F (37.5°C).
- Axillary
(armpit) temperature is over 99.0°F (37.2°C).
- Ear (tympanic) temperature is over:
100.4°F (38°C) -- if rectal mode
99.5°F (37.5°C) -- if oral mode
Tactile (touch) fever is the impression that your child has a
fever because he feels hot to the touch. Checking a fever this
way is more accurate than we used to think. But if you're going
to call the doctor, actually measure the fever.
The body's
average temperature when it is measured orally is 98.6°F
(37°C), but it normally fluctuates during the day. Mildly increased
temperature (100.4 to 101.3°F, or 38 to 38.5°C) can be caused by
exercise, excessive clothing, a hot bath, or hot weather. Warm
food or drink can also raise the oral temperature. If you suspect
such an effect on the temperature of your child, take his temperature
again in a half hour.
Causes
Fever is a
symptom, not a disease. It is the body's normal response to infections.
Fever helps fight infections by turning on the body's
immune system. The usual fevers (100 to 104°F, or 37.8 to 40°C),
which all children get, are not harmful. Most are caused by viral
illnesses; some are caused by bacterial illnesses. Teething does
not cause fever.
Expected Course
Most fevers
with viral illnesses range from 101 to 104°F (38.3
to 40°C) and last for 2 to 3 days. In general, the height of the
fever doesn't relate to the seriousness of the illness. How sick
your child acts is what counts. Fever causes no permanent harm
until it reaches 107°F (41.7°C). Fortunately, the brain's thermostat
keeps untreated fevers below this level.
While all children get fevers, only 4% develop a brief convulsion
from the fever. Since this type of seizure is generally harmless,
it is not worth worrying about excessively. If your child has had
high fevers without seizures, your child is probably safe.
Home Care
- Extra fluids and less clothing
Encourage your child to drink extra fluids, but do not
force him to drink. Popsicles and iced drinks are helpful.
Body fluids are lost during fevers because of sweating.
Bundling can be dangerous. Clothing should be kept to a
minimum because most heat is lost through the skin. Do not
bundle up your child; it will cause a higher fever. During
the time your child feels cold or is shivering (the chills),
give him a light blanket.
- Acetaminophen products
Children older than 2 months of age can be given any one
of the acetaminophen products. Tylenol, Anacin-3, Liquiprin,
Panadol, and Tempra all have the same dosage.
Remember that fever is helping your child fight the infection.
Use drugs only if the fever is over 102°F (39°C) and preferably
only if your child is also uncomfortable. Give the correct
dosage for your child's weight every 4 to 6 hours, but no
more often.
Two hours after they are given, these drugs will reduce
the fever 2 to 3°F (1 to 2°C). Medicines do not bring the
temperature down to normal unless the temperature was not
very elevated before the medicine was given. Repeated dosages
of the drugs will be necessary because the fever will go
up and down until the illness runs its course. If your child
is sleeping, don't awaken him for medicines.
CAUTION: The dropper that comes with one product should
not be used with other brands.
- Dosages of acetaminophen
Type
Weight of Child (Dosage Form) Dose
-----------------------------------------------------------
More than acetaminophen drops 1/2 dropper
7 pounds (80 mg/0.8 ml)
More than acetaminophen drops 1 dropper
14 pounds (80 mg/0.8 ml)
acetaminophen syrup 1/2 tsp
(160 mg/5 ml)
More than acetaminophen drops 1+1/2 dropper
21 pounds (80 mg/0.8 ml)
acetaminophen syrup 3/4 tsp
(160 mg/5 ml)
chewable acetaminophen 1+1/2 tablets
(80-mg tablets)
More than acetaminophen drops 2 droppers
28 pounds (80 mg/0.8 ml)
acetaminophen syrup 1 tsp
(160 mg/5 ml)
chewable acetaminophen 2 tablets
(80-mg tablets)
chewable acetaminophen 1 tablet
(160-mg tablets)
More than acetaminophen drops 3 droppers
42 pounds (80 mg/0.8 ml)
acetaminophen syrup 1+1/2 tsp
(160 mg/5 ml)
chewable acetaminophen 3 tablets
(80-mg tablets)
chewable acetaminophen 1+1/2 tablets
(160-mg tablets)
More than acetaminophen syrup 2 tsp
56 pounds (160 mg/5 ml)
chewable acetaminophen 4 tablets
(80-mg tablets)
chewable acetaminophen 2 tablets
(160-mg tablets)
adult acetaminophen 1 tablet
(325-mg tablets)
More than acetaminophen syrup 2+1/2 tsp
84 pounds (160 mg/5 ml)
chewable acetaminophen 5 to 6 tablets
(80-mg tablets)
chewable acetaminophen 3 tablets
(160-mg tablets)
adult acetaminophen 1 to 1+1/2 tablets
(325-mg tablets)
More than acetaminophen syrup 4 tsp
112 pounds (160 mg/5 ml)
chewable acetaminophen 8 tablets
(80-mg tablets)
chewable acetaminophen 4 tablets
(160-mg tablets)
adult acetaminophen 2 tablets
(325-mg tablets)
-----------------------------------------------------------
Abbreviations: mg = milligrams
ml = milliliter
tsp = teaspoon
As the above table shows, acetaminophen is available in
several oral forms. It is also available as a rectal suppository
in 120-mg, 325-mg, and 650-mg dosages. Suppositories are
useful if a child with a fever is vomiting often or having
seizures caused by the fever. Use twice the oral dose (that
is, double the amount of milligrams listed in the chart)
for the suppository (1999 change in dosage). Most suppositories
can be cut (for example, cut in half) to supply the right
dose for your child's age.
If your infant is under 12 weeks of age, call your doctor
and don't give acetaminophen.
- Ibuprofen
Ibuprofen is similar to acetaminophen in its ability to
lower fever. Its safety record is also similar. One advantage
ibuprofen has over acetaminophen is a longer lasting effect
(6 to 8 hours instead of 4 to 6 hours). Children with special
problems requiring a longer period of fever control may do
better with ibuprofen. Give the correct dosage for your child's
weight every 6 to 8 hours.
Type
Weight of Child (Dosage Form) Dose
-----------------------------------------------------------
More than ibuprofen liquid 1/2 tsp
12 pounds (100 mg/5 ml)
More than ibuprofen liquid 3/4 tsp
18 pounds (100 mg/5 ml)
More than ibuprofen liquid 1 tsp
24 pounds (100 mg/5 ml)
More than ibuprofen liquid 1+1/2 tsp
36 pounds (100 mg/5 ml)
More than ibuprofen liquid 2 tsp
48 pounds (100 mg/5 ml)
ibuprofen tablets 1 tablet
(200 mg)
More than ibuprofen liquid 2+1/2 tsp
60 pounds (100 mg/5 ml)
ibuprofen tablets 1 tablet
(200 mg)
More than ibuprofen liquid 3 tsp
72 pounds (100 mg/5 ml)
ibuprofen tablets 1+1/2 tablets
(200 mg)
More than ibuprofen liquid 4 tsp
96 pounds (100 mg/5 ml)
ibuprofen tablets 2 tablets
(200 mg)
-----------------------------------------------------------
Abbreviations: mg = milligrams
ml = milliliter
tsp = teaspoon
- Combining or alternating acetaminophen and ibuprofen
We don't recommend combining acetaminophen and ibuprofen
for the following reasons:
- There is no added benefit in reducing fever compared
to either product used alone.
- Combining can cause confusion, dosage errors, and poisoning.
- You don't need to control the fever this closely.
- If instructed by your physician to alternate both products,
do it as follows:
- Use
both if the fever is over 104°F and does not
go down using only one medicine.
- Give a fever medicine every 4 hours (acetaminophen
every 8 hours and ibuprofen every 8 hours).
- Alternate medicines for only 24 hours or less,
then return to a single product.
- Avoid aspirin
The American Academy of Pediatrics recommends that children
(through age 21 years) not take aspirin if they have chickenpox
or influenza (any cold, cough, or sore throat symptoms).
This recommendation is based on several studies that have
linked aspirin to Reye's syndrome, a severe encephalitislike
illness. Most pediatricians have stopped using aspirin for
fevers associated with any illness.
- Sponging
Sponging is usually not necessary to reduce fever. Never
sponge your child without giving him acetaminophen first.
Sponge immediately only in emergencies such as heatstroke,
delirium, a seizure from fever, or any fever over 106°F (41.1°C).
In other cases sponge your child only if the fever is over
104°F (40°C), the fever stays that high when you take the
temperature again 30 minutes after your child has taken acetaminophen
or ibuprofen, and your child is uncomfortable. Until acetaminophen
or ibuprofen has taken effect (by resetting the body's thermostat
to a lower level), sponging will just cause shivering which
is the body's way of trying to raise the temperature.
If you do sponge your child, sponge him in lukewarm water
(85 to 90°F, or 29 to 32°C). Use slightly cooler water for
emergencies. Sponging works much faster than immersion, so
sit your child in 2 inches of water and keep wetting the
skin surface. Cooling comes from evaporation of water. If
your child shivers, raise the water temperature or stop sponging
until the acetaminophen or ibuprofen takes effect. Don't
expect to get the temperature down below 101°F (38.3°C).
Don't add rubbing alcohol to the water; it can be breathed
in and cause a coma.
Call Triangle Pediatrics Immediately If:
- Your child is less than 3 months old.
- The fever
is over 105°F (40.6°C).
- Your child looks or acts very sick.
Call Triangle Pediatrics Within 24 Hours If:
- Your child is 3 to 6 months old (unless the fever is due to
a DTP shot).
- The fever
is between 104 and 105°F (40 and 40.6°C).
- Your child has had a fever more than 24 hours without an obvious
cause or location of infection.
- Your child has had a fever for more than 3 days.
- The fever went away for over 24 hours and then returned.
- You have other concerns or questions.
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