At this time of year, illness can develop quickly. One minute, your child is running and playing and the next moment, her cheeks are flushed and she is sitting in a listless slump due to a fever. Fevers cause a great deal of anxiety for parents and can make children feel awful. However, a fever is usually no cause for significant alarm.

What is a fever and how do I measure it?

Parents often refer to any temperature above 98.6 as a fever but doctors define it a little differently. Temperatures naturally fluctuate during the day and with different activities. In addition, there are a lot of myths about “adding” to a thermometer reading. Here’s what I recommend:

  • In children under 2 years, a rectal temperature is most accurate and a reading above 100.4 is a fever
  • In children over 2 years, an armpit temperature above 99 may signal a fever but this type of reading is very inaccurate. Consider taking a rectal temperature if the child cannot cooperate with an oral temperature. Again, rectal temperature above 100.4 is a fever.
  • After about 4 years of age, an oral temperature can be measured by placing the thermometer under the back of the tongue with the lips closed. A reading above 100 is considered a fever.
  • In general, forehead and ear temperatures are very inaccurate and I don’t recommend them 

What does a fever mean?

Fever can mean your child has a viral illness like a cold or a stomach virus. Sometimes, fevers are associated with bacterial illnesses like strep throat, ear infections, and urinary tract infections. Other times, fevers result from an excited immune system like when your child receives immunizations. The degree of fever doesn’t help distinguish between these causes very much.

Is a fever dangerous?

Fevers are one of our body’s natural defenses against infection. Fevers can make children feel really bad but are not themselves dangerous. Lots of parents worry that high fevers will cause brain or organ damage but this is generally not true. In fact, it is very common for children, especially children under age 3 years, to run high fevers with common infections like colds. A high fever is no cause to panic although fever that lasts for more than 72 hours or is associated with other concerning symptoms may need to be evaluated in our office. If you are having trouble knowing how to handle your child’s fever, just call us at 919-467-5543. Our nurses are available 24/7 to answer your questions.

Should I treat my child’s fever? How?

If a child has a fever but seems to feel well and is eating and drinking normally, treatment is not necessary. If your child seems to feel bad and especially if they are drinking less, treatment is a good idea. In children from 2 months to 6 months, acetaminophen (Tylenol) is an option. After age 6 months, both Ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) are good choices. The dose is based on weight and a dosing chart can be found at link to dosing chart (en espanol). It is also important to encourage your child to drink plenty of fluids as fever causes children to lose more fluids through sweating. 

Remember, never treat fever in an infant younger than 2 months. Fever in these young babies needs to be evaluated by a physician right away. Please call our office to discuss your baby’s fever at 919-467-5543.

What about Febrile Seizures?

Some of you may have heard about children who experience seizures due to fevers. This occurs in about 1-3% of children between the ages of 3 months and 6 years. Most occur in children 12-18 months of age. These seizures are harmless and do not mean that a child has epilepsy. In children who get these types of seizures , they may occur many times but are always associated with a fever. By age 6, children outgrow these seizures. Often, the tendency to get febrile seizures runs in families. No specific treatment is required and your doctor can discuss with you how to keep your child comfortable and safe during these episodes. While fever is the cause of these seizures, parents do not need to take extra measures to prevent fever.

The bottom line:

Fever is a normal part of childhood illnesses.

Parents should expect that their children will get many illnesses with fever during the course of the year. As long as children seem comfortable and are drinking well, most fevers can be managed at home. Tylenol and Ibuprofen can be helpful and children should be encouraged to drink fluids. If the fever lasts beyond 3 days or if you are concerned about your child, we encourage you to call us. Sometimes a child may need treatment or you may just need reassurance. Either way, we are happy to see you in the office.