children-with-fevers-when-to-worry

Fevers can be a scary thing for parents. Watching your children suffer – whether you’re a new parent or not – is never easy. And when they are sick with a fever, sometimes you don’t know what to do or where to go.

Whatever the thermometer reads, there are several factors to consider before you call your child’s pediatrician, or visit an urgent care center or emergency room. A child’s age, symptoms, and temperature reading all determine your next steps. Understanding why fevers occur and what to look for will help you feel more equipped to handle the next one.

Your child’s average body temperature is 98.6 degrees Fahrenheit. This can fluctuate throughout the day ranging from 97.4 to 99.6 degrees Fahrenheit. When it rises beyond 99 degrees Fahrenheit, it is their body’s natural way of fighting an infection. Your child’s immune system releases chemicals when there is an infection, raising their internal temperature. This doesn’t necessarily indicate a serious situation. Just as an absence of a fever doesn’t necessarily mean there isn’t a problem.

Typically, most fevers subside in three to four days and require nothing more than proper hydration, over-the-counter medication and rest. Depending on the age of your child and how high the temperature, you may want to allow nature to take its course. Several factors, including easing your child’s discomfort, will determine your next steps.

How Age Impacts Treatment of Fevers

Typically, the younger the child, the quicker the response. Infants 6 weeks of age and younger with a fever of 100.4 degrees Fahrenheit or higher should seek immediate medical attention. Notify your child’s pediatrician so that your child can be evaluated either in the office or at the ER. Avoid the temptation to administer any fever-reducing medications until your child has been seen by a doctor. Also make sure you take their temperature rectally for the most accurate reading. There are other methods to take your child’s temperature, which I will mention later.

I recommend that infants 3 months or younger be seen by their pediatrician. Illnesses can escalate quickly and babies’ immune systems are not as robust as older children or adults.

If your child is between the ages of 3 months and 3 years old and has a fever of 102.2 degrees Fahrenheit (39°C) or higher, contact your child’s pediatrician to determine if your child should be seen. When it comes to older kids, their behavior and activity level speaks volumes. You know your child best, so you’ll have a good idea as to whether you’re dealing with a minor illness or if a doctor’s visit is necessary.

If your child demonstrates the following with an elevated body temperature, it’s probably not serious and needs to run its course.

  • Remains interested in playing or normal activities
  • Continues eating and drinking well with light color urine (indicating proper hydration)
  • Is smiling and awake/aware of his or her surroundings
  • Appears normal in skin color/overall appearance
  • Improved behavior and appearance when their fever drops

Many times, fevers occur in the middle of the night, creating panic and uncertainty about how to treat them. Again, the age and accompanying symptoms will determine whether you should wait to contact your child’s pediatrician in the morning or take your child to an ER. Follow your doctor’s advice in treating the fever at home based on your specific situation. And make an appointment to see the doctor the next day. In the early evening hours, your doctor’s office likely has an on-call physician ready to take calls after-hours so they can best direct you for the right care in the right place.

When kids have a fever, they often are fussy, not eating and visibly uncomfortable. However, if your child has any of the following symptoms, call your child’s pediatrician immediately:

  • Fevers of 104 degrees Fahrenheit (40 Celsius) or higher that do not drop despite your at-home treatment measures.
  • Lethargy – This is not simply fatigued. In this instance, your child is seen as limp, almost unresponsive and won’t make eye contact.
  • Irritability – Again, this not just discomfort or fussiness. A truly irritable child will cry for hours with little to no verbal interaction and is almost impossible to calm down.
  • Meningitis – While there is a vaccination given to avoid this serious illness, symptoms include high fever, stiff neck or pain in the back of the neck, vomiting, headache, and bright light that hurts the eyes. Check for and record any other symptoms your child has, such as cough, vomiting, rash, etc., and inform your child’s pediatrician.

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Causes of High Fever in Children

If your child has a fever, the chances are high that one of the following conditions caused it:

Viral Infection

This is the most common cause of fever in children and does not require antibiotics. It must run its course over several days. These infections include:

  • Colds
  • Flu
  • Roseola
  • Chicken Pox
  • Hand, foot, and mouth disease
  • Fifth Disease

Bacterial Infection

Treatable with antibiotics and contagious, these infections can wait for twelve hours until your child is seen by a doctor. Common examples are:

  • Ear infection
  • Sinus infection
  • Pneumonia
  • Bladder infection
  • Strep throat

Taking Your Child’s Temperature

You can use the following methods to take your child’s temperature:

1. Regular Glass Underarm Thermometer
While “old fashioned,” this method still may be the most accurate. It’s also one of the most difficult when you have an upset, mobile child. The al is to hold in place for three minutes, making sure the tip is deep in the soft underarm of the skin.

2. Ear Thermometer
An increasingly popular, quick, and easy method using an infrared sensor to measure the temperature of energy radiating from the ear drum. While the eardrum is an accurate point to measure body temperature, one ear may read several degrees different from the other. The rule of thumb is if it reads close to normal, it’s probably true. If it reads 103 degrees Fahrenheit (39.5 Celsius) or greater, confirm this with a glass underarm thermometer.

3. Digital Thermometer
A kind of thermometer that may be used for an oral, underarm, or rectal reading. They are much faster than a glass thermometer, although you do lose some accuracy as with the ear thermometer.

4. Forehead Thermometer
Seen in most pediatrician’s offices, this method of reading the child’s temperature is painless, not scary and pretty accurate. Similar to the ear thermometer, it uses infrared technology to measure the body’s core temperature.

5. Pacifier Thermometer
A non-invasive tool readily accessible and seen as an acceptable method of taking a child’s temperature.

At-Home Relief for Fevers

If your child is otherwise healthy and not under 3 months of age or exhibiting any of the other serious symptoms that requires immediate attention, you can ease the discomfort a fever brings. As always, check with your child’s pediatrician to ensure you are doing the right things for your child’s specific condition and overall health. When it comes to giving the right dose of medicine, by your child’s weight and not his or her age.

  • Medications
    • Acetaminophen – this fever reducer/pain reliever has been around a long time and is effective in most cases. May be used in conjunction with Ibuprofen by alternating between the two over the recommended dosage timeframe. This medication also can help ease body aches.
    • Ibuprofen – this is also effective for fever and pain. It often works better for higher fevers and lasts longer too. May be used in conjunction with acetaminophen by alternating between the two over the recommended dosage timeframe.
    • WARNING – don’t give Aspirin to children 12 and under. Reye’s Syndrome is a serious, but rare disorder that causes brain and liver damage. It occurs in children suffering from a recent viral infection and taking aspirin to treat an infection greatly increases the risk of Reye’s Syndrome.
    • Keeping your child’s energy up is important. If your child is vomiting and won’t keep down any medication, you can use acetaminophen suppositories available at your local pharmacy. Replace nutrients once the stomach has settled down with bland, foods such as crackers, applesauce, rice, toast. Their appetite likely won’t be strong and that’s OK. It’s more important to keep your child hydrated. Avoid anything with spice, dairy or citrus, which can aggravate the stomach.
  • Lukewarm bath and cool compresses – Although it may not be the most comfortable feeling with a higher body temperature, a cooler (not cold) bath can help reduce a fever quickly. It’s recommended that you use this along with a fever reducing medication and not in place of it. Applying a cool washcloth on the head may also bring some relief.
  • Cool liquids help cool down a fever and keep your child well hydrated. Give Pedialyte to restore electrolytes and plenty of water.

How long do fevers last?

It may feel like forever to you and your child between the sleepless nights and crankiness. Most fevers and accompanying cold-like symptoms can last from three to five days. Beyond that, a child should see the doctor to eliminate any risk of complications. Caregivers should use the appropriate method in taking their child’s temperature. Consult your pediatrician if your child’s symptoms are worsening or the fever is climbing despite the use of at home remedies.

Knowing when the fever occurs helps us determine our treatment approach, along with the child’s age, health history, and accompanying symptoms. While fevers can be disconcerting, they are usually not a reason for major concern. If a fever presents more than three days after cold symptoms surface, it could indicate a secondary infection such as pneumonia or an ear infection.

Also, when your child’s temperature rises toward 104 or 105 degrees Fahrenheit, or it does not decrease abruptly with acetaminophen or ibuprofen, you should contact your child’s pediatrician, who likely will direct them to an urgent care or ER.

Of course, as we’re in the middle of flu season, a high fever along with early onset of body aches or headaches can also be influenza. If you suspect your child has influenza, seeking medical attention early. That can help shorten the time your child suffers, reduce complications from the virus, or prevent spreading the illness to others.

A flu shot always is the best way to protect your child against the flu. We recommended the vaccine for all children older than 6 months.

The best thing to help your child recoup from an illness is to ensure he or she is getting plenty of rest and taking it easy. Staying hydrated and staying at home also is recommended. Typically, it is safe for your child to back to school when their temperature has returned to normal for 24 hours.

You child’s pediatrician is your best resource for advice on treating fevers and other illnesses. Fevers should not immediately warrant fear. However, when in doubt, call your child’s pediatrician for advice and to comfort both your child and your frazzled nerves. A summary of when to call your doctor or seek emergency care is below.

CALL YOUR DOCTOR

If your child is between the ages of 3 months and 3 years old and exhibits fever lower than 102.2 degrees Fahrenheit, but also:

  • Refuses fluids or appears too ill to drink enough to stay hydrated.
  • Has lasting diarrhea or repeated vomiting.
  • Shows signs of dehydration (peeing less than usual, no tears when crying, less alert and less active than usual).
  • Has a specific complaint (like a sore throat or earache).
  • Maintains a fever after 24 hours (in kids younger than 2 years old) or 72 hours (in kids 2 years or older).
  • Is getting fevers a lot, even if they only last a few hours each night.
  • Has a chronic medical problem, such as heart disease, cancer, lupus, or sickle cell disease.
  • Develops a rash.
  • Experiences pain when urinating.

VISIT THE EMERGENCY ROOM

If your child experiences any of these symptoms:

  • Non-stop crying
  • Trouble breathing (after nose is cleared)
  • Blue lips, nails, or tongue
  • Extreme irritability
  • Trouble waking up or refusal to move
  • New, sudden rash or purple spots that mimic bruises on the skin
  • Soft spot on the head seems to be bulging out or sunken in
  • Stiff neck
  • Severe headache
  • Leaning forward and drooling
  • Seizures (can occur in children with fevers at 105 degrees Fahrenheit or higher)
  • Abdominal (belly) pain

Temperature Ranges

  • Temperature between 99 -100 degrees generally are not cause for concern. This can be normal temperature variation during the day and can be monitored at home until evaluated by your doctor.
  • Fevers of 100.4 to 103 degrees should be discussed with your child’s provider. They will help determine next steps. 
  • High child fevers of 104 degrees or higher that quickly come down to 100 or 101 degrees with the treatment measures described are also generally not serious and can wait until morning, unless your child is 3 months or younger.

About UPMC Harrisburg

UPMC Harrisburg is a nationally recognized leader in providing high-quality, patient-centered health care services in south central PA. and surrounding rural communities. UPMC Harrisburg includes seven acute care hospitals and over 160 outpatient clinics and ancillary facilities serving Dauphin, Cumberland, Perry, York, Lancaster, Lebanon, Juniata, Franklin, Adams, and parts of Snyder counties. These locations care for more than 1.2 million area residents yearly, providing life-saving emergency care, essential primary care, and leading-edge diagnostic services. Its cardiovascular program is nationally recognized for its innovation and quality. It also leads the region with its cancer, neurology, transplant, obstetrics-gynecology, maternity care, and orthopaedic programs.

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