Fever in Children
What causes fever?
Fever is a symptom and not a diagnosis or a medical condition. The most common cause of a fever in children is an infection, mostly viral but in some cases a bacterial. One of the challenges in evaluating children with fever is trying to determine the cause, or at least to make sure it is not due a bacterial infection. This distinction is important, as viral infections do not need antibiotic treatment, but bacterial infections usually do. More rarely there are other, so called "non infectious" causes of fever, but in this circumstance, the fever persists for prolonged periods of time(weeks or even months) rather than just for a short period coincident with a current infection.
Fever is part of the overall picture
In general, the younger the child, the sicker looking the child and/or the longer the fever persists, the higher the chance of a bacterial infection. Also as important as the degree of fever is how a febrile child generally looks. A sick looking child with a low fever may be more ill than a very well, active child with a higher fever.
Taking a child's temperature
There are 3 ways to take a child's temperature:
- Rectal: this is the most exact reading and is recommended for children less than 5 years of age
- Oral(by mouth): recommended for children older than 5 years of age
- Axillary(armpit): this is the least precise way to measure the temperature
What is the normal body temperature?
The average (normal) body temperature is usually 98.6º F (37ºC), rectally. However there are ranges of normal temperatures depending on how the temperature is measured:
The normal temperature range when measured rectally is: 36.6º - 38º (C), or 97.9º - 100.4º (F)
The normal temperature range when taken by mouth is: 35.5º to 37.5º (C), or 95.9º - 99.5º (F)
The normal temperature range when taken from the armpit is: 34.7º to 37.3º (C), or 94.5º - 99.1º (F)
What body temperature is considered to be fever?
A child is considered to have a fever if:
The rectal temperature is
greater than 38º (C) or 100.4º (F),or
The oral( by mouth) temperature is
greater than 37.8º (C ) or 100º (F),or
The armpit temperature is
greater than 37.2º (C) or 99º (F)
About fever medications:
Today, there are 2 commonly used anti-pyretic or anti-fever medications:
- Acetaminophen(Tylenol, Tempra or Panadol) is a medication that has a long and favorable track record and is considered to be appropriate for use in children for fever and/or pain control.Available in liquid, drop or pill form, acetaminophen is given every four to six hours, as needed. Acetaminophen is also available in suppository form which can be helpful when a child needs to take fever medication but is throwing up, with a "gastro" or stomach flu, for example. Although acetaminophen is considered safe when used as recommended, taking it regularly, for more that a week at a time can be dangerous. Over dosage of acetaminophen can result in liver damage. So it is important to follow the dosage based on a child's age or weight and not to give it regularly for more than 4 or 5 days
- Ibuprofen(Advil, Motrin) is a newer fever medication which has not been around as long as acetaminophen. Most experts agree that ibuprofen is a relatively safe and very effective medication, but still recommend acetaminophen as a first line fever medication given its longer track record.
Here are some general guidelines for using fever medications in children:
- Aspirin(acetylsalicylic acid) should never be used in children
- Overdosing by accidental ingestion of these fever medications can be very serious. These medications, as all others, should be stored well out of the reach of children.
- Acetaminophen and ibuprofen are available in combined preparations with decongestants or cough medicines. These combination forms should be avoided.
- If a child is on antibiotics for a bacterial infection( an ear infection) and has fever, then fever medication can be given as well for temperature control during the first 48 hours which is the time usually needed for to antibiotics to start working.
Other measures to help lower the fever:
Lowering the temperature with Acetaminophen or Ibuprofen can help your child feel better and be less irritable. It usually takes up to 60-90 minutes for the fever to go down. If fever medication does not bring the temperature down, the child could be given a luke-warm sponge bath. Do not use cool or cold compresses or baths and never use alcohol sponging. Also children with fever should not be overdressed.
When to call your doctor about your child's fever
Worrisome or alarm signs needing immediate medical attention include:
- the fever is higher than 39.5º C(103ºF)rectal or
- the child appears unwell or unusually ill(this applies even when there is no fever) or
- persistent fever(more than 3-4 days) or
- the child is less than 6 months of age