Health Topic

Fever

FEVER

Symptom Definition

  • Fever is the only symptom
  • Rectal temperature above 100.4°F (38.0°C).
  • Oral temperature above 99.5°F (37.5°C).
  • Axillary (armpit) temperature above 99.0°F (37.2°C).
  • Pacifier temperature above 100°F (38.0°C)  New digital electronic ones are accurate.
  • Ear (tympanic) temperature above 100.4°F(38.0 C) (Note: Not reliable for less than 6 months old.)
  • Temporal artery (TA) temperature above 100.4 F (38.0 C) (Note: more reliable than tympanic thermometers, but not to be used for children under 6 months old)

Causes

  • Main cause: colds and other viral infections. Fever may be the only symptom for the first 12-24 hours (i.e., viral fevers). The onset of symptoms (runny nose, cough, diarrhea, etc.) are often delayed. In the case of Roseola, fever may be the only symptom for 2 or 3 days. The cause of the fever often can't be determined during the first 24 hours.

See More Appropriate Topic (instead of this one) If

 

WHEN TO CALL YOUR DOCTOR FOR FEVER

Call 911 Now (your child may need an ambulance)

  • Not moving or very weak.
  • Unresponsive or difficult to awaken.
  • Difficulty breathing with bluish lips.
  • Rash with purple (blood-colored) spots or dots.

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick.
  • Any difficulty breathing.
  • Great difficulty swallowing fluids or saliva.
  • Child is confused or has stiff neck or bulging soft spot.
  • Had a seizure with a fever.
  • Age less than 12 weeks with fever above 100.4°F (38°C) rectally.
    (Caution: do NOT give these babies any fever medicine before being seen.)
  • Fever above 105°F (40.6°C) at any age.
  • Very irritable (e.g., inconsolable crying or cries when touched or moved).
  • Won't move an arm or leg normally.
  • Signs of dehydration (very dry mouth, no urine in more than 8 hours, etc.).
  • Chronic disease or medication that causes decreased immunity.

Call Your Doctor Within 24 Hours (between 9am and 4pm) If

  • You think your child needs to be seen.
  • Age 3-6 months with fever.
  • Age 6-24 months with fever present for more than 24 hours but no other symptoms (e.g., no cold, cough, diarrhea, etc.).
  • Burning or pain with urination.
  • Fever lasts for more than 3 days (72 hours).

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns.

Parent Care at Home If

  • Fever with no other symptoms AND you don't think your child needs to be seen.
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HOME CARE ADVICE FOR FEVER

  1. Reassurance:  Your child probably has an early virus infection. Most fevers are good for children and help the body fight infection.  Use the following definitions to help put your child's level of fever into perspective:
    • 100°-102°F (37.8° - 39°C)   low grade fevers and beneficial
    • 102°-104°F (39 - 40°C)      moderate grade fevers and beneficial
    • Above 104°F (40°C)         high fevers and cause discomfort, but harmless
    • Above 105°F (40.6°C)      higher risk of bacterial infections
    • Above 108°F (42.3°C)      the fever itself can be harmful
  2. Treatment for All Fevers:  Extra Fluids and Less Clothing
    • Give cold fluids orally in unlimited amounts (reason: good hydration replaces sweat and improves heat loss via skin).
    • Dress in 1 layer of light weight clothing and sleep with 1 light blanket (avoid bundling).  (Caution: overheated infants can't undress themselves.)
    • For fevers 100°-102°F (37.8° - 39°C), this is the only treatment needed (fever medicines are unnecessary).
  3. Fever Medicine:  Give acetaminophen (e.g., Tylenol) or ibuprofen (e.g., Advil) for fevers above 102°F (39°C), if your child is uncomfortable.  The goal of fever therapy is to bring the temperature down to a comfortable level. Remember, the fever medicine usually lowers the fever by 2° to 3°F. See the dosage charts.
    • Avoid aspirin (reason: risk of Reye's syndrome, a rare but severe brain disease).
  4. Sponging:  Sponge for fever above 104°F (40°C) that doesn't come down with acetaminophen (e.g., Tylenol) or ibuprofen AND causes discomfort.
    How to sponge:  Use lukewarm water (85°-90°F) (29.4° - 32.2°C).  (Do not use rubbing alcohol.)  
    Always give fever medicine first.  Sponge for 20-30 minutes.  If your child shivers or becomes cold, stop sponging or increase the water temperature. (NOTE: Sponging is optional for high fevers, not required.)
  5. Contagiousness:  Your child can return to day care or school after the fever is gone.
  6. Expected Course of Fever:  Most fevers associated with viral illnesses fluctuate between 101° and 104°F (38.4° and 40°C) and last for 2 or 3 days.
  7. Call Your Doctor If:
    • Fever goes above 104°F (40° C).
    • Fever without a cause persists for more than 24 hours. (if age less than 2 years)
    • Any fever occurs if < 12 weeks old
    • Fever lasts for more than 3 days (72 hours).
    • Your child becomes worse or develops any of the "Call Your Doctor" symptoms.
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Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Pediatric HouseCalls Online. Copyright © 2000-2005 Barton Schmitt, M.D. FAAP

Reviewed 8/2005

Revised 8/2005

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