Fever Management

Fever itself is not a disease. It is a sign that accompanies a variety of illnesses. The normal body temperature varies in a daily cycle with the low point (97.6° F) in the morning and the high point (100° F) in the late afternoon and evening. The so-called “normal temperature” of 98.6° F is the average for the normal daily range. Some children may register a temperature reading which “below normal”. This is nothing to worry about in an older child who has no other symptoms.

Fever is defined as any temperature of 100.4°F (38.0°C) or higher. In any aged child, we recommend that you use a digital thermometer to take the temperature under the arm. If a child is less than 12 months of age and has an under arm temperature of 99° F – 100° F (37.2° C – 37.8° C), you should repeat the measurement with a rectal thermometer. We do not recommend taking rectal temperatures after 12 months of age.

Newborn babies up to the age of 8 weeks should not have a fever. If they do, it may be the sign of a serious infection. In addition, newborn babies can have an infection without fever, especially if they are feeding poorly, irritable, or more lethargic than usual. If your newborn has a temperature of 100.4° F or greater, or has any of the above symptoms, call us immediately.

It must be understood that fever alone does not cause brain damage. To do so, a fever must be over 106° F or greater, and damage is rare with fevers of less than 107° F.

Do not try to decide whether a child has fever by feeling the forehead. Skin temperature is not a reliable indicator of actual body temperature. Always confirm the temperature with a thermometer. Digital thermometers are accurate and inexpensive. They can be used to take oral, axillary (under the arm) and rectal temperatures. When using a digital thermometer, keep the control button set on the “oral” indicator, regardless of where the temperature is obtained. Fever strips, ear thermometers, and digital pacifier thermometers are inaccurate, and therefore should not be used.   Glass thermometers are filled with mercury. If broken, the small amount of mercury spilled may cause an environmental hazard. They should never be used.

Fever Management

  1. To reduce fever, give your child either Acetaminophen (Tylenol) or Ibuprofen (Advil; Motrin). Please note that products containing Ibuprofen cannot be given to children less than six months of age.
  2. There is no benefit in alternating dosages of Acetaminophen and Ibuprofen. We advise you to use only one of these products.
  3. Be aware that fever control medications are meant to reduce the fever and make your child feel more comfortable. They will not shorten the duration of the illness causing the fever.
  4. Do not overdress your child. Do not wrap your child in a blanket. Usually a diaper or underpants and a t-shirt are sufficient.
  5. Encourage your child to drink liquids.
  6. There is minimal benefit to sponging your child with water to bring the temperature down. Therefore, this should not be done.
  7. Never bathe or sponge a child in alcohol because it can be absorbed through the skin, causing alcohol poisoning.
  8. If your child is acting inappropriately, is hard to arouse, or is making unusual muscle movements, calls us immediately!

Summary

Call us immediately for any fever during the first two months of your child’s life. In the older child, call us if the fever is associated with abnormal behavior, abnormal sleepiness, neck pain, rash, changes in the normal breathing pattern, lightheadedness, seizures, fainting, limp muscle tone, refusal to use an extremity normally, or if you are unsure of whether your child needs to be seen.