Fever in pediatrics
By Dr.Ashraf El-awadi
Head of pediatric department
- Rectal, Ear or Temporal Artery (TA) temperature: 100.4 F (38.0 C) or higher
- Pacifier or Oral temperature: 100 F (37.8 C) or higher
- Axillary (armpit) temperature: 99 F (37.2 C) or higher
- Limitation: Ear (Tympanic Membrane) and Temporal Artery (TA) temperatures are not reliable before 6 months of age
- Use this guideline if fever is your child’s only symptom
- Main cause: colds and other viral infections
- Fever may be the only symptom for the first 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 usually can’t be determined until other symptoms develop. That may take 24 hours.
- Bacterial infections (e.g., Strep throat or urinary tract infections) also cause fever
- Teething does not cause fever
Return to School
- Your child can return to day care or school after the fever is gone and your child feels well enough to participate in normal activities.
WHEN TO CALL YOUR DOCTOR FOR FEVER
CALL AND COME IMMEDIATELY TO EMERGENCY
- Your child is not moving or very weak
- Your child is unresponsive or difficult to awaken
- Your child has difficulty breathing with bluish lips
- Your child has purple or blood-colored spots or dots on skin
CALL YOUR DOCTOR NOW (NIGHT OR DAY) IF
- Your child looks or acts very sick
- Not alert when awake
- Any difficulty breathing
- Great difficulty swallowing fluids or saliva
- Child is confused (delirious) or has stiff neck or bulging soft spot
- Had a seizure with the fever
- Age under 12 weeks with fever above 100.4° F (38.0° C) rectally (Caution: Do not give your baby any fever medicine before being seen)
- Fever AND >105 F (40.6 C) by any route or axillary >104 F (40 C). (EXCEPTION: age >1 year, fever down and child comfortable. If recurs, see now.
- 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.).
- Burning or pain with urination
- Chronic disease (e.g., sickle cell disease) or medication (e.g., chemotherapy) that causes decreased immunity
CALL YOUR DOCTOR (WITHIN 24 HOURS) IF
- You think your child needs to be seen
- Age 3-6 months with fever
- Age 6-24 months with fever present over 24 hours but no other symptoms (e.g., no cold, cough, diarrhea, etc.)
- Fever repeatedly above 104° F (40° C) despite fever medicine
- Fever present for more than 3 days
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
HOME CARE ADVICE FOR FEVER
- Reassurance: Presence of a fever means your child has an infection, usually caused by a virus. Most fevers are good for sick children and help the body fight infection. Use the following definitions to help put your child’s level of fever into perspective:
- 100Â°-102Â°F (37.8Â° – 39Â°C) Low grade fevers: beneficial, desirable range
- 102Â°-104Â°F (39 – 40Â°C) Mild fever: still beneficial
- Over 104Â°F (40Â°C) Moderate fever: causes discomfort, but harmless
- Over 105Â°F (40.6Â°C) High fever: higher risk of bacterial infections
- Over 106Â°F (41.1Â°C) Very high fever: important to bring it down
- Over 108Â°F (42.3Â°C) Dangerous fever: fever itself can harm brain
- Treatment for All Fevers:Â 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 100Â°-102Â° F (37.8Â° – 39Â°C), this is the only treatment needed (fever medicines are unnecessary).
- Fever Medication:
- Fevers only need to be treated with medicine if they cause discomfort. That usually means fevers above 102Â°F (39Â°C).
- Give acetaminophen (e.g., Tylenol) or ibuprofen (e.g., Advil). See the dosage charts.
- The goal of fever therapy is to bring the temperature down to a comfortable level. Remember, the fever medicine usually lowers the fever by 2Â° to 3Â° F (1 – 1.5Â° C).
- Avoid aspirin (Reason: risk of Reye’s syndrome, a rare but serious brain disease)
- Avoid alternating acetaminophen and ibuprofen (Reason: unnecessary and risk of overdosage)
- Note: Sponging is optional for high fevers, not required.
- Indication: May sponge for (1) fever above 104Â° F (40Â° C) AND (2) doesn’t come down with acetaminophen (e.g., Tylenol) or ibuprofen (always give fever medicine first).
- How to sponge: Use lukewarm water (85 – 90Â° F) (29.4 – 32.2Â° C). Do not use rubbing alcohol. Sponge for 20-30 minutes.
- If your child shivers or becomes cold, stop sponging or increase the water temperature.
- Contagiousness: Your child can return to day care or school after the fever is gone and your child feels well enough to participate in normal activities.
- Expected Course of Fever: Most fevers associated with viral illnesses fluctuate between 101Â° and 104Â° F (38.4Â° and 40Â° C) and last for 2 or 3 days.
- Call Your Doctor If:
- Fever goes above 104Â° F (40Â° C) repeatedly
- Any fever occurs if under 12 weeks old
- Fever without a cause persists over 24 hours (if age less than 2 years)
- Fever persists over 3 days (72 hours)
- Your child becomes worse