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Fever Management

“How high should the fever be before I bring little Susie in to the Emergency Room? What can I do to treat little Johnny’s fever?” These are common questions asked by parents concerned about fevers in their little ones. The answer is that there is no “magic number” that indicates your child needs to be seen by a medical provider. There are over the counter medications and other interventions that can be done at home to help make your child comfortable. When in doubt about what to do, contact your medical provider.

How do I properly take a temperature?
There are several different types of thermometers available now. It can be confusing to know whether to use an oral, rectal, axillary (armpit), temporal (forehead) or aurical (ear) thermometer. The truth is that all can be effective if used properly. If you are concerned that your thermometer is reading inaccurately, bring it to your doctor’s visit to compare your value to that of the doctor’s office. If your child is unable to hold a thermometer in the mouth or axilla, it is generally recommended to use a rectal thermometer, especially in infants and children under age two. Also, if you don’t have a specific rectal thermometer, subtract one degree for a standard thermometer used in the rectum. Similarly, add one degree for an axillary temperature. Aurical thermometers are inaccurate in infants under one year of age.

What do I do when there is a fever?
A fever is considered to be a temperature greater than 100.4 degrees. Below that in children, it is not clinically seen as a fever. There is no set number as far as how high a fever should get before you seek emergency care. The emphasis is rather placed on how the child is acting. If there are any signs of seizure activity, seek medical care immediately. There are many reasons why children develop fevers. If your child has a fever that persists past 24 hours, it is recommended to have an evaluation by a medical provider. Common causes this time of year include influenza and RSV (respiratory syncytial virus).

Over the counter antipyretics, or fever reducers, are available to help with temperature. These medications include Tylenol (acetaminophen) and Advil or Motrin (ibuprofen). They come in different forms such as liquids, chewable tablets, and pills. Dosing recommendations are printed on the box down to age two. For recommendations below that range, ask your doctor’s office for proper dosing. These medications can be alternated so medication is given every 3 to 4 hours. For example, ibuprofen is given and then 4 hours later Tylenol and then 4 hours later a second dose of ibuprofen.

Other interventions can be done to reduce fever. In infants, over bundling or dressing in too many layers can be a cause of fever. If your child is wearing warm clothing or several layers indoors, try removing some clothing and see if the “fever” reduces on its own. If your child has been outside playing on a hot day, bring the child into a cooler environment and see if the body temperature returns to normal. If these are not concerns and fever reducing medication has been given but is not yet effective, you can try cool baths or removing clothing. Although chills (feeling cold and shaking while body temperature is elevated) are common and your child may want a blanket, do not bundle them as this will cause the temperature to elevate more. Give the medication some time to work and contact your medical provider if you have concerns.

Can I do anything to prevent my child from getting fevers?
It is important to keep up with immunizations in your child to prevent illnesses that may cause high fevers, including seasonal influenza. Also, make sure your child has a healthy, balanced diet and is getting adequate sleep. Some important things you can do are to encourage good hand washing and teach your child to “cover his cough.” Children are going to be exposed to illnesses and will develop fevers but following healthy routines at home may decrease the incidence. If you ever have questions about a fever or are concerned about your child, contact your medical provider right away.

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