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FEVER FEARS

A Guide To Empower Parents

We DO NOT recommend combination cold products containing
Mortin®, Advil®, Tylenol®, Ibuprofen, or Acetaminophen.

Fever is a symptom, not a disease. It represents the body’s normal response to infections and plays a role in fighting them. Fever turns on the body’s immune system. The usual fevers (100°-104° F) that all children get are not harmful. Most are caused by viral illnesses and may last 3 to 5 days. Viral illnesses do not respond to antibiotics. Most office visits for fever will result in no specific treatment except watchful waiting. Your doctor will tell you what to expect and when they may want to recheck your child. The following are some commonly held fears regarding fevers.

Will my child have a seizure?

Only about 5% of children have febrile seizures, or a seizure caused by fever. These can occur in children between 6 months and 6 years of age. It is not just the height of the fever, but also how rapidly the temperature rises, that puts a child at risk for a febrile seizure. This type of seizure is usually without long term consequences. If you think your child has had a febrile seizure, please call your doctor to talk about the implications of this, and how to treat future fevers.

Will my child suffer brain damage as a result of fever?

Fever alone does not cause permanent brain damage unless it is extremely high (>107°F) and occurs for a prolonged period of time.

Is high fever a sign of meningitis?

High fevers can be associated with meningitis. Despite the press coverage, however, meningitis is rare (though we must all monitor for it closely).

WHAT TO USE, AND HOW TO TAKE A TEMPERATURE

Recommendations for Age-Appropriate Thermometers*

  • Newborn – 3 months: glass or digital rectal thermometer underarm thermometer (if unable to use rectal)
  • 3 months – 18 months: underarm or rectal thermometer
  • Over 18 months: underarm, rectal, oral or ear* thermometer

* Ear thermometers, though not always accurate, can be used for children 18 months of age and older.
* Pacifier thermometers and fever strips are not recommended.

Taking the Temperature

Obtaining an accurate measurement of your child’s temperature requires some practice. If you have questions about this procedure, ask a physician or nurse to demonstrate how it is done, and then to observe you do it.

1. Taking Rectal Temperatures

  • Have your child lie down on your lap.
  • Apply a small amount of petroleum jelly to the end of the thermometer and to the opening of the anus.
  • Insert the thermometer into the rectum about 1 inch, but never force it. Hold your child still while the thermometer is in.
  • Leave the thermometer in your child’s rectum for 1 minute, then remove and read the temperature.*

2. Taking Underarm (Axillary) Temperatures

  • Place the tip of the thermometer in a dry underarm.
  • Close the underarm by holding the elbow against the chest for 3 minutes.
  • If you’re uncertain about the result, check it with a rectal temperature.

3. Taking Oral Temperatures

  • Be sure your child has not taken a cold or hot drink within the last 10 minutes.
  • Place the thermometer under one side of the tongue and toward the back. An accurate temperature depends on proper placement.
  • Have your child hold it in place with the lips and fingers (not the teeth) and breathe through the nose, keeping the mouth closed. (If your child can’t keep his mouth closed because his nose is blocked, suction out the nose).
  • Leave it inside for 3 minutes.

* To read a glass thermometer, rotate the thermometer until you can see the silver mercury line. The mercury line ends at the number which represents your child’s temperature.

CLASSIFICATION OF FEVERS

MILD: 99°F – 101.5°F
MODERATE: 101.6°F – 104.5°F
SIGNIFICANT: >104.5°F

Please note: if your child is 3 months of age or less, a temperature of 100.5°F or greater (taken rectally or under the arm) is considered a significant fever and you should call your doctor immediately. See below for other symptoms associated with fever that would require a call to the doctor.

TREATMENT OF FEVERS

ACETAMINOPHEN PRODUCTS (Tylenol® and Tempra)

Children older than 3 months of age (with the exception of medicating with Tylenol at the time of the DTaP vaccine at 2 months) can be given any one of the acetaminophen products. Tylenol and Tempra have the same dosage.

Remember that fever is helping your child fight the infection. Use medication only if the fever is over 101°F and your child is uncomfortable. Give the correct dosage for your child’s weight (or age) every 4-6 hours, but not more often. See the Children’s Dosage Guide for doses.

Usually within 1 hour after they are given, these medications will reduce the fever 1.5°-2°F. Medicines do not bring the temperature down to normal unless the fever was not very high to begin with. Repeated dosages may be needed because the fever will go up and down until the illness runs its course. If your child is sleeping, don’t awaken him for fever medicine.

CAUTION: The dropper that comes with one product should not be used with other forms of the
same product, or with other brands!! 
LIQUID IBUPROFEN (Motrin and Advil)

Children older than 6 months of age can be given any one of the ibuprofen products. Motrin and Advil have the same dosage.
Ibuprofen is similar to acetaminophen in its ability to lower fever, and its safety record is also similar. As with acetaminophen, this medication should be used only if the fever is over 101°F and your child is uncomfortable. Give the correct dosage for yourchild’s weight (or age).*

*This medication is longer acting than acetaminophen, and should be given every 6-8 hours (instead of every 4-6 hours), but not more often. See the Children’s Dosage Guide for doses.

ALTERNATING ACETAMINOPHEN AND IBUPROFEN

Some persistent fevers may respond best to treatment with alternating doses of acetaminophen and ibuprofen every 3 hours. If you think your child requires this treatment, speak with your doctor before beginning alternating dosing.

CAUTIONS ABOUT ASPIRIN

The American Academy of Pediatrics has recommended that children (through 21 years of age) not take aspirin products. This is based on several studies that have linked aspirin to Reye’s syndrome, a severe illness which can cause swelling of the brain. Most pediatricians have stopped using aspirin for fevers associated with any illness.

SPONGING

Sponging is usually not necessary to reduce fever. Never sponge your child without giving him acetaminophen or ibuprofen first. Sponge immediately only in emergencies such as heat stroke, delirium, febrile seizure, or any fever >106°F. In other cases, sponge your child only if the fever is >104°F, the fever stays that high when you take the temperature 45 minutes after your child has taken medication, and your child is uncomfortable. Until the medication has taken effect (by resetting the body’s thermostat) sponging will only cause shivering, which is the body’s attempt to raise the temperature.

If you sponge your child, use lukewarm water (85°- 90°F). Sponging works much faster than immersion, so sit your child in 2 inches of water and keep wetting the skin surface for about 20 minutes. If your child shivers, warm up the water or wait for the medication to take effect. Don’t expect to get the temperature below 101°F. Never use rubbing alcohol alone or in water. It is absorbed by the skin and can cause a coma &inhaled.

EXTRA FLUIDS

Encourage your child to drink extra fluids, but do not force him to drink. Popsicles and iced drinks are helpful. Body fluids are lost during fevers because of sweating.

LESS CLOTHING

Clothing should be kept to a minimum because most heat is lost through the skin. Dressing in a single layer should be adequate. During the time your child feels cold or is shivering (the chills), give him/her a light blanket.

DOSAGES OF MEDICATION

The Children’s Dosage Guide shows our recommended dosage for acetaminophen (Tylenol) and ibuprofen (Motrin/Advil). Your nurse or doctor will go through the dosing at each well child visit.

You may notice that the dosing on our chart is different from the dosing listed on the bottle of medicine itself. This is because the dosing on the bottle is lower than necessary. You can actually give slightly more than that which is listed on the bottle – DON’T WORRY. The dosing on our chart will not result in any overdosing, as long as you properly follow it, and the medication will be more effective.

The best way to determine the appropriate amount of medicine for your child’s fever is to give the amount appropriate for his/her weight. If you are unsure of the exact weight, you may use his/her age, but this method is not as accurate. Our chart uses both methods, but we recommend that you use weight for the most precise results.

WHEN TO CALL YOUR DOCTOR IF YOUR CHILD HAS A FEVER

Note: The following are guidelines only. Your child’s general appearance and the way he/she is acting are more important indicators of illness than the height of the fever. You should always call if your child looks or acts significantly ill for any period of time.

CALL IMMEDIATELY IF:

  • Your child looks or acts very sick for any period of time
  • Your child is less than 3 months old with a temperature greater than 100.5° (rectal)
  • Your child is 3 – 6 months old and the fever is 102° or greater
  • Your child is less than 3 years old and the fever is over 105°
  • Your child is older than 3 years and the fever is over 105° and the temperature has not dropped within 45 minutes after administration of acetaminophen or ibuprofen, or after sponging
  • Your child is crying inconsolably
  • Your child is difficult to awaken
  • Your child complains of a stiff neck, and cannot put his/her chin to his/her chest without pain
  • Purple spots are present on the skin and these do not blanch (whiten when touched)
  • Breathing is difficult, and no better after the nose is cleared
  • Your child is unable to swallow anything and drooling saliva
  • Your baby’s soft spot is bulging when he/she is sitting up quietly
  • Your child complains of back pain with fever
  • There is redness or swelling of the eye, or pain with movement of the eye
  • There is tenderness, swelling or redness over an arm or leg
  • Your child walks with a limp or refuses to move a joint
  • Your child’s immune system is compromised (i.e. their spleen has been removed, they are undergoing chemotherapy or are H1V positive)
  • You have any other concerns which make you feel an immediate call is necessary

CALL THE NEXT MORNING IF:

  • Your child is older than 3 years with a fever over 105° which responds to acetaminophen or ibuprofen (i.e., the temperature drops after administration, but otherwise persists)
  • Your child suffers from burning or pain during urination
  • Your child complains of ear pain (note: if the ear appears swollen, you should call the office immediately)
  • Your child complains of sore throat and any of the following: fever, swollen glands, headache, abdominal pain, rash or joint pain
  • Dark urine occurring up to 3 or 4 weeks after a sore throat
  • Your child’s fever lasts more than 48 hours without any obvious cause or infection

CALL DURING REGULAR HOURS IF:

  • Your child’s fever is over 101° for more than 72 hours
  • The fever abated for 24 hours, then turned
  • Your child has a history of febrile seizures, and you wish to review the management of fevers
  • You have other concerns or questions

ACKNOWLEDGMENTS: WE WOULD LIKE TO THANK DR. BARTON SCHMITT, DR. HANNA SHERMAN AND THE NIGHT TRAIN TELEPHONE TRIAGE SERVICE FOR THEIR ASSISTANCE IN THE DEVELOPMENT OF THIS MATERIAL.