Fever without Fear: When to Call the Pediatrician

Fever in infants and children can be very scary for parents. We have written this handout to provide you with information about what causes fever, to ease parental anxiety when infants and children develop a fever, and to help you treat your child when he or she develops a fever.

What is a fever:

Fever is usually a sign that the body is fighting off an illness or infection. Fever is generally harmless and is a good sign that your child‘s immune system is working and the body is trying to heal itself.

Normal body temperature varies with age, activity level, time of day, and even by the amount of clothing your baby may be wearing. Infants tend to have higher body temperatures than older children. The average body temperature is 98.6 F. However, body temperatures can range from 97.5F to 99.5F. Generally, most pediatricians consider a temperature above 100.4F to be a sign of fever. Fevers may rise quickly and often reach up to 105F in infants and toddlers. Again, high fevers are not dangerous and will not harm your child

Signs and symptoms of a Fever:

If your baby or child has a fever, he or she may feel warm or hot to touch, appear flushed, sweat more, breathe faster, have shaking chills, body aches, appear tired, or generally be very fussy or whiny. Some children are more thirsty than usual while others eat or drink much less than normal. Some children will complain of other signs of illness like a sore throat, earache, or stomach ache. These signs can point to the cause of the fever.

You do not need to panic if your infant or child has a fever. Once you have identified a fever, you can begin to treat the fever based on your child’s age and symptoms. If you child feels uncomfortable or the fever is higher than 101F, we usually suggest giving your child acetaminophen or ibuprofen which will usually reduce the fever within a few hours and help your child to feel more comfortable. It is ok if the fever does not return to normal despite the use of fever medications.

Call immediately for fever if:

  • Your baby is under 8 weeks of age and temp above 100.4F rectally
  • Your baby/child looks very ill or not responding to you
  • Has signs of difficulty breathing
  • Has signs and symptoms of stiff neck with severe headache
  • Has immune system problems such as cancer or sickle cell disease
  • Has had a seizure
  • You observe signs of dehydration such as dry mouth, no tears when crying, or no wet diapers for more than 8-12 hours.

When to come to the office for fever:

  • Your child is “acting sick” when the fever is brought down
  • Fever persists for more than 48 hours in a child under 2 years of age
  • Fever persists for more than 3 days in a child over 2 years of age
  • Has complaints of ear pain, sore throat, pain with urination or other complaints of pain

When to treat a fever:

Fevers should be treated to make your child feel more comfortable, not to rapidly normalize body temperature. Again, elevated body temperatures are a normal way to fight off infections. We usually do not recommend waking a sleeping child to treat fever alone. In addition to fever medications, we encourage you to monitor your child or infant’s activity level, watch for other signs of serious infection, and to try to keep your child as well hydrated as possible.

Dosing for Acetaminophen (Tylenol) This information is available on “KidsFever MD” app for $0.99

Child’sWeight(pounds) 6-11 12-17 18-23 24-35 36-47 48-59 60-71 72-95 96+
Infant susp (160mg/5ml) 1.25ml 2.5ml 3.75ml 5ml 7.5ml —-
Children’s liquid(160mg/5ml) 2.5ml 3.75ml 5ml 7.5ml 10ml 12.5ml 15ml 20ml
JR Chewable tabs 80mg —- 2tabs 3tabs 4tabs —a
Chewable tabs 160mg —- 1tab 1.5tab 2tabs 2.5tabs 3tabs 4tabs
Rectal suppository(80mg) -1/4 —1/2 3/4 1 1.5 2 2.5 3
Tablet 325mg —- —- —- 1tab 1.5tab 2tabs

Dosing for Ibuprofen (Motrin or Advil) for infants over 6 months of age

Child weight (pounds) 6-11 12-17 18-23 24-35 36-47 48-59 60-71 72-95 96+
Infant Drops (50mg/1.25ml) 1.25ml 1.875ml 2.5ml
Childrens liquid (100mg/5ml) 2.5ml 3.75ml 5ml 7.5ml 10ml 15ml 20ml
Chewable  50 mg 2 tabs 3tabs 4tabs 5tabs
Jr strength 100mg 1tab 1.5tab 2tabs 3tabs 4tabs 4tabs
200mg tabs 1tab 1tab 2tabs 2tabs

How to Take a Rectal Temperature

Taking a rectal temperature is the most accurate way to measure a young child’s true body temperature.. Here are the steps for taking a rectal temperature:

  1. Use a rectal thermometer (preferably digital) that has a round bulb at the end.
  2. Clean the tip of the thermometer with rubbing alcohol or soap and water.
  3. Lubricate the tip with a water-soluble lubricant.
  4. Place your baby on his stomach across a firm surface or your lap. Or, if your child is more comfortable on her back, gently lift her legs and proceed to step 6.
  5. Stabilize your child by placing one hand on his lower back just above the buttocks. If your child is wiggling, ask someone to help you restrain him.
  6. Slowly insert the lubricated thermometer into the anal opening about one-half inch, stopping if you feel any resistance. Never force the thermometer.
  7. Gently hold the thermometer in place between your index and forefinger while keeping your hand against your baby’s bottom.
  8. Wait until your thermometer beeps or signals that it’s done. A reading of 100.4 degrees Fahrenheit or more is generally considered to be a fever.

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