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Fevers: What You Need to Know
There are many myths about fevers in children. Test your own knowledge about fevers by determining whether the following statements are true or false:
1. A fever is any body temperature above 98.6 degrees F. (37 degrees C.).

2. Fevers can be dangerous for young children and should always be treated with a fever-reducing medicine.

3. A higher fever means that the child is sicker and needs to be treated with antibiotics.

4. If a child has a fever, you should always call the doctor right away.
All of the above statements are false. Unfortunately, these misconceptions have led many parents to worry unnecessarily. Let’s review the facts about fevers.

What does “fever” mean?
A fever is when the body temperature is higher than normal. Although 98.6 degrees F. (37 degrees C.) is considered “normal” body temperature, this is just the average, and normal body temperature can range from approximately 97-100 degrees F. (36-37.8 degrees C.) Body temperature is usually lower in the morning and higher in the late afternoon and evening. Fevers can be descoted as low-grade (100-102 degrees), moderate (102-104 degrees) and high (above 104 degrees). If a child has a temperature of 99 degrees F., it would not be considered a fever.

The height of the fever does not indicate how sick the child is or whether antibiotics are needed to treat the illness. Observing how sick your child looks and acts is the best indicator. No matter what your child’s temperature is, if he is still alert, comfortable, playing, and eating and drinking well, then he is likely to be only mildly ill; and if he is listless, irritable, and refusing to eat or drink, he may be more seriously ill. The need for antibiotics depends on whether the doctor determines that the illness is caused by a bacteria. In fact, some viral illnesses like roseola cause high fevers; but they are typically mild illnesses and the children recover on their own in several days without any medication. On the other hand, sometimes newborns with low-grade fevers can be very sick with bacterial infections and may need immediate medical evaluation and treatment.

What causes fevers?
A fever is not an illness in itself—it is a possible sign of an illness. Body temperatures can rise in response to illnesses, immunizations, exercise, overdressing, or hot weather.

In fact, when a child has an illness, the body naturally raises its temperature to help fight off the disease. The fever is actually helpful in activating the immune system. Fevers are usually not harmful to children if they are under 106 degrees F (41 degrees C.). When a child is sick, the body naturally regulates the temperature and it almost never gets to this dangerous level unless the child is left in an overheated environment, such as a closed car in the summer.

What kind of treatment is needed?
If your child has a low-grade fever and is fairly comfortable, you do not need to treat it with fever-reducing medicine. Try the following to help her feel comfortable:

  • Remove excess clothing and blankets. It is not necessary to bundle your child to “sweat out” the fever—this can actually increase her temperature. Dress her in light clothes and cover her with a light blanket.

  • Encourage her to drink lots of fluids. The illness and fever can lead to dehydration, which can make her more irritable; and staying hydrated will help her recover faster. Breastfeed or give the bottle more frequently. Give toddlers and older children clear fluids such as water, diluted fruit juice, oral electrolyte solution, chicken broth, or popsicles. If they have an appetite, you don’t need to “starve a fever”—try bland foods such as dry toast, crackers, rice, pasta, tortillas, bananas, and gelatin.

  • If your child is uncomfortable or irritable with a moderate or high fever, you can also try the following:

  • Give a fever-reducing medicine such as acetaminophen or ibuprofen (for children over 6 months). Ask your pediatrician and read the medicine label to make sure you give your child the right dose on the right schedule. Remember, these medications can be dangerous if you give your child too much. It is not necessary to wake your child up to give him the medicine—if he’s sleeping comfortably, let him sleep. Do not give these medicines if you are using cough/cold medicines that also contain a fever-reducer. Also, do not give your child aspirin—it can cause a dangerous condition called Reye Syndrome.

  • For a high fever over 104 degrees, consider cooling your child down with a damp washcloth on his forehead or a lukewarm bath. A brief 5-10 minute bath can help bring down the fever, but stop if your child is uncomfortable or shivering. Don’t give a cold bath since it can cause shivering and raise his temperature. Never bathe your child with alcohol since it can be irritating and toxic.

  • When should you call the doctor?
    Different doctors may have slightly different guidelines, so be sure to ask your own doctors when they want you to call them. Generally, the guidelines for when to call the doctor depend on your child’s age. For older children with mild illnesses, you can usually wait for 2-3 days to see if they’re getting better on their own; but newborns with fevers need to be checked right away because their immune systems are not as developed and they can get sicker faster. Here are some general guidelines for when to call the doctor for illnesses with fever:

  • For infants under 3 months of age: For any illness with a fever over 100.4 degrees F. (38 degrees C.)

  • For babies 3 months to 2 years: For illness with fever over 102 degrees (39 degrees C.) for more than 24 hours.

  • For children over age 2: For illness with fever over 102 degrees (39 degrees C.) for more than 3 days.

  • Also call the doctor when your child looks and acts very ill, e.g., he is lethargic or extremely irritable; complains of severe pain; has persistent vomiting or diarrhea, is not drinking fluids and shows signs of dehydration (sunken eyes, dry lips, reduced urination); has difficulty breathing; or has an unexplained rash.

    Sometimes, young children with fevers can have seizures or convulsions (“febrile seizures”) where they become unconscious, their eyes roll up, and their body stiffens and twitches. Febrile seizures usually last for less than 5 minutes. Although they can be frightening for a parent to watch, febrile seizures are usually not dangerous for the child. Young children are generally not aware of or scared by the seizure, and they tend to be disoriented and sleepy afterward. In case of a febrile seizure:

    Protect your child from injuring himself. If possible, lay him on his side. Move away sharp objects and furniture. If necessary, place pillows around the child for padding.

    Do not put anything—your fingers, a stick, or medications—in your child’s mouth during the seizure. Although some people may believe that you need to “prevent the child from choking on his tongue,” there is more danger that you might get bitten or choke your child.

    Look at your watch or the clock, and record the time the seizure begins and ends. A seizure always seems to last longer than it actually does.

    Call your doctor right away. If your child has had febrile seizures before, follow your doctor’s instructions.
Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician