Overview: Fevers in Children
My Child Has a Fever: What Do I Do?
When your child is sick and has a fever, it can be a parent’s first instinct to try to immediately treat and bring down the fever as well as call the pediatrician to be seen right away. While this reaction is understandable—we all just want our kids to be healthy and safe—it may not be necessary. A fever alone is not reason to panic and seek medical attention: In fact, a fever can even be beneficial when the body is fighting infections. Learning the basics of fevers, including what causes them and what to look out for, can lessen parents’ fears and anxieties and help them confidently care for their children when sick.
What Is a Fever?
Everyone’s body has an “internal thermostat” used to regulate body temperature. Normal body temperature is around 98.6℉ (plus or minus 1℉) or 37℃ (plus or minus 0.6℃). Time of day, age, and activity level all can affect a child’s “normal” body temperature. For instance, body temperature is typically highest in the early afternoon and early evening and lowest at night and early morning. Infants tend to have higher body temperatures than older children and therefore can have higher fevers. The body can temporarily reset its thermostat to a higher temperature in response to an infection or other illness. This increase in temperature helps to activate the immune system to help get rid of germs and fight off the infection.
A fever is a rectal temperature of 100.4℉ (38℃) and higher. Different methods of measuring a temperature result in different readings. Keep this in mind when determining if your child has a fever:
Rectal Temperature—Children 3 years old and under—100.4℉ (38℃) and higher. The most accurate reading, especially for infants under 3 months old.
Temporal (Forehead) Temperature—All ages—100.4℉ (38℃) and higher. The second-most accurate reading after rectal temperature.
Oral Temperature—Children 4 years old and over and can cooperate—100℉ (37.8℃) and higher. Accurate if done properly.
Tympanic (Ear) Temperature—6 months old and over—100.4℉ (38℃) and higher. Accurate if done properly. Not reliable for younger babies as their ear canals may be too narrow.
Axillary (Armpit) Temperature—All ages—99℉ (37.2℃) and higher. The least accurate of all methods.
What Causes a Fever?
Fevers are common in children, and most of these fevers are caused by viruses, like the common cold. Bacterial infections, such as ear infections, strep throat, or pneumonia, are responsible for a much smaller number of fevers. Some other illnesses that can cause fevers in children include urinary tract infections (UTIs), throat or sinus infections, respiratory syncytial virus (RSV), croup, influenza (flu), and intestinal (bowel) infections. Meningitis (an infection of the brain and spinal cord) and sepsis (a life-threatening overreaction of the body’s immune system to an infection) are more serious conditions that can cause fevers in children. Immunizations can sometimes cause a mild fever in babies and children that lasts about one day after being vaccinated.
Does Teething Cause a Fever?
While teething may cause a slight increase in body temperature, research shows that teething does not cause a true fever of a temperature at or above 100.4℉ (38℃) rectally. The increase in body temperature while teething typically remains within the normal range. If a child who is teething has a temperature of 100.4℉ (38℃) or higher rectally, then there is most likely another underlying cause.
Heatstroke vs. Fever—What’s the Difference?
Fever should not be confused with heatstroke or other heat-related illnesses. A fever is caused by an infection, whereas heatstroke and heat-related illnesses are caused by environmental heat overheating the body to dangerous temperatures above 105℉ (40.5℃). This can happen when a newborn is overdressed or wrapped in a blanket as they are unable to regulate their body temperature as well as older children. It can also happen if a child is left unattended in overheated cars. Never leave your baby or child unattended in a closed car, even if just for a few minutes. Call 911 or go to the emergency department right away if you think your child has heatstroke.
What Are the Signs and Symptoms of a Fever?
Feeling warm
Flushed/red skin
Cranky/fussy
Sleepier than usual
Headaches
Body aches
Sweating
Shivering
Loss of appetite
Slight increase in heart rate and breathing rate
When Should I Call My Child’s Primary Care Provider (PCP)?
Infants younger than 2 months old—Go to the emergency department immediately if your child younger than 2 months old has a rectal temperature of 100.4℉ (38℃) or higher.
Infants between 2 and 3 months old—Call your child’s primary care provider immediately if your child between 2 and 3 months old has a temperature of 100.4℉ (38℃) or higher (taken any way).
Infants and children older than 3 months—Call your child’s primary care provider right away if your child has a fever and:
Looks or acts very sick
Is crying inconsolably
Is difficult to awaken
Has been in a very hot place (like inside of a car)
Other symptoms like severe headache, stiff neck, severe throat or ear pain, repeated vomiting or diarrhea, or an unexplained rash
Has signs of dehydration like a sunken soft spot, less wet diapers/peeing less than usual, no tears when crying, or dry mouth
Is taking steroids or has other immune system problems such as cancer
Has had a seizure
Has a fever above 104℉ (40℃) repeatedly
Other Times to Call Your Child’s Primary Care Provider:
Your child still acts sick after the fever comes down or seems to be getting worse
Your child is younger than 2 years old and has a fever for more than 24 hours
Your child is 2 years old or older and has a fever for more than 3 days (72 hours)
When and How Is a Fever Treated?
According to the American Academy of Pediatrics (AAP), a child older than 6 months typically does not need to be treated for a fever unless they are uncomfortable. A child who is drinking and eating, sleeping normally, and able to play does not need the fever to be treated. Instead, you should monitor your child’s behavior for changes and wait to see if the fever improves on its own. Remember, a fever can be beneficial as it stimulates the body’s immune system and starts the healing process. Also, treating a fever does not help the body fight the infection or heal quicker as it only helps to relieve any discomfort caused by the fever.
If your child is uncomfortable, over-the-counter fever-reducers such as acetaminophen and ibuprofen may be given. Do NOT give ibuprofen if your child is under 6 months old. Call your doctor if you do not know the recommended dose or if your child is younger than 2 years old. Do NOT give your child aspirin or other salicylates as it has been linked to a serious, potentially life-threatening disease called Reye syndrome that affects the liver and brain.
Other Ways to Help Your Child Remain Comfortable Include:
Dress your child in light, comfortable clothing so as not to trap body heat and increase temperature. However, allow an extra blanket if your child is cold as the main goal is comfort.
Keep the room cool but comfortable.
Encourage plenty of fluids such as water, electrolyte drinks (like Pedialyte, Enfalyte, or store brands), soup broth, popsicles, or flavored gelatin.
Avoid drinks with caffeine (like soda or tea) as these can worsen dehydration by increasing urination.
Offer food, but it is okay if your child does not feel like eating.
Lukewarm baths if your child finds this comforting. Do NOT use cool or cold water or allow your child to shiver as this can raise body temperature. NEVER leave your child unattended in the bathtub.
Use cold washcloths placed over the forehead, wrists, groins, or other areas that have blood vessels that are close to the surface of the skin.
Do NOT use alcohol baths as rubbing alcohol may be absorbed into the skin or inhaled, causing serious health conditions.
Your child should stay home from school or daycare until fever-free for 24 hours without the aid of over-the-counter fever-reducing medications.
What Are Febrile Seizures?
According to the AAP, a fever can trigger seizures in children between the ages of 6 months and 5 years, known as febrile seizures. During a febrile seizure your child may stiffen, twitch, roll their eyes, and become unresponsive for a short time (typically less than a minute or even just a few seconds). Febrile seizures are relatively common and do not typically cause any lasting damage to the brain or nervous system. A febrile seizure is not epilepsy. Treating a fever does not prevent a febrile seizure as most febrile seizures occur at the onset of a fever before you may even know that your child is sick.
If your child has a febrile seizure, be sure to place them gently on the floor so that they cannot fall and their airway can be extended. Do not hold them as this may narrow their airway if their neck is flexed, making it difficult to breathe. Call your child’s pediatrician or seek medical attention right away.
Key Points to Remember
A fever can be frightening for a parent, especially in young infants or if your child is uncomfortable. It is important to remember that a fever is the body’s appropriate response to an infection and helps stimulate the immune system. Most children are “back to normal” within a few days and may require no treatment at all if they are older than 6 months and are drinking and acting fine. Treatment with over-the-counter medications and other comfort measures may be used if your child is uncomfortable. However, a fever in a child less than 2 months old is an emergency, and they should be taken to the emergency department immediately. A fever in a child between 2 and 3 months old warrants a call to the primary care provider right away. However, always trust your gut. You know your child best: If your child seems off (even with no fever), or if you’re ever unsure about what to do with their fever, call your child’s pediatrician for advice. When in doubt, just ask!
