Fevers in Children

Fevers in Children - No More Fever Fear!

Do you know that 1/3 of all unexpected visits to healthcare providers for children are because of fever? There is a feeling among parents that children must maintain a 'normal' temperature. And many parents quickly become afraid when their child does have a fever. Today I'm going to help you understand what fevers are all about and help you be more confident in your abilities to handle your child's illness.

First off, what is a fever? I'm going to get scientific for a moment here. A fever is an elevation in body temperature caused by infection or stress on the body. The most common cause of a fever is viruses or bacteria that trigger the body's immune response. Pyrogens are released when the body begins fighting an infections. When these chemicals get to the hypothalamus, they bind to certain receptors and the body temperature begins rising. This rise in body temperature is the body's attempt to kill off the invaders causing infection.

So exactly what number on the thermometer is a fever? The general definition is 100.4 F or greater in adults. Let's break it down for children:

• Temperature greater than 100.4F taken in the bottom (rectally)
• Temperature greater than 99.5F taken in the mouth (orally)
• Temperature greater than 99F taken under the arm (axillary)

Viruses and bacteria thrive at a temperature of 98.6 F and as your child builds his or her immune system, they are going to be coming into contact with a lot of germs. Their body knows it can burn off these germs by raising the body's temperature. It's actually a very smart mechanism! 

The higher the fever is does NOT indicate the severity of illness!

High fevers can come on quickly in response to a simple virus. The number on the thermometer does not indicate how ill your child truly is. 

There is NO evidence that fevers cause brain damage!

This is a common misconception. While hyperthermia, or overheating due to external causes such as extreme heat, can cause brain damage, a fever is the body's natural mechanism towards fighting illness. A fever alone will not cause brain damage. Febrile seizures, while scary, are actually very common and usually quite harmless. Fever seizures can occur at any temperature however most children had a rectal temperature around 102F at the time of the seizure. Approximately 1 in 25 children will experience a febrile seizure. They are most common in children 6 months old to 5 years old, however if your child has not had one before the age of 3 years, they are unlikely to develop one. 

If a child has a febrile seizure, simply place them on the floor on their side. If a seizure lasts longer than 5-10 minutes, please call 911 and have the child taken to the nearest ER for evaluation. 

So fevers are not dangerous but they make my child miserable. How do I treat them?

The best rule for treating a fever is this:

If your child is uncomfortable, use fever reducer medications to make them more comfortable. Do not make your goal of treatment to get the temperature back to normal. I recommend parents treat their child, not the number on the thermometer.

Acetaminophen or Ibuprofen? Both work as excellent fever reducers in children. (Please never use aspirin products in children.) Let's talk about dosing. At least 15% of parents do not give their children enough medication. Many parents fear giving too much. One of the most common phrases I hear in my practice is "I gave them a little bit". Caregivers, I need you to hear me on this one. Appropriate dosing of medications is essential. Giving too little is a waste of time and can hinder diagnosis of your child if we think they truly did not respond to appropriate medications. Just as importantly, do not give more than what is recommended nor more often. It is more important to give medication based on current weight vs strictly age. Some children are much smaller or larger than the average child. For this reason, I am going to give you dosing for weight so you can find the most appropriate dose for your child. 

• Weight 6-11 lbs (2.7-5 kg)
• Acetaminophen Infant Drops (80mg/0.8mL) = Dose 0.4 mL
• Children less than 6 months should not receive ibuprofen
• Weight 12-17 lbs (5.5-7.7 kg)
• Acetaminophen Infant Drops (80mg/0.8mL) = Dose 0.8 mL
• Acetaminophen Children's Elixir (160mg/5mL) = Dose 1/2 tsp
• Acetaminophen Chewable Tablets (80mg tabs) = Dose 1 tab
• Ibuprofen Infant Drops (50mg/1.25mL) = Dose 1.25 mL
• Ibuprofen Children's Elixir (100mg/5mL) = Dose 2.5 mL
• Weight: 18-23 lbs (8.2-10.5 kg)
• Acetaminophen Infant Drops (80mg/0.8mL) = Dose 1.2 mL
• Acetaminophen Children's Elixir (160mg/5mL) = Dose 3/4 tsp
• Acetaminophen Chewable Tablets (80mg tabs) = Dose 1 1/2 tab
• Ibuprofen Infant Drops (50mg/1.25mL) = Dose 1.875 mL
• Ibuprofen Children's Elixir (100mg/5mL) = Dose 3.75 mL
• Ibuprofen Chewable Tablets (50mg tabs) = Dose 1 tab
• Weight: 24-34 lbs (10.9-15.9 kg)
• Acetaminophen Infant Drops (80mg/0.8mL) = Dose 1.6 mL
• Acetaminophen Children's Elixir (160mg/5mL) = Dose 1 tsp
• Acetaminophen Chewable Tablets (80mg tabs) = Dose 2 tabs
• Ibuprofen Infant Drops (50mg/1.25mL) = Dose 2.5 mL
• Ibuprofen Children's Elixir (100mg/5mL) = Dose 5 mL
• Ibuprofen Chewable Tablets (50mg tabs) = Dose 2 tabs
• Weight: 36-47 lbs (16.3-21.4 kg)
• Acetaminophen Infant Drops (80mg/0.8mL) = Dose 2.4 mL
• Acetaminophen Children's Elixir (160mg/5mL) = Dose 1 1/2 tsp
• Acetaminophen Chewable Tablets (80mg tabs) = Dose 3 tabs
• Ibuprofen Children's Elixir (100mg/5mL) = Dose 7.5 mL
• Ibuprofen Chewable Tablets (50mg tabs) = Dose 3 tabs

So you've given a dose of medication. What should you look for now? I ask that you monitor your child's comfort and signs of any severe illness, not just the drop on the thermometer. Any time your child is appearing ill and not perking up with reduction in fever, please get them seen by a healthcare provider. If you are taking your child to the doctor, please treat their fever first. Trust me, we WILL believe you. Measure the child's temperature, record it, treat it appropriately, then come on in to be seen. We much prefer you take care of your child before leaving the house. Coming in with a child suffering from a high temperature will not make you seen faster and only makes your child miserable for longer than necessary. 

Acetaminophen can be given every 4-6 hours. Ibuprofen can be given every 6-8 hours. So how do you keep them straight? This is what I recommend:

First off, take a piece of paper and quick make 4 columns. Title them "Time", "Temperature", "Acetaminophen", and "Ibuprofen". Simply record the time, fever, and how much Acetaminophen or Ibuprofen was given.

This will help you keep track of how you are treating your child, especially when you and other caregivers are tired in the middle of the night. It will also ensure everyone is giving the same dose and being consistent. 

I recommend treating children that are quite miserable with their fevers every 3 hours. Here's how to do this. Give a dose of Acetaminophen. In 3 hours, give a dose of Ibuprofen. 3 hours later, give a dose of Acetaminophen. This will get you on a great schedule and keep your child most comfortable. Temperature should begin to come down 30-60 minutes after giving the medication. 

Now, there are a few exceptions to the treat at home rule. Here's when your child MUST be seen by a healthcare provider:

• Infants under 2 months old with a recorded fever of 100.4 F or higher taken rectally
• Children with persistent high fever that will not come down despite appropriately dosed medication
• Any child who appears very ill - especially those too weak to eat, have stopped urinating, or have drastic changes in behavior or level of consciousness

I tell parents if you are concerned, it is better to be safe and get your child seen. Really take a look at your child. If they had 103 fever, you treated it appropriately, and now they are running around the house, eating and drinking, and looking great, they are likely fighting a virus and are doing just fine! If they had 103 fever, you treated it appropriately, and they are laying on the couch, won't get up, won't drink, and look very ill, then please get them seen.

So let's stop fever phobia! Let's be proactive, keep our kids feeling good, and treat them the way they should be treated!