Understanding the Role of Fever
While it’s completely normal to worry when a child has a fever, it’s also completely normal for a child to have a fever when they have an illness. Unfortunately, because many parents do not understand the role of fever, they become increasingly worried and fearful when their child has a fever.
Checking a Temperature
It’s important to accurately check the child’s temperature in order to determine whether or not a fever is present.
- Rectal (in the bottom): A rectal temperature will most accurately evaluate the body’s core temperature. This is the best place to take an infant’s temperature.
- Axillary (under the arm): An axillary temperature is acceptable after the infant is 2 months of age or older.
- Oral (in the mouth): An oral temperature is acceptable after the child is 2 years of age.
- Tympanic (in the ear): A tympanic temperature is acceptable after the child is 2 years of age.
* Unfortunately, because temporal (forehead) thermometers are often inconsistent and inaccurate, this route is discouraged for temperature assessment.
Evaluate Before You Medicate
- If your child has a fever, but is active, alert, and drinking well, it isn’t necessary to give a fever-reducing medication, such as acetaminophen or ibuprofen.
- If your child has a fever, but refuses to drink any fluids, appears glassy-eyed, or seems uncomfortable, give a fever-reducing medication, such as acetaminophen or ibuprofen, based upon your child’s weight.
- The goal when giving fever-reducing medications is not to bring the temperature down to 98.6°F; the goal is to help your child feel less uncomfortable so that he/she will continue drinking adequate fluids.
- Our bodies know what to do; in understanding that fever plays a very important role in fighting infection, giving acetaminophen or ibuprofen for every fever may not allow our bodies to fight the infection as well.
- Do not give aspirin to a child under the age of 18.
- It isn’t necessary to wake your sleeping child to give fever-reducing medication; let your child rest as needed.
- Sponging/cooling baths are unnecessary; they can often make your child more uncomfortable.
- Avoid bundling. Light clothing and a blanket are adequate.
- Encourage fluids.
- Ibuprofen (Motrin, Advil) is safe when your child is 6 months of age or older.
- Acetaminophen (Tylenol) is safe when your child is about 4 months of age or older.
- Never give medication to an infant 90 days or younger before checking with the doctor.
- The American Academy of Pediatrics recommends that parents use either acetaminophen or ibuprofen, rather than alternating both medications.
When to Call the Doctor
- Fever for more than 72 hours
- Usually, the body stops fighting the virus within 72 hours. If the fever lasts longer, call your child's doctor for advice.
- Fever greater than 104 degrees
- A fever greater than 104 degrees might indicate a more serious illness. Call your child’s doctor for advice.
- Fever that returns after 48 hours
- Fevers that come back after being gone for at least 48 hours might indicate a bacterial infection (sinus, ear, or lung). Call your child’s doctor to make an appointment.
When to Seek Emergent Care
- Temperature equal to or greater than 100.4°F in an infant 3 months of age or younger.
- Fever in a difficult-to-wake child.
- Fever in a child with a chronic health condition or impaired immune system.
- Fever after spending extensive time in the heat.
- Fever in a child with a purple rash.
*Remember: Your child’s doctor is there to help. If you have concerns, you can always call.
Credit: Laura Weber, RN, BSN, DNP Candidate