So…what is a fever?

As everyone already knows, a fever is an elevation in body temperature often due to an infection. Everyone also knows [for the most part] that a “normal” body temperature is considered to be 98.6 degrees Fahrenheit. What most people do not realize is that although a temperature may be increased slightly, a temperature is not considered a “true fever” until it reaches 100.4 degrees Fahrenheit or higher. Even at that temperature, a fever is considered “low grade” until it reaches 102. Fevers are not always a bad thing! They are actually your body’s way of making yourself an inhospitable environment for viruses and bacteria, therefore, helping the body to kill off whatever is causing the fever in the first place.

Wait, back up…how should I even be taking a temp?

I know it’s not the most comfortable thing ever and your kid will likely scream like you’re trying to kill them, but if they’re under the age of 5 and exhibiting signs of fever/illness, their temperature should be taken RECTALLY. After the age of 5, oral temperatures are the standard. Just be cognizant of eating/drinking hot or cold foods immediately before hand effecting the thermometer reading.

Do I need to see a doctor?

Some fevers can be treated or monitored at home; others require emergency medical treatment. The age of the person will dictate what constitutes an emergency and what can be more conservatively treated. Special consideration should be taken with immunocompromised people such an unimmunized person [whether because of being too young or by choice] or a cancer patient receiving chemotherapy treatment.

Infants (>3 months): Any fever over 100.4 RECTALLY constitutes a trip to the ER.

Young Children (3 months-3 years): A fever greater than 102 rectally that won’t respond to antipyretics (medication that reduces fever) OR if the fever is accompanied by a rash, if they can’t keep fluids down, if they’re having difficulty waking up, having trouble breathing, having reduced urine output or are inconsolably crying all constitute a visit to your doctor. As a general rule: Sick kids don’t have to eat but they DO need to drink fluids.

Older Children (3 years to 12 years): A fever over 102 for 3 days that is not responding to antipyretics constitutes a visit to see your doctor. This is very similar to young children except that additional symptoms of concern include a stiff neck, abdominal pain or if they generally appear ill. Watch the kiddo’s behaviors–are they playing or sleeping? Do they look ill to you? As their parent, you will know best when they don’t look like themselves.

Teens: A fever over 103 for 3 days means it’s time to see your doctor. A fever accompanied by an intense headache, abdominal pain, or repetitive vomiting are also reasons to see the doc ASAP.

Adults: A fever in an adult without special circumstances is not concerning and should not even be treated with antipyretics until it reaches 102. If an adult has a fever of 103 for 3 days, a visit to the doctor is a good idea.

Older adults: This population requires a bit more of a delicate approach. A fever of 101 or higher should be addressed by a physician sooner rather than later.

**If a temperature over 104 occurs in anyone of any age, see a doctor as soon as possible.

**If you are concerned about your child’s immediate well-being at any time, you can always take them to the ER.

How do I treat a fever at home?

There are several ways to treat fevers at home. Remember when you were little and your mom would stack piles of blankets on top of you in an effort to “sweat out” the fever? DO NOT DO THIS. Instead:

– Give antipyretics such as acetaminophen (Tylenol) or ibuprofen (Motrin)

– Lukewarm baths can help; cold baths will not. If shivering occurs, your efforts are working against you. Shivering is the body’s way of creating heat so don’t do anything that is causing shivering. It’ll just make the body temp rise.

– Provide or eat cold foods such as popsicles.

– Dress in less clothing; kids will say they’re cold but this is because their body temperature is so much higher than the air around them. Light clothing or even diaper time is a great idea in kids as long as they’re NOT SHIVERING.

About this fever medication situation…

There are 2 main medications given to treat fevers in children: Tylenol/Acetaminophen and Ibuprofen/Motrin. Do not EVER give aspirin to children under 18 years old. Aspirin in children under 18 can cause Reyes Syndrome which causes confusion, brain swelling and liver damage. Many fevers remain out of control due to under-dosing these antipyretic medications. Let’s bring on the dose charts!
Remember: In children under 18, DO NOT GIVE ASPIRIN!!!!

*EDIT: Don’t forget the option of using RECTAL suppositories for medication if your child is vomiting or simply will not tolerate oral meds. It is so easy to do and no, you are absolutely not going to hurt them if you do it correctly! Lube up the suppository with Vaseline and use your pinky finger to pop it in their booty just enough to get it past their sphincter so they can’t just shoot it out again at you. You’ll know it is in far enough when their butt essentially “swallows” the suppository; usually you just have to insert your finger up to the first knuckle, sometimes even less.

Acetaminophen/Tylenol

**This medication should optimally be given based on weight at a dose of 10-15mg/kg/dose given every 4-6 hours
Max: 5 doses per day
[1kg = 2.2lbs]
Broken down by: Liver

When the weight is unknown, a rough guide is:
0 – 3 months—- 40mg/dose
4 – 11 months—- 80mg/dose
12 – 23 months—- 120mg/dose
2 – 3 years—- 160mg/dose
4 – 5 years—- 240mg/dose
6 – 8 years—- 320mg/dose
9 – 10 years—- 400mg/dose
11 – 12 years—- 480mg/dose
Adult max—- 4000mg/24 hours

Ibuprofen/Motrin

** This med should also be optimally given based on weight at a dose of:
4 – 10mg/kg/dose every 6-8 hours
Max: 40mg/kg/DAY
Broken down by: Kidneys

When the weight is unknown, a rough guide is:
0 – 6 months—- NOPE
6 – 11 months—- 50mg/dose
12 – 23 months—- 75mg/dose
2 – 3 years—- 100mg/dose
4 – 5 years—- 150mg/dose
6 – 8 years—- 200mg/dose
9 – 10 years—- 250mg/dose
11 – 12 years—- 300mg/dose
Adult max—- 2400mg/24 hours

A good guide to treating fevers is a rotating medication method. This technique makes it easier to give children both Motrin and Tylenol on a rotating schedule without confusion (when one med is given every 4 hours and the other every 6…it gets kind of complicated). Because Tylenol is broken down by your liver and Motrin is broken down by your kidneys, it won’t overwhelm your body to take both medications. Here’s what to do:

EVERY 3 HOURS give either Tylenol or Motrin!
Example: given Tylenol at onset of fever; 3 hours later given Motrin; 3 hours after that give Tylenol; 3 hours later given Motrin again; and on and on until fever has resolved.

What are these febrile seizures I’ve heard of?

Febrile seizures are a very scary but usually non-damaging occurrence that can occur when fevers get too high too quickly. Only around 4% of children are even capable of having febrile seizures and most of those children will never experience this. Febrile seizures are most often caused by viruses and most often last less than 5 minutes and leave no permanent damage behind.

Febrile seizures are possible in children up to the age of 5 but are most common between 12 – 18 months. These seizures are NOT epilepsy although children who have a febrile seizure are at a slightly higher risk for developing epilepsy later in life. Kids who have 1 febrile seizure are at a higher risk of having more, however, they usually outgrow this by the age of 5.

Fevers do not cause brain damage until they reach 108 degrees or higher. Fevers of this magnitude are very rare because our bodies know not to let us get that high in the face of an infection [either viral or bacterial]. When a fever reaches 108 or higher, it is almost always due to very high air temperatures around a child. For example, a child left in a hot car.

If my kid has one, what do I do?

If your baby/child does have a febrile seizure, the most important thing to do is remain calm so you can help your child.

– FIRST, place your child on their side on the floor or a soft surface they will not fall from. This will help prevent choking and protect your child’s airway.

– Protect your child’s head but do not try to restrain them fully. It could end up hurting them.

– Time the seizure so medical staff later will be able to better assess the situation. Time seems like it stands still when an emergency occurs, especially to a loved one so making a cognitive effort to time the event will be very helpful.

– Watch for breathing problems such as their lips turning blue

– Do not put anything in your child’s mouth, including medications unless specifically instructed by a physician. Rectal antipyretics are necessary at this point to avoid choking/aspirating.

– Call 911!

Does my fever need antibiotics to go away?

Probably not! High fevers are usually caused by viruses which do not require antibiotics. Viral infections are caused by, duh, VIRUSES. These are extremely small organisms that are rapidly adapting and changing. The treatment of viruses include TIME, hydration, rest and symptom control [including fever control]. Antibiotics do not kill viruses which is why they are not prescribed for viral infections.

Bacterial infections are caused by, you guessed it, BACTERIA! This will require antibiotics to go away [usually]. It will also require the same hydration, rest and symptom control to get better quickly.

**Side note: A probiotic should be taken simultaneously with antibiotics to replenish the good bacteria in our bodies [the kind that keep our gut healthy and our dark and private areas yeast free…wink wink]. Take your probiotic and antibiotic 2-4 hours apart.

Remember, an illness can start as a virus and turn into bacterial as it progresses. This means that just because you didn’t need an antibiotic to start with doesn’t mean you won’t need one later if your symptoms get worse or persist. Get re-checked by your doctor if you are concerned you have developed a bacterial infection!

I’m starting to feel better now…can I go back to work/school?

As a general rule, you can go back to work or school once you are FEVER FREE for 24 hours WITHOUT antipyretics in the case of a virus or 24 – 48 hours after starting antibiotics if bacterial.

Remember common sense things for infection control such as:
– Wash your hands!
– Throw out your old toothbrushes and get new ones
– Don’t share medication syringes between siblings or with other family members. Wash them thoroughly between uses!

Healthy travels <3

Disclaimer: This blog contains researched facts from credible sources and educated opinions of a registered nurse and trauma specialist with 7 years experience specializing in emergent care and pediatric oncology. This blog is not intended as a replacement for medical consultation from a physician.