Few issues can raise parents’ anxiety like a fever. How high it will get? How long will it last? Is it a sign of something more serious? When you’re dealing with a sick child, it’s understandable to feel worried.
The good news is that, most of the time, a fever is simply a sign that your child’s immune system is working well. When your child comes down with a virus or infection, their immune system jumps into action to fight it off. The fever is a byproduct of their body destroying the illness.
The fever itself is not harmful. Even a high, 105-degree fever does not necessarily need to be treated. In fact, the fever makes it slightly easier for the body to beat the infection. Fevers spur the production of sickness-fighting white blood cells, and many of the microbes that cause infections can’t reproduce as well in hotter temperatures.
How to diagnose,
treat a fever
The definition of a fever is straightforward — a temperature of 100.4 degrees or higher. It’s getting a precise number that can be harder. A rectal thermometer is the most accurate way to determine a baby’s temperature. Oral thermometers are accurate in older children. Ear, skin, and armpit thermometers tend to read low on everyone, so if you get a temperature of 100 degrees or higher from those devices, consider it a fever.
Once you’ve determined there’s a fever present, you can treat it if you wish. If your child is comfortable, they do not need medicine. If the fever is making them uncomfortable, then it is reasonable to give them Acetaminophen or ibuprofen to lower the fever.
It is rarely worth alternating medicines, but if a child is still feverish and uncomfortable 30 to 60 minutes after receiving one of those medicines, then it is okay to give the other one. It is never worth trying to give fever medicines to a child who is sleeping.
Children under 6 months old should not have ibuprofen, and no children should take aspirin.
How to handle
febrile seizures
Very rarely, a fever can cause a seizure. This almost always happens within the first 24 hours of the fever. The seizure is not dangerous, and is not related to epilepsy, but is obviously very scary. If the seizure lasts more than five minutes, then it is best to call 911 in case the seizure doesn’t stop on its own. (This is very rare.)
Unfortunately, although Acetaminophen and ibuprofen lower fevers, they do not help prevent febrile seizures. It is not helpful or necessary to give medicine as a preventative measure. The best defense is to keep children healthy by helping them get a good night’s sleep and reminding them to wash their hands frequently.
When to see your pediatrician
The infections that cause fevers are typically harmless. Viral colds or stomach bugs resolve on their own. Sometimes a more significant bacterial infection—such as pneumonia, strep, or a urinary infection—is present, and antibiotics or other measures may be necessary.
In my practice, I ask parents to bring children with a fever in if:
The child is under 3 months old. (Babies under 1 month old need to be seen in the emergency room.)
The fever has lasted more than three days. (In this case, the clinic is better than the emergency room.)
The child has severe pain, trouble breathing, purple spots, pain with urination, or other concerning symptoms, or is unable to drink enough to stay reasonably hydrated.
Dr. Kevin Hatcher-Ross is a pediatrician at The Vancouver Clinic and chair of the Pediatrics department
