Fever 

Repeat after me. "FEVER IS OUR FRIEND (Unless my baby is under 2 months old, in which case I will call the doctor immediately!)."

Fever is present if the oral temperature is greater than 100 degrees Fahrenheit (37.8 degrees Centigrade) or the rectal temperature is 100.5 degrees Fahrenheit or greater. Auxiliary temperatures are variable but usually a fever is present with an auxiliary temperature over 99-100 degrees Fahrenheit. A child may "feel hot" without having an actual increase in body temperature so if you think your child may have a fever and are concerned, USE A THERMOMETER to check the actual temperature.

There are many types of thermometers available. Acceptable choices include glass thermometers and digital thermometers. Thermoscans (thermometers which take the temperature in the ear) are fine for older children (over 3 years of age). If a child under 2 months of age is felt to have a fever, we request you check a rectal temperature using a glass or digital thermometer before calling us. The thermometer strips available for use on a child's forehead are notoriously INACCURATE and not recommended. Be sure to tell us which method you used to take the temperature.

Mild fevers may be caused by too much clothing, recent exercise, hot weather or hot foods. A fever is expected after certain immunizations and is a normal reaction of the immune system to the vaccine.

Pediatricians as a group are very concerned about fever in infants under 2 months of age. This is because their immune systems are still developing and they often don't give clinical signs of severe illness other than fever at a young age.

After 2 months of age, we consider fever a NORMAL RESPONSE to infection. It should be treated only if your child is UNCOMFORTABLE or the fever is fairly high (over 104-105).

Either an acetaminophen product or ibuprofen (if over 6 months) may be used to treat fever. The ibuprofen products are particularly effective but may cause stomach upset in some children and should NOT be given to children who are vomiting or having severe diarrhea.

Two common reasons for the lack of response to fever-reducing medication are: 1) not waiting long enough to see the effect, which may take 60-90 minutes, and 2) underdosing. But it is better to err on the side of underdosing if the weight of your child is not accurately known.

CALL IMMEDIATELY IF YOUR CHILD HAS FEVER ASSOCIATED WITH ANY OF THE FOLLOWING:

  • Age under 2 months
  • Constant crying as if in pain
  • Fever of 105 or higher NOT responding to medication
  • Stiff neck
  • Purple spots on the skin
  • Difficulty breathing (other than a stuffy nose)
  • Your child is becoming difficult to arouse, confused or delirious
  • Your child appears extremely ill or has other signs that worry you

CALL THE OFFICE DURING REGULAR HOURS IF:

  • Your child complains of sore throat or ear pain
  • Your child complains of pain with urination or is voiding frequently or wetting the bed
  • Your child has a significant cough or any other symptoms along with fever persisting beyond 48 hours.

As discussed previously, fever may be treated with medication such as acetaminophen (Tylenol) or ibuprofen (Motrin). The practice of alternating fever reducing medication is no longer routinely recommended since the potential for errors is so great. Thus, to prevent confusion and possible overdosage, choose either acetaminophen every 4 to 6 hours with a maximum of 5 doses in 24 hours or ibuprofen every 6 to 8 hours. Base dosage on your child's weight NOT age.

Sponging in a bath with lukewarm water may initially lower the temperature but its effects are not lasting and it may actually trigger the body to conserve and raise its temperature due to goose-bumps, shivering, and other mechanisms it causes. Therefore, the bathing should be abandoned if a child is expressing discomfort.

Note: Fevers are normal the first 24-48 hours after a DPT vaccine and 5-15 days after MMR.