My fifteen month old daughter spiked a temp to 103.5 last week, of course in the middle of the night and on the first day of my husband’s business trip. I spent the rest of the night awake with a screaming, miserable child who later went on to develop croup the next night. My story is one I hear reported over and over again, as parents are incredibly stressed about fevers. As per the most recent American Academy of Pediatrics News, “Fever, in and of itself, is not known to endanger a generally healthy child and actually may be beneficial.” Fever is a natural response to illness, and is a result of chemical mediators being released as the body fights the infection. High fevers can NOT fry the brains of children, which is also a commonly asked question.
Why then, do parents have such a “phobia” about fevers? I think physicians are partially to blame, because the moment the child is delivered we stress that everything must be done to lessen the chance of illness, and that it is an emergency if a baby develops a fever. This is true for all infants less than eight weeks old, and a fever at that point is anything greater than 100.4 rectally. However, after eight weeks of age, fevers are just a routine symptom of illness. The other reason parents are so concerned about fevers is how sick kids look with high fevers. They are lethargic to the point of looking like wet noodles, they don’t want to eat or drink, and they are just miserable.
So if fevers are a normal part of the bodies response to illness, why do we treat them with ibuprofen and acetaminophen? The only reason we recommend those over the counter medicines is just to provide some symptomatic relief to the kids. I call Motrin the miracle drug, because generally an hour after given, the “wet noodle” kid is up and jumping around again. However, yet another misconception of the treatments is that the fever needs to go back to normal range. The goal of these meds is just to provide comfort- not to normalize the fever. Fever is not dangerous. These medications need to be dosed according to the patients weight, and must be used correctly to limit the potential for overdose. Acetaminophen can only be given every FOUR hours, ibuprofen can only be given every SIX to EIGHT hours. If your child is sleeping, don’t wake them up to give them medicines. Believe me, they will wake up if they get uncomfortable enough with the fever and then you can give them the anti-fever medications.
Finally, parents always want us to give them a number that is “dangerous” and the child needs to be taken in for. This is very hard to do because the height of the fever doesn’t always correlate with the severity of th infection. Influenza can cause 104-105′ fevers, where a pneumonia can be only a low grade temperature. The other reason it is difficult to give a number is because of the error in taking accurate temperatures. Ear thermometers are notoriously horrible for providing high temperature readings. The temporal ones are not much better. The most accurate temperature in a infant and young child is rectal, and in an older child is oral. As I tell my parents, the other methods will tell you fever or no fever, just don’t depend upon the number. So if I had to pick a number what would it be? Generally, anything in the high 104′s to 105 should be seen within that day just to make sure the child is doing OK. More alarming to me is the child who does not perk up when the fever is brought down.
To Summarize:
- Infants less than eight weeks old with a temperature greater than 100.4 rectally need to be seen immediately
- Fevers in kids greater than eight weeks old are not dangerous- they are the bodies natural response to fighting illness
- Treatment of fevers is to provide COMFORT- not to bring the temperature back to normal
- Kids should be brought in for fevers >101 for more than 4-5 five days, fevers that come back after they had normalized for a few days, or temperatures greater than 105
- Kids should be brought in if they don’t perk up significantly when the fevers come down
- Ibuprofen and acetaminophen should be dosed by weight, and not given more than every four hours for acetaminophen, and every six hours for ibuprofen
There is a dosing chart on our website under For Parents tab that can assist in the appropriate dose for acetaminophen and ibuprofen.
Please contact your physician with more specific questions regarding your child’s illness and fever.
