Children’s Fever Guide

A pediatric nurse practitioner’s advice on fever

Fever freaks parents out. Over 90% of kids I see in the emergency room are there because of their child’s fever (probably more than 90%).

There are so many reasons that we stress out as a parent, but don’t let fever be one of them.

Fever facts:

We believe you. If your child is miserable because he/she has a fever, give that poor baby some medicine.
What is a fever? Any temp >100.4. So a temperature of 100.1 by definition is not a fever.
Fever is not an emergency. (I probably just blew people’s minds.) It’s not. It just means that your child is getting sick and it’s a SYMPTOM just like cough or a snotty nose. They may have other symptoms that are an emergency, but the fever itself is not. (**This is for the average healthy child and excludes children with things like sickle cell disease, kids on chemo, etc. Another exception is a baby less an 1 month old.)
Fever makes you feel MISERABLE. It makes your heart beat faster. Maybe even breathe a little faster. Your body feels like a furnace, but you feel freezing cold and may be shivering with chills. ALL NORMAL. After you give some medicine (and you give it time to work), the child should look less miserable. Make your assessment of how sick your child is based on what they look like after their temp comes down. It’s usually much better. And they might even play! However…..
When the medicine wears off, the fever may come back. This doesn’t mean that you didn’t break it. You did! It just came back because your child is sick and the medicine probably wore off. This is where parents are usually rotating Tylenol and Motrin. (For your child’s dose, click here.)
Fever is not dangerous. So many parents ask “at what number should I be worried and come to the emergency room?” There is not a number where I’m more concerned than another. 100.9 and 104.6 both fall under “fever” to me. Higher temperatures do not indicate that your child is sicker than if they had a lower temperature. An ear infection may cause a super high temp in 1 kid and not another. Some viruses (such as the flu or roseola) may cause super high temps or they may not. Fever is just your body’s natural response to an illness. It means your child’s body is doing it’s job! So if you see a high temp at home, give an appropriate dose of fever medicine. What we like to see is that the number trends down.
After giving meds, your child’s temp may go from 104.5 to 101 and spike back up again. Does that mean the medicine didn’t work? It absolutely did work! It trended that number down nicely. But as the medicine wore off, it spiked again. Rotating Tylenol and Motrin would be helpful in this situation.
In addition to giving fever medicine, strip your child down to the bare minimum clothing and take away those heavy blankets. Your child may be shivering and saying they are cold, but if the thermometer is reading 102, they are not cold. Prostaglandins are throwing his/her body out of whack and it is just confused. Once you get the temp down, they will no longer feel freezing when they aren’t. Some parents also like using ice packs or throwing them in a lukewarm bath. But guess what…..
You don’t even have to treat a fever with medicine. (Did I just lose credibility?) You don’t! We give fever medicine because fever makes you feel miserable. So don’t obsess over it and wake your peacefully sleeping child out of his/her sleep. Or check their temp when they are playing and happy. Our main concern is that the child is drinking plenty of fluids. If they have a fever and they are too miserable to drink, then honestly that should be the only time you would HAVE to treat a fever.
Motrin, ibuprofen, Advil…..all the same thing. Same with acetaminophen and Tylenol. The off-brand is just as effective as the name brand. Just make sure you are alternating between a medicine that has the ingredient ibuprofen with another medicine that has the ingredient acetaminophen. But feel free to save your money. And make sure that any additional medicine (like cough/cold) you may be giving does not include those 2 ingredients (cough medicine is worthless in kids so you can save some money there too).
Give the whole dose. Don’t be timid. It doesn’t work unless you give the appropriate dose. And unfortunately the packaging underdoses the majority of children which causes anxiety in parents because it didn’t work. Check with your doctor and get the appropriate dose of both Tylenol and Motrin based off of their WEIGHT not their age. (Or use my dose calculator.)
Fever may come and go for several days. Whether your child has a virus and you are doing symptomatic care, or if your child is on antibiotics, the fever may continue to come and go. And this is normal. A lot of parents bring their kid in because they started antibiotics X-amount of days ago and still has a fever. The doctor wrote the antibiotic for 10 days because it takes a full 10 days to kill the bacteria. And most viruses last 7-10 days. A fever is just a symptom that your child is still sick.
Fever indicates illness and most parents would like to know the source of the fever and have their child seen. For just the fever itself, it is usually most appropriate to call your doctor and take them to their appt (even if you have to wait a day or so). The fever itself is not a reason to rush to the emergency room. However, your child may have a fever and have other reasons that warrant you to rush to the ER. And that is 100% appropriate. But the fever itself should not be the reason. (Again this is excluding a special population of immunocompromised patients that are always instructed to go to the ER).

Being a parent is hard. You never know if what you’re doing is the right thing or not. You see your child with those glassy, sad eyes and instantly know they have a fever. And that’s ok. Kids are going to get sick. And always look WAY more sick when they are febrile. So give them some medicine, let their temp come down, and then reassess before you panic. They usually look and feel much better.

Then pour yourself a big glass of wine because it’s going to be a rough, sleepless few days… 🙂

(This post is for fever alone in the average healthy child. If your child is struggling to breathe, not making wet diapers or tears, seizing, or any other worrisome symptoms then have your child seen right away.)

See my Cold and Flu Guide post for additional information regarding other symptoms.