First off let’s talk a little about fever and temperature regulation in kids. A “normal” temperature in a healthy infant or child is 96 F to 100.4 F. Acceptable methods for taking a child’s temperature include under the tongue, under the arm, and rectally. Other signs of fever in your child could be flushed, warm skin, laying around without energy, racing heart or rapid breathing, and shivering despite being very warm to touch. Our brain regulates our temperature. A fever greater than 101 F often indicates infection somewhere in the body. In babies under the age of 28 days they often will not have a fever or change in temperature when they are very sick so we need to watch for other signs then a fever. In an infant from birth to 4 months with a temperature over 100.4 F they need to be seen for a work up of the fever, as they cannot tell us what hurts or may not have other signs of a serious infection. If you check your baby’s temperature and it is 99.5 F that is not a “fever.” If he is eating and drinking well and acting fine, take off a layer of clothing or unwrap him and recheck him in 30 minutes to one hour. Fever is the body’s way of fighting infection, often we will see a fever with no other signs. In a child 2 and up often you can just observe them, make sure they are drinking fluids and in a day or two the fever will be gone. In a child younger than 2 years old depending on their other symptoms they may need to be seen in the clinic the next day. A fever is not an emergency! No need to go to the Emergency Room for a fever. Many parents ask the following questions. We have tried to provide easy to understand answers to these questions.
What temperature is too high? If a child has a fever over 104 F that is not going away after fever reducing medication (click here for dosing chart for weight, do not give an infant under 6 months ibuprofen) should be seen within 24 hours. When we worry that a fever can hurt a baby is if they become “dehydrated” (in other words they are not drinking very much and not urinating very often). When it comes down to the actual number of the fever what is more important is what is going on with the infant or child. If their fever is 104 F, but once they have fever reducer they are playful and acting normal indicates they are not seriously ill at that time. If their fever is 102- 104 F and not going down with an appropriate dose of fever reducer and they are laying around, crying, or sleeping too much then they need to be seen.
Won’t a high fever cause a seizure? Febrile seizures are uncommon. Typically a child that has had a previous febrile seizure is more likely to have another febrile seizure. Often with a febrile seizure they will go from a normal temperature to a high temperature very rapidly and that is when they have a seizure. There is not way to predict what children will have a seizure. If your child becomes unresponsive or has seizure activity then make sure they don't hurt themselves by putting them on the floor on a soft surface and timing how long it lasts. When it is over roll them over to their left side. Take them to the emergency room. If the seizure lasts longer then 5-10 minutes call an ambulance.
Should I put them in a cool bath or rub them with alcohol to bring their temperature down? No!! Absolutely not! Often when a child is experiencing a fever they are chilling and cold. You can cover them with a light blanket. If you put them in a cool bath that will be very unpleasant for the child. Give them their dose of fever reducer and have them drink cool fluids. Never rub a child down with alcohol to bring a fever down. Remember fever is a good thing, it is the body’s natural anti-illness, it is the body’s way of fighting off bacteria and viruses. We only treat with fever reducer to make the child feel better not because we think that fever is bad.
What do you need to do if your infant/child has a fever >100.4 F?
- Don’t panic.
- If they are playing and eating/drinking normally give them fever reducer and watch for other symptoms. If the fever lasts longer than 3 days take them to your primary care provider.
- If they are sickly looking, not drinking, not urinating get them into your primary care doctor as soon as possible (if it is Saturday and they have not urinated all day call the after hours number to try to talk to the on call provider, if unable to reach them then go to the emergency room or urgent care).
- If the baby is under 4 months old take them to your primary care provider within 24 hours.
- If your child has a seizure and fever take them to the Emergency Room.