My child has a fever:  What do I do?

Hylton I Lightman, MD, DCH (SA), FAAP

The fear of parents when a child has fever often sends them into orbit, including paging the doctor in the middle of the night.

The good news:  Not always is a fever a fever.  Read on.

Here are five facts about fevers and kids. 

1. No number on a thermometer requires a call to Hatzoloh or a trip to the Emergency Room.  This includes even 104 degrees on a rectal thermometer.  Kids do not maintain regular temperatures when sick because a fever is a normal healthy way for the body to fight infection.  If anything, a fever shows that the body is doing what G-d has intended it to do.  Remember:  Fever is not the body’s enemy.  Bacteria and viruses are.
2. The severity of the fever does not always correlate with the severity of the illness.  Simply put, a number on a thermometer is just a number and there is rarely a difference between a 100.3 degree and a 103.4 degree fever.  Even febrile seizures – and they can be scary to watch – is not a reason to panic.  Rather, you should be looking at signs of illness.  Can he stay hydrated?  Is he urinating regularly?  How’s his level of activity?  If you’re concerned about any of these three questions, then call your pediatrician.  If it’s a first febrile seizure, it warrants evaluation.  A 105 rectal temperature in a child under 2 years of age needs an assessment by a physician.
3. Fevers due to illness in a normal child will NOT cause brain or organ damage.  Every normal brain has an internal “thermostat” that will prevent a person’s temperature from getting high enough to cause brain damage. Hyperthermia or heat stroke occurs rarely, i.e., when a person’s brain cannot regulate temperature well (as in a rare case of brain injury) or when the person is not able to cool himself (as in a closed car on a summer day.)  Fever due to illness in a normal child will not cause organ damage.
4. We know fevers can make a child feel pretty lousy.  In turn, the child can make the parents feel horrible.  But antipyretic (anti-fever) medications like Tylenol and Motrin do NOT get high temperatures back to normal.  These medications help a child to feel less uncomfortable.  If you choose to bring your child to the doctor because of the fever, please medicate them with Tylenol or Motrin prior to coming in so the doctor can conduct an exam that yields better information and is more pleasant for your child.
5. Dosing the Tylenol or Motrin correctly is essential.  We dose according to WEIGHT, not according to age.  Therefore, it’s important to keep a record of each child’s last weight done in the pediatrician’s office.  Use the measuring device that often comes with the medication or some other kind of standard measuring instrument such as a syringe.  Don’t waste time with half-doses; they don’t work.  ALWAYS USE MEDICATION JUDICIOUSLY. 

And a sixth interesting fact:  Teething often seems to be associated with a fever.  What’s happening is the body’s metabolism speeds up and the teeth erupt.

When should a child’s fever cause you to call your pediatrician?

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For babies younger than 2 months with a rectal temperature of 100.4 or more, fever is urgent! 

Call Your Pediatrician  

If this happens even in the middle of the night – again, you have taken the baby’s temperature with a rectal thermometer and it registers 100.4 degrees or greater – page your baby’s doctor immediately to let him/her know that your baby is younger than 2 months and has a fever. If you can’t reach your baby’s doctor, go to the emergency room right away (you don’t need Hatzoloh for transport), even if it’s the middle of the night. Don’t give your baby any medicine to reduce fever unless the doctor advises it – you don’t want to mask any symptoms before your baby is examined.

There are two reasons for the urgency.

• First, the protective layer of cells between the bloodstream and the central nervous system is very thin in young babies. This means that in bacterial infections, the bacteria can “cross over” and cause damage rapidly.
• Second, young babies don’t show signs of severe infection like older babies do and, G-d forbid, can developed full-fledged blood infections (sepsis) without displaying typical symptoms.

If the doctor determines the fever is viral, there’s no need to worry about sepsis. But the problem is that it’s impossible to distinguish between a bacterial fever and a viral fever with just a physical exam. That’s why an infant with a fever may need blood, urine, X-rays, or stool tests to determine whether there’s a bacterial infection. (The exact tests ordered depend on your baby’s age and symptoms).  An infant with a fever may also need a spinal tap to test for meningitis, an uncommon but serious infection that causes inflammation of the protective membranes covering the brain and spinal cord.

If a fever persists longer than 7 days, then a thorough evaluation by the pediatrician is required to ascertain whether it’s an acute infection or possibly other infections, i.e., Kawasaki disease or autoimmune.

Still have questions?  Call the doctor.

And always, stay cool.