Common Questions

Fever 101

By: Suzanne Ulmer, CPNP

One of the most common reasons that parents call their healthcare provider is for fever. This guideline will hopefully answer a lot of your questions surrounding fevers and help you know what to do when your child has one.

First off, What is a Fever?

Fever is a symptom of an illness, not an illness itself. Fever is a normal response to a variety of conditions and all children will likely develop a fever at some point in their life. The challenge for parents is to know when a fever is a cause for concern. Fever is the body’s normal response to fight infections by turning on the body’s immune system. Most fevers are rarely harmful (100.4°F – 104°F or 38°C – 40°C).

Because of the normal variation in body temperature in general, a fever means a temperature above 100.4°F (38°C). You may get slightly different numbers depending on how you take your child’s temperature. ***Please note: Always take your child’s temperature before giving them fever medication.***

How to Take an Accurate Body Temperature?

There are many ways to take your child’s temperature. In all children, a rectal temperature is the most accurate. At Parkside we recommend a rectal thermometer for infants and young children-especially under the age of 3 months. It is possible to accurately measure the temperature in the mouth for children older than 4-5 years of age when the proper technique is used. Temperatures measured in the armpit are less accurate but may be useful as a 1st test in an infant under 3 months or an older child who can’t hold the thermometer under their tongue. Temperature strips, pacifier thermometers or feeling your child’s skin are not accurate to estimate a child’s temperature.

***Please note: Glass thermometers are not recommended due to the potential risks of exposure to mercury. Digital thermometers are inexpensive, widely available, and the most accurate way to measure temperature.***

Rectal temperature

  • Have your child lie down on their stomach
  • Apply a small amount of petroleum jelly to the end of the thermometer
  • Gently insert the thermometer into your child’s anus (about ½ an inch inside the anus)
  • Hold the thermometer in place for approx. 1 minute (or until it beeps)

Oral temperature

  • Rinse the thermometer with cool water and clean with a mild soap
  • Place the tip of the thermometer under your child’s tongue toward the back. Ask your child to hold the thermometer with their lips keeping their lips sealed around the thermometer. Most digital thermometers need less than one minute.
  • Do not measure the temperature in your child’s mouth if they have consumed a hot or cold food or drink in the last 30 minutes

Armpit temperature

  • Place the tip of the thermometer in the child’s dry armpit
  • Hold the thermometer in place by holding the child’s elbow against their chest for 4-5 minutes or until it beeps

Ear temperature

  • To measure the temperature accurately the parent will need to pull the outer ear backward before inserting the thermometer.
  • Hold the ear probe in the ear for approximately 2 seconds or until you hear a beep
  • If your child has been outside on a cold or hot day, wait 15 minutes before measuring the ear temperature.

Temporal artery temperature

  • To measure the temperature of the temporal artery, use a device that is run over the forehead and in front of the ear with contact or one that takes the temperature without touching your child using an infrared sensor (noncontact)
  • These devices or not as accurate as a rectal or oral temperature but may be used to screen for fever in children older than 4 years of age
When to Treat a Fever?

The height of your child’s fever is not always the best indicator of whether or not you need to treat the fever. The most important factor is how your child appears and how they are feeling. Treatment of fever is not necessary if they are acting normally and if the child is otherwise healthy.

Treatment of fever is recommended for a child with an underlying medical issue, including disease of the lungs, heart, brain, or nervous system. In children with a history of febrile seizures, treatment is not known to prevent seizures but is still a reasonable precaution. If your child seems uncomfortable or has one of the previously mentioned medical issues, you can try one of the following treatment options…

  • Extra fluids and less clothing
  • Rest
  • Sponging: Sponging is not as effective as medications for fever and is generally not recommended. Alcohol should never be used for sponging because of the risk of toxicity if it is absorbed through the skin. Never sponge your child without giving them a fever reducer (ie Tylenol or Motrin) first because sponging will cause shivering-which is the body’s way of trying to raise its own temperature. Sponge your child immediately only in situations such as heatstroke, delirium, a seizure from fever, or any fever over 106°F (41.1°C).  If you do sponge your child your child in an emergency situation, use lukewarm water or slightly cooler water.
  •  Medications/fever reducers: Tylenol, Advil, and Motrin can offer temporary comfort for your little one. Parkside’s dosage chart makes measuring medicine a breeze despite your child’s weight and/or age. ***Please note: Avoid Aspirin in all children through age 21 years. Aspirin has been linked to a severe illness called Reye’s Syndrome with certain viral infections.***

Most fevers can safely be observed and treated at home regardless of the number. It is important however to know when a fever needs to be evaluated by a healthcare provider.

When to See A Doctor?

Despite the normality of a fever, there are clear times to see a healthcare professional…

  • Infants who are less than 3 months of age who have a rectal temperature of 100.4°F (38°C) or greater, regardless of how the child appears. Newborns and infants within this age range should not receive fever medication until they consult with their healthcare provider.
  • Children who are 3 months to 3 years who have a rectal temp of 100.4°F (38°C) or greater for more than 3 days or who appear ill.
  • Children of any age whose oral, rectal, tympanic membrane or forehead temperature is 104°F (40°C ) or greater or whose axillary temperature is 103°F (39.4°C) or greater.
  • Children of any age who have a febrile seizure. Febrile seizures are convulsions that occur when a child has a fever greater than 100.4°F (38°C) and typically occur between 6 months and six years of age.
  • Any child with a recurrent fever for more than 7 days.
  • Children of any age who have a fever and a chronic medical problem such as cancer, heart disease, lupus, or sickle cell anemia.
  • Children who have a fever and a new skin rash.

Make no mistake, fevers can be scary and it’s never fun to see your little one experiencing pain or discomfort. But, rest assured that fevers are quite common and are actually helpful for fighting infection. When in doubt, follow the guidelines above and never hesitate to call us if you feel unsure about your child’s fever.

Until next time,

Suzanne Ulmer

Parkside Provider, grandmother of four, and strongly opposed to mayonnaise

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