UNDERSTANDING A FEVER

A fever is a body temperature that is higher than normal. Your child's normal body temperature varies with his age, general health, activity level, the time of day and how much clothing he is wearing. Everyone's temperature tends to be lower early in the morning and higher between late afternoon and early evening. Body temperature also will be slightly higher with strenuous exercise.
Most pediatricians consider any thermometer reading above 100.4 degrees Fahrenheit (38 degrees Celsius) a sign of a fever. This number may vary depending on the method used for taking your child's temperature. If you call your pediatrician, say which method you used.

If your child has a fever, it is probably a sign that her body is fighting an infection. When your child becomes ill because of a virus or bacteria, her body may respond by increasing body temperature. It is important to remember that, except in the case of heat stroke, fever itself is not an illness — only a symptom of one. Fever itself also is not a sign that your child needs an antibiotic.

Many conditions, such as an ear infection, a common cold, the flu, a urinary tract infection or pneumonia, may cause a child to develop a fever. In some cases, medication, injury, poison or an extreme level of overactivity may produce a fever. An environment that is too hot may result in heat stroke, a potentially dangerous rise in body temperature. It is important to look for the cause of the fever.

Fevers are generally harmless and help your child fight infection. They can be considered a good sign that your child's immune system is working and the body is trying to rid itself of the infection.

If your child has a fever, her heart and breathing rates naturally will speed up. You may notice that your child feels warm. She may appear flushed or perspire more than usual. Her body also will require more fluids.

Some children feel fine when they have a fever. However, most will have symptoms of the illness that is causing the fever. Your child may have an earache, a sore throat, a rash or a stomachache. These signs can provide important clues as to the cause of your child's fever.

How to Take a Temperature

While you often can tell if your child is warmer than usual by feeling his forehead, only a thermometer can tell if he has a fever and how high the temperature is. There are several types of thermometers and methods for taking your child's temperature.
Mercury thermometers should not be used. The American Academy of Pediatrics (AAP) encourages parents to remove mercury thermometers from their homes to prevent accidental exposure to this toxin.

Rectal: If your child is younger than 3 years of age, taking his temperature with a rectal digital thermometer provides the best reading. Clean the end of the thermometer with rubbing alcohol or soap and water. Rinse it with cool water. Do not rinse with hot water. Put a small amount of lubricant, such as petroleum jelly, on the end. Place your child belly down across your lap or on a firm surface. Hold him by placing your palm against his lower back, just above his bottom.
With the other hand, turn on the thermometer switch and insert the thermometer 0.5" to 1" into the anal opening. Hold the thermometer in place loosely with two fingers, keeping your hand cupped around your child's bottom. Do not insert the thermometer too far. Hold in place for about one minute, until you hear the "beep." Remove the thermometer to check the digital reading.

Oral: Once your child is 4 or 5 years of age, you may prefer taking his temperature by mouth with an oral digital thermometer. Clean the thermometer with lukewarm soapy water or rubbing alcohol. Rinse with cool water.
Turn on the switch and place the sensor under his tongue toward the back of his mouth. Hold in place for about one minute, until you hear the "beep." Check the digital reading. For a correct reading, wait at least 15 minutes after your child has had a hot or cold drink before putting the thermometer in his mouth.

Ear: Tympanic thermometers, which measure temperature inside the ear, are another option for older babies and children. Gently put the end of the thermometer in the ear canal. Press the start button. You will get a digital reading of your child's temperature within seconds. While it provides quick results, this thermometer needs to be placed correctly in your child's ear to be accurate. Too much earwax may cause the reading to be incorrect.

Underarm (Axillary): Although not as accurate, if your child is older than 3 months of age, you can take his underarm temperature to see if he has a fever. Place the sensor end of either an oral or rectal digital thermometer in your child's armpit. Hold his arm tightly against his chest for about one minute, until you hear the "beep." Check the digital reading.
Other methods for taking your child's temperature are available. They are not recommended at this time. Ask your pediatrician for advice.

Making Your Child Comfortable

While most fevers don't require a call to your pediatrician, there are certain circumstances when a fever could indicate something more serious.

Call your pediatrician immediately if your child has a fever and:

Looks very ill, is unusually drowsy or is very fussy
Has been in an extremely hot place, such as an overheated car
Has additional symptoms, such as a stiff neck, severe headache, severe sore throat, severe ear pain, an unexplained rash, or repeated vomiting or diarrhea
Has a condition that suppresses immune responses, such as sickle-cell disease or cancer or is taking steroids
Has had a seizure
Is younger than 2 months of age and has a rectal temperature of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher
A child older than 6 months of age who has a temperature below 101 degrees Fahrenheit (38.3 degrees Celsius) probably does not need to be treated for fever, unless the child is uncomfortable. Observe her behavior. If she is eating and sleeping well and is able to play, you may wait to see if the fever improves by itself.

In the meantime:

Keep her room comfortably cool
Make sure that she is dressed in light clothing
Encourage her to drink fluids such as water, diluted fruit juices, or a commercially prepared oral electrolyte solution
Be sure that she does not overexert herself
There are also medications you can give your child to reduce his temperature if he is uncomfortable. Both acetaminophen and ibuprofen are safe and effective in proper doses. Be sure to follow the correct dosage and medication schedule for your child. Remember, any medication can be dangerous if you give your child too much.

Ibuprofen should only be used for children older than 6 months of age. It should not be given to children who are vomiting constantly or are dehydrated. Do not use aspirin to treat your child's fever. Aspirin has been linked with side effects such as an upset stomach, intestinal bleeding and, most seriously, Reye syndrome.

If your child is vomiting and unable to take medication by mouth, your pediatrician may recommend a rectal suppository for your child. Acetaminophen suppositories can be effective in reducing fever in a vomiting child.

Read the label on all medications to make sure that your child receives the right dose for his age and weight. To be safe, talk to your pediatrician before giving your child any medication to treat fever if he is younger than 2 years of age.

An alternative to over-the-counter medications is to sponge your child with lukewarm water. Sponging may reduce your child's temperature as water evaporates from her skin. Your pediatrician can advise you on this method.

Your pediatrician may recommend that you try sponging your child with lukewarm water in cases such as the following:

Your child's temperature is above 104 degrees Fahrenheit (40 degrees Celsius)
She is vomiting and unable to take medication
She has had a febrile seizure in the past
Do not use cold water to sponge your child, as this could cause shivering. That could increase her temperature. Never add alcohol to the water. Alcohol can be absorbed into the skin or inhaled, causing serious problems such as a coma.

Usually 5 to 10 minutes in the tub is enough time for a child's temperature to start dropping. If your child becomes upset during the sponging, simply let her play in the water. If she is still bothered by the bath, it is better to remove her even if she has not been in long enough to reduce her temperature. Also remove her from the bath if she continues to shiver because shivering may increase body temperature.

Do not try to reduce your child's temperature to normal too quickly. This could cause the temperature to rebound higher. Be sure to call your pediatrician if your child still "acts sick" once the fever is brought down, or if you feel that your child is very sick. Also call if the fever persists for more than 24 hours in a child younger than 2 years of age, more than three days in a child 2 years of age or older.

Home Treatment of a Fever

Fevers under 101 degrees Fahrenheit (38.3 degrees Celsius) generally do not need to be treated unless your child is uncomfortable or has a history of febrile convulsions. Even higher temperatures are not in themselves dangerous or significant unless your child has a history of convulsions or a chronic disease. It is more important to watch how your child is behaving. If he is eating and sleeping well, and has periods of playfulness, he probably doesn't need any treatment. If he seems to be bothered by the fever; however, you can treat it by a variety of ways, including medication and sponging.

Fever Medication

There are several medications that can reduce body temperature by blocking the mechanisms that cause a fever. These so-called antipyretic agents include acetaminophen, ibuprofen and aspirin. All three of these drugs appear to be equally effective at reducing fever. However, since aspirin may cause or be associated with side effects, such as stomach upset, intestinal bleeding and (most seriously) Reye syndrome, we do not recommend using it to treat a simple fever. Ibuprofen use is approved for children 6 months of age and older; however, ibuprofen should never be given to children who are dehydrated or vomiting continuously.

Ideally, the dose of acetaminophen should be based on a child's weight, not his age. The dose of ibuprofen should be based on baseline temperature and weight, not his age. However, the dosages listed on the labels of acetaminophen bottles (which are usually calculated by age) are generally safe and effective unless your child is unusually light or heavy for his age.

Be sure to read and follow the instructions on the manufacturer's label when using any medication. Following the instructions is important to ensure that your child receives the proper dosages. Acetaminophen may be contained in other over-the-counter medications, such as cold preparations. Read all medication labels to ensure your child is not receiving multiple doses of the same medicine. As a general rule, do not give a baby under 2 years acetaminophen or any other medication without the advice of your pediatrician.

Sponging to Ease Fever

In most cases, using oral acetaminophen or ibuprofen is the most convenient way to make your feverish child more comfortable. However, in some cases you might want to combine this with tepid sponging or just use sponging alone. Sponging is preferred over acetaminophen if your child is known to be allergic to, or is unable to tolerate, antipyretic (antifever) drugs (a rare case).

It is advisable to combine sponging with acetaminophen or ibuprofen if:

Fever is making your child uncomfortable.
He has a temperature over 104 degrees Fahrenheit (40 degrees Celsius).
He has a history of febrile convulsions or someone else in your immediate family has had them.
He is vomiting and may not be able to retain the medication.

How to Sponge Your Child for Fever

To sponge your child, place him in his regular bath (tub, bathinette or baby bath), but put only 1 to 2 inches of tepid water (85 to 90 degrees Fahrenheit or 29.4 to 32.2 degrees Celsius) in the basin. If you do not have a bath thermometer, test the water with the back of your hand or wrist. It should feel just slightly warm. Do not use cold water, since that will be uncomfortable and may cause shivering, which can raise his temperature. Seat your child in the water, it is more comfortable than lying down.

Then, using a clean washcloth or sponge, spread a film of water over his trunk, arms and legs. The water will evaporate and cool the body. Keep the room at about 75 degrees Fahrenheit (23.9 degrees Celsius), and continue sponging him until his temperature has reached an acceptable level. Never put alcohol in the water; it can be absorbed into the skin or inhaled, which can cause serious problems, such as coma.

Usually, sponging will bring down the fever in thirty to forty-five minutes. However, if your child is resisting actively, stop and let him just sit and play in the water. If being in the tub makes him more upset and uncomfortable, it is best to take him out even if his fever is unchanged. Remember, fever in the moderate range (less than 102 degrees Fahrenheit [38.9 degrees Celsius]) is in itself not harmful.

Treating a Mild Fever

Keep your child's room comfortably cool, and dress him lightly.
Encourage him to drink extra fluid (water, diluted fruit juices, gelatin-flavored water).
Avoid giving extremely fatty foods or others that are difficult to digest, as fever decreases the activity of the stomach, and foods are digested more slowly. There is no reason to discontinue giving your child the milk he normally drinks.
If the room is warm or stuffy, place a fan nearby to keep the cool air moving.
Your child does not have to stay in his room or in bed when he has fever. He can be up and about the house, but he should not run around and overexert himself.
If the fever is a symptom of a highly contagious disease (e.g., chickenpox), keep your child away from other youngsters and elderly people.

Excerpted from Caring for Baby and Young Child: Birth to Age 5, Bantam 1999