Fever

A common dilemma that parents face when their child is ill; is whether or not to call their health care provider. Often the symptom in question is Fever. How high should a child's fever be to warrant a call to the health care provider? Hopefully, this report will shed some light on the topic of Fever, as it is associated with children.

Basic Information

Fever occurs when the body's temperature is raised above its normal level. However, what is considered a normal level fluctuates between different people and different situations.

Fever can be affected by:

A Person's age
Time of day
Means used to obtain the temperature

An infant's normal temperature can range from 98.2 degrees Fahrenheit to 100.4 degrees Fahrenheit and for any child it would be a temperature of 100.4 degrees Fahrenheit by rectum and 99.5 degrees Fahrenheit by mouth. Body temperature normally fluctuates during the day. Typically, it is slightly lower in the morning, and slightly higher in the evening. A high temperature is often defined as a temperature of 102 degrees Fahrenheit orally, or 103 degrees Fahrenheit rectally. Adults can usually tolerate a high temperature without much discomfort or danger unless it goes over 103 degrees Fahrenheit. However, in small children and infants, even slightly elevated temperatures may indicate an infection.

Fever is not an illness itself, but it may be a sign that something is going on in the body. Fevers are often an indication that the body is fighting off a viral or bacterial infection. Due to this, finding the cause of the fever is a priority.

Some children and infants develop fevers after receiving routine immunizations such as diphtheria, tetanus, pertussis (DPT) or pneumococcal vaccines.

The normal body temperature is set by the hypothalamus, an area at the base of the brain that acts as the thermostat for the whole body. When something is wrong, the normal temperature is set a few points higher. This higher setting made by the hypothalamus is usually due to the presence of small molecules, known as pyrogens, in the blood. Pyrogens can come from external substances such as bacteria, viruses, or toxins. Sometimes tumors and other substances created within the body can release pyrogens. At this point, chills may be experienced. When the temperature begins to return to normal, sweating may be observed. Sweating is the way in which the body dissipates the excess heat.

Fever in a child is recognized as such if the temperature is:

Higher than 100.4 degrees Fahrenheit (38 degrees Celsius) measured rectally
Higher than 100 degrees Fahrenheit (37.8 degrees Celsius) measured orally
Higher than 99 degrees Fahrenheit (37.3 degrees Celsius) measured under the arm
The health care provider should be contacted if:
An infant 3 months or younger has a rectal temperature of 100.4 degrees Fahrenheit (38 degrees C) or higher
An infant age 3-6 months has a temperature of 101 degrees Fahrenheit (38.3 degrees C) or higher
A child older than 6 months has a temperature of 104 degrees Fahrenheit (40 degrees C) or higher
Important signs to be aware of would be:
Unexplained irritability; such as marked crying when changing diapers or moving the child
Lethargy
Unresponsiveness

In infants and children younger than the age of two, these may be the signs of meningitis. If meningitis is suspected contacting the health provider is imperative. Do not wait until morning, or for the weekend to be over.

Other symptoms of fever may include:

Sweating
Shivering
Headache
Muscle aches
Lack of appetite
Dehydration
General weakness

Some health care providers may have different suggestions for when to call regarding a fever, and again it is important to know what one's own health care provider suggests. However the following guidelines are common ones to follow concerning calling the health provider. Call if the child has a fever and:

Is an infant aged 3 months or younger
Refuses fluids or seems too ill to drink adequately
Has any of the signs of dehydration
Has a seizure
Is still feverish after 72 hours

Or if any of the following symptoms are present:

Inconsolable crying
Continued irritability after fever has dropped
Difficulty awakening
Confusion or delirium
Rash with fever
Stiff neck
Difficulty breathing
Diarrhea or repeated vomiting

Complications

One of the complications of fever as concerns children is dehydration. Dehydration can be caused by excessive loss of water from the body due to:

Vomiting
Diarrhea
Excessive urine output
Excessive sweating
Nausea
Stomatitis or pharyngitis
Acute illness with loss of appetite
And with children it is most often due to:
Stomach flu with vomiting and diarrhea
Acute illness where the child refuses fluids and loses excessive fluid through sweating associated with fever
Other symptoms might include:
Poor intake of fluids
Sunken eyes
Markedly sunken fontanelles in an infant
Dry or sticky mucus membranes in the mouth
The skin may lack it's normal elasticity and sag back into position slowly when pinched up into a fold
Decreased or absent urine output
Decreased tears

Parents should be aware of the possibility of dehydration any time their child is ill. Providing adequate fluids and paying attention to the intake and output of fluids is helpful in preventing dehydration. The health care provider should be contacted as to what fluids would be advised. Another complication having to do with children's fever is febrile seizures. "Febrile" means pertaining to or characteristic of fever. These seizures may be caused by a rapid rise or fall in temperature. Febrile seizures occur in 2-5 percent of children younger than age 5. The vast majorities of febrile seizures cause NO lasting effects such as epilepsy, cerebra palsy or mental retardation, and are simply outgrown. Febrile seizures tend to run in families. Procedures to follow if a child has a febrile seizure are:

Laying the child on one side
Removing sharp objects near the child
Loosening tight clothing
Gently holding child down to prevent injury

Do not attempt to put anything into the child's mouth during a seizure as this could cause choking.

Although most seizures stop on their own, and should be timed if possible, call for emergency medical assistance if the seizure lasts longer than five minutes. After a seizure take the child to the health care provider as soon as possible. Noting which side of the body began to shake first can be helpful to the health care provider in determining the cause.

A third complication associated with children and fever is Reyes Syndrome. Reyes syndrome is a rare but potentially fatal disease that can be triggered by giving aspirin to children. Because of this:

ASPIRIN IS NOT RECOMMENED FOR ANY CHILDREN UNDER THE AGE OF 12.

Always ask your health care provider what he/she recommends for fever.

Prevention

Hand washing is the most effective and simplest way to reduce exposure to infectious diseases that can involve fever.

Teaching children to wash their hands often, before they eat, after visiting public or private restrooms, and after handling a pet, is suggested. Hand washing by the caretaker is also strongly recommended, especially after changing diapers.

Effective hand washing includes covering both front and back or each hand with soap, and rinsing under running water.

Taking a Child's Temperature

There are many new thermometers on the market today that will give an accurate reading. Many of these are safer and easier to use with children than the mercury thermometer.

The American Association of Pediatrics (AAP) recently said it no longer recommended using mercury thermometers with children, due to accidental breakage and mercury poisoning.

Glass thermometers and digital thermometers will give an accurate reading, however, glass thermometers can shatter and release the harmful mercury inside. Therefore, safe handling is a necessity.

Ear canal thermometers are quick and comfortable for children, but they are still relatively expensive compared to glass and digital models, and some training in how to use them is required.

Digital thermometers are usually reasonably priced and give an accurate reading.

Forehead thermometers are all right for speedy readings and are the easiest to use on infants, but do not give as accurate a reading as would a digital or a glass thermometer.

Taking a child's temperature following a bath can affect the accuracy of the reading.

A child's temperature can be taken either rectally, orally (if the child is old enough to comfortably hold the thermometer under his/her tongue), or under the armpit.

If a rectal temperature is taken, then ONLY a Rectal thermometer should be used.

These thermometers have shorter bulbs than the oral ones.

Temperature taken in the armpit is called an axillary temperature reading and is useful in children younger than four or five. It is also useful in older children who are too distressed to cooperate with taking either a rectal or oral temperature.

NEVER LEAVE A CHILD UNATTENDED WHILE TAKING HIS/HER TEMPERATURE!!!

Treatment: Always check first with your health care provider concerning the possible ways to treat your child's fever. DO NOT:

BATHE CHILD IN COLD OR ICY BATH
RUB CHILD DOWN WITH ALCOHOL(EACH OF THESE PRACTICES CAN RAISE THE TEMPERATURE RATHER THAN LOWER IT)
DO NOT GIVE ASPIRIN TO ANY CHILD UNDER THE AGE OF 12 DUE TO COMPLICATIONS WITH REYES SYNDROME

In any case where the care of a child is concerned, especially if there are questions, the health care provider should be contacted.

Always Your Choice Updated August 2001