When Your Child Has a Fever...
Updated: Feb 5, 2022
Fevers are one of the TOP complaints that cause parents to seek medical care for their children. There are a lot of misconceptions about fevers that I see time and time again.
DISCLAIMER: When we talk about kids with fevers, we have a VERY different approach to little tiny babies or kids with compromised immune systems. This post is focusing on babies and children older than 3 months of age who are not immunocompromised.
Here are the top things I tell parents about fevers:
There is nothing inherently dangerous about a fever.
Fevers are uncomfortable, but not dangerous. A fever is a sign that the body's natural immune system is hard at work! The MOST common cause of a fever is from a viral infection, and these generally get better on their own. A fever can be an indicator that your child should be evaluated for a problem that needs treatment, but a fever itself is not dangerous.
A fever is defined as a temperature >100.4F.
There is natural variation in body temperature, and temperatures that creep up to 99F or so are not technically considered a fever. The reason that this matters is because when you talk to your doctor or healthcare provider, knowing how many days in a row that your child spiked a true fever may be helpful for decision-making.
Over-the-counter medications like Tylenol and Motrin are safe and effective. Fevers are uncomfortable. Go ahead and treat the fever prior to going to the doctor - you don't need to prove to your doctor that the fever is real! Make sure that you are using the correct dose of medication for your child's age.
Tylenol (acetaminophen) is safe for children >3mo of age
Motrin (ibuprofen) is safe for children >6mo of age.
Fevers will come and go.
For most viral illnesses, fevers can pop up for several days. If the fever comes back, it is not an indication of things getting worse.
A higher number on the thermometer does not indicate more severe illness.
There is no difference in severity between a fever of 100.4F and a fever of 104F! A higher temperature does not make it more likely to be a bacterial infection - in fact, MANY viruses can cause very high fevers. We care more about how your child looks and acts than the actual number.
Forehead scanners are notorious for over-estimating temperature.
They just aren't very accurate. Often a child will have an oral temperature of 101F but the forehead scanner will say 104F. Don't panic! The best way to take a temperature is under the tongue or under the armpit. For babies, a rectal temperature will be most accurate.
One time, I saw a child in the ER whose mom said his temperature was "about 225 degrees." She didn't have a thermometer, so she had preheated her oven and held one hand on her baby's head and one hand in the oven and estimated when they felt equal. This is not an accurate way to measure!
Another time, I had a dad bring a happy child into the ER at 2am because he thought she had a fever but his wife was out of town. He didn't know where the thermometer was, but had an infrared thermometer that he used at work to measure the temperature of metal ductwork. He pointed it at her head and it said "107F." This was also not accurate! (her temperature was actually normal).
Tips for when your child has a fever:
Use the right medication dose!
If you know your child's weight, you can dose the medicine appropriately. Here are a couple of great resources so you can measure correctly:
TYLENOL/Acetaminophen dosing tables
MOTRIN/Ibuprofen dosing tables
Keep track of what you give your child and when they had a fever.
I generally do not recommend rotating medications because it gets confusing. Write down the time, dose, and medication you gave your child so all caregivers can be on the same page. It will be helpful for your doctor or healthcare provider to know the fever pattern - did your child have a true fever every day? If so, for how many days?
Know when you need to seek care.
Dehydration (not making urine at least once every 6 hours)
Not responding appropriately
For other concerns: The best option is to reach out to your child's own doctor. They may need to be examined or tested for an issue that requires additional treatment (like an ear infection, pneumonia, strep throat, or a urine infection) or may have different management (such as quarantine if positive for COVID).