Fever

Background:

Fever is defined as a core body temperature of 38°C or higher. To measure your child's temperature, you must use a thermometer. Measuring by touch, such as they feel hot has no accuracy in determining if a child has a fever. If your child feels hot or is acting unwell, that means you need to pull out the thermometer to measure if they have a fever.

 

For children under one year of age, the best way to measure their temperature is with a rectal thermometer. You only need to insert it just far enough that the silver tip is inside, no further. For children who are old enough to hold the thermometer under their tongue, (which is by age 4 for most children), the oral route is best. For those who are too old to check rectally but too young to know how to hold the thermometer in their mouth, checking an axillary (underarm) temperature is best. Because an axillary temperature is not an inside (core) temperature, we have to adjust by adding 0.5°C to what every number you measure in order to equal a core temperature. Thus an axillary temperature of 37.5°C or higher is a fever.

 

Forehead scanners should not be used. There is no scientific data that correlates with core temperatures. Please do not use them.

 

What To Do:

Newborn babies 28 days of age or younger must go to the emergency room immediately if they get a fever.

 

For babies between 29 and 60 days, they can come to clinic but should be seen within 24 hours. Children between 2 and 6 months of age should be seen within 1 to 2 days of fever. For 6 months to 18 months of age, they should be seen within 2 – 3 days. 18 months to 4 years should be seen around day 3 of fever and children over 4 years of age do not need to be seen until they have had fever for 5 days.

 

Of course, they should be seen sooner if there are other symptoms such as trouble breathing that need to be addressed or if they have any of the issues in the "when to be concerned" section of this instruction sheet.

 

Contrary to popular belief, fever is not a bad thing. It means your immune system is working to protect the body by fighting the infection.

 

For that reason we don't treat fevers. We treat the child.

 

All the things that people think are dangerous about fevers, are not true.

 

• There is no relationship between how high the fever is and how serious the illness is. Children can have a simple cold and have a fever of 40. They can have a life-threatening bacterial infection with a low-grade fever. So there is no number that you should be worried about.
• It is impossible for fevers to go high enough to cause brain damage. Fevers are an internally caused increase in temperature. There has to be an external heat source such as extreme weather in order to cause the body temperature to go high enough to cause damage. Heat exhaustion or heatstroke are examples of this.
• High fevers do not cause seizures. While there are fever associated seizures (febrile seizures) that occur in children between 6 months and 6 years of age, they are not related to how high the temperature is. And while they are definitely very scary for parents to witness, we can assure you that they are quite harmless, do not cause brain damage, and except in very specific circumstances, are not associated with children having ongoing problems with seizures.

However, if your child is not feeling well, then we want to make them feel better. To do this, you can give your child a cool cloth on their forehead, they can take a lukewarm bath, keep them dressed in a way they feel comfortable and use feel better medicine such as ibuprofen and acetaminophen. Please note that we do not call them fever medicines because we don't treat the fever, we are treating the child.

 

Your doctor should have given you a piece of paper with the correct doses of feel better medicine for your child's weight. Please note that these doses are often different than what is on the bottle. This is because the doses on the bottle are at the low end of the recommended dosing and are often not enough.

 

When To Be Concerned:

Children are allowed to look and feel terrible when they have a fever. The child who does not perk up and look and feel better when you bring their temperature down are the ones who need to go to the Emergency room.

 

If you are giving your child appropriate doses of ibuprofen and acetaminophen but their temperature is NOT coming down, they should be seen by a doctor. All children, unless you were otherwise instructed by the physician, should be assessed around 5 days of fever.

 

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