Description
A fever means the body temperature is above normal. Your child has a fever if his:
• Rectal temperature is over 100.4°F (38.0°C).
• Oral temperature is over 99.5°F (37.5°C).
• Axillary (armpit) temperature is over 99.0°F (37.2°C).
• Ear (tympanic) temperature is over:
100.4°F (38°C) -- if rectal mode
99.5°F (37.5°C) -- if oral mode.
• Pacifier temperature is over 99.5°F (37.5°C). (Note: Use the digital pacifier thermometer for children over 3 months old. This method is okay for checking for a fever, but it is not as accurate as the oral, ear, or rectal methods.)
Tactile (touch) fever is the impression that your child has a fever because he feels hot to the touch. Checking a fever this way is more accurate than we used to think. But if you're going to call the doctor, actually measure the fever.
The body's average temperature when it is measured orally is 98.6°F (37°C), but it normally fluctuates during the day. Mildly increased temperature (100.4 to 101.3°F, or 38 to 38.5°C) can be caused by exercise, excessive clothing, a hot bath, or hot weather. Warm food or drink can also raise the oral temperature. If you suspect such an effect on the temperature of your child, take his temperature again in a half hour.
Causes
Fever is a symptom, not a disease. It is the body's normal response to infections. Fever helps fight infections by turning on the body's immune system. The usual fevers (100 to 104°F, or 37.8 to 40°C), which all children get, are not harmful. Most are caused by viral illnesses; some are caused by bacterial illnesses. Teething does not cause fever.
Expected Course
Most fevers with viral illnesses range from 101 to 104°F (38.3 to 40°C) and last for 2 to 3 days. In general, the height of the fever doesn't relate to the seriousness of the illness. How sick your child acts is what counts. Fever causes no permanent harm until it reaches 107°F (41.7°C). Fortunately, the brain's thermostat keeps untreated fevers below this level.
While all children get fevers, only 4% develop a brief convulsion from the fever. Since this type of seizure is generally harmless, it is not worth worrying about excessively. If your child has had high fevers without seizures, your child is probably safe.
Home Care
1. Extra fluids and less clothing
Encourage your child to drink extra fluids, but do not force him to drink. Popsicles and iced drinks are helpful. Body fluids are lost during fevers because of sweating.
Bundling can be dangerous. Clothing should be kept to a minimum because most heat is lost through the skin. Do not bundle up your child; it will cause a higher fever. During the time your child feels cold or is shivering (the chills), give him a light blanket.
2. Acetaminophen products
Children older than 2 months of age can be given any one of the acetaminophen products. Tylenol, Anacin-3, Liquiprin, Panadol, and Tempra all have the same dosage.
Remember that fever is helping your child fight the infection. Use drugs only if the fever is over 102°F (39°C) and preferably only if your child is also uncomfortable. Give the correct dosage for your child's weight every 4 to 6 hours, but no more often.
Two hours after they are given, these drugs will reduce the fever 2 to 3°F (1 to 2°C). Medicines do not bring the temperature down to normal unless the temperature was not very elevated before the medicine was given. Repeated dosages of the drugs will be necessary because the fever will go up and down until the illness runs its course. If your child is sleeping, don't awaken him for medicines.
CAUTION: The dropper that comes with one product should not be used with other brands.
3. Dosages of acetaminophen
Type
Weight of Child (Dosage Form) Dose
-----------------------------------------------------------
More than acetaminophen drops 1/2 dropper
7 pounds (80 mg/0.8 ml)
More than acetaminophen drops 1 dropper
14 pounds (80 mg/0.8 ml)
acetaminophen syrup 1/2 tsp
(160 mg/5 ml)
More than acetaminophen drops 1+1/2 dropper
21 pounds (80 mg/0.8 ml)
acetaminophen syrup 3/4 tsp
(160 mg/5 ml)
chewable acetaminophen 1+1/2 tablets
(80-mg tablets)
More than acetaminophen drops 2 droppers
28 pounds (80 mg/0.8 ml)
acetaminophen syrup 1 tsp
(160 mg/5 ml)
chewable acetaminophen 2 tablets
(80-mg tablets)
chewable acetaminophen 1 tablet
(160-mg tablets)
More than acetaminophen drops 3 droppers
42 pounds (80 mg/0.8 ml)
acetaminophen syrup 1+1/2 tsp
(160 mg/5 ml)
chewable acetaminophen 3 tablets
(80-mg tablets)
chewable acetaminophen 1+1/2 tablets
(160-mg tablets)
More than acetaminophen syrup 2 tsp
56 pounds (160 mg/5 ml)
chewable acetaminophen 4 tablets
(80-mg tablets)
chewable acetaminophen 2 tablets
(160-mg tablets)
adult acetaminophen 1 tablet
(325-mg tablets)
More than acetaminophen syrup 2+1/2 tsp
84 pounds (160 mg/5 ml)
chewable acetaminophen 5 to 6 tablets
(80-mg tablets)
chewable acetaminophen 3 tablets
(160-mg tablets)
adult acetaminophen 1 to 1+1/2 tablets
(325-mg tablets)
More than acetaminophen syrup 4 tsp
112 pounds (160 mg/5 ml)
chewable acetaminophen 8 tablets
(80-mg tablets)
chewable acetaminophen 4 tablets
(160-mg tablets)
adult acetaminophen 2 tablets
(325-mg tablets)
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Abbreviations: mg = milligrams
ml = milliliter
tsp = teaspoon
As the above table shows, acetaminophen is available in several oral forms. It is also available as a rectal suppository in 120-mg, 325-mg, and 650-mg dosages. Suppositories are useful if a child with a fever is vomiting often or having seizures caused by the fever. Use twice the oral dose (that is, double the amount of milligrams listed in the chart) for the suppository (1999 change in dosage). Most suppositories can be cut (for example, cut in half) to supply the right dose for your child's age.
If your infant is under 12 weeks of age, call your doctor and don't give acetaminophen.
4. Ibuprofen
Ibuprofen is similar to acetaminophen in its ability to lower fever. Its safety record is also similar. One advantage ibuprofen has over acetaminophen is a longer lasting effect (6 to 8 hours instead of 4 to 6 hours). Children with special problems requiring a longer period of fever control may do better with ibuprofen. Give the correct dosage for your child's weight every 6 to 8 hours.
Type
Weight of Child (Dosage Form) Dose
-----------------------------------------------------------
More than ibuprofen liquid 1/2 tsp
12 pounds (100 mg/5 ml)
More than ibuprofen liquid 3/4 tsp
18 pounds (100 mg/5 ml)
More than ibuprofen liquid 1 tsp
24 pounds (100 mg/5 ml)
More than ibuprofen liquid 1+1/2 tsp
36 pounds (100 mg/5 ml)
More than ibuprofen liquid 2 tsp
48 pounds (100 mg/5 ml)
ibuprofen tablets 1 tablet
(200 mg)
More than ibuprofen liquid 2+1/2 tsp
60 pounds (100 mg/5 ml)
ibuprofen tablets 1 tablet
(200 mg)
More than ibuprofen liquid 3 tsp
72 pounds (100 mg/5 ml)
ibuprofen tablets 1+1/2 tablets
(200 mg)
More than ibuprofen liquid 4 tsp
96 pounds (100 mg/5 ml)
ibuprofen tablets 2 tablets
(200 mg)
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Abbreviations: mg = milligrams
ml = milliliter
tsp = teaspoon
5. Combining or alternating acetaminophen and ibuprofen
We don't recommend combining acetaminophen and ibuprofen for the following reasons:
•There is no added benefit in reducing fever compared to either product used alone.
•Combining can cause confusion, dosage errors, and poisoning.
•You don't need to control the fever this closely.
•If instructed by your physician to alternate both products, do it as follows:
• Use both if the fever is over 104°F and does not go down using only one medicine.
• Give a fever medicine every 4 hours (acetaminophen every 8 hours and ibuprofen every 8 hours).
• Alternate medicines for only 24 hours or less, then return to a single product.
6. Avoid aspirin
The American Academy of Pediatrics recommends that children (through age 21 years) not take aspirin if they have chickenpox or influenza (any cold, cough, or sore throat symptoms). This recommendation is based on several studies that have linked aspirin to Reye's syndrome, a severe encephalitislike illness. Most pediatricians have stopped using aspirin for fevers associated with any illness.
7. Sponging
Sponging is usually not necessary to reduce fever. Never sponge your child without giving him acetaminophen first. Sponge immediately only in emergencies such as heatstroke, delirium, a seizure from fever, or any fever over 106°F (41.1°C). In other cases sponge your child only if the fever is over 104°F (40°C), the fever stays that high when you take the temperature again 30 minutes after your child has taken acetaminophen or ibuprofen, and your child is uncomfortable. Until acetaminophen or ibuprofen has taken effect (by resetting the body's thermostat to a lower level), sponging will just cause shivering which is the body's way of trying to raise the temperature.
If you do sponge your child, sponge him in lukewarm water (85 to 90°F, or 29 to 32°C). Use slightly cooler water for emergencies. Sponging works much faster than immersion, so sit your child in 2 inches of water and keep wetting the skin surface. Cooling comes from evaporation of water. If your child shivers, raise the water temperature or stop sponging until the acetaminophen or ibuprofen takes effect. Don't expect to get the temperature down below 101°F (38.3°C). Don't add rubbing alcohol to the water; it can be breathed in and cause a coma.
Call Your Child's Physician Immediately If:
• Your child is less than 3 months old.
• The fever is over 105°F (40.6°C).
• Your child looks or acts very sick.
Call Your Child's Physician Within 24 Hours If:
• Your child is 3 to 6 months old (unless the fever is due to a DTP shot).
• The fever is between 104 and 105°F (40 and 40.6°C).
• Your child has had a fever more than 24 hours without an obvious cause or location of infection.
• Your child has had a fever for more than 3 days.
• The fever went away for over 24 hours and then returned.
• You have other concerns or questions.
Written by B.D. Schmitt, M.D., author of "Your Child's Health," Bantam Books
