Medical Moment: My Child Has A Fever, What Should I Do?

Dr. Simon Kotylar answers this week’s question: My child has a fever, what should I do?

Fever in children is usually a result of the immune system’s response to an infection and is one of the most common reasons for parents and their little ones to seek medical care. Generally speaking, an armpit reading above 100°F or a rectal temperature above 100.4°F is considered elevated. Fortunately, most causes of fever in children are not dangerous and a dose of love and patience is often all that is needed to see kids through their illness. Fever in itself usually causes no harm until it exceeds 105°F and actually may help to fight infection. While a fever can make kids uncomfortable and worsen problems such as dehydration, the level of the fever does not necessarily correlate with seriousness and thus parents should watch for other associated symptoms. Fortunately, in the United States, most infectious causes of fever in children are due to viral infections and are fought off by our own immune systems.

What could be causing the fever?

Most cases of fever in children are due to infections caused by viruses, which lead to upper respiratory symptoms or gastrointestinal illness. There are a multitude of viruses out there that infect humans, however, we rarely know exactly which virus is causing an illness and most of the time that makes little difference, as there is no good treatment for these infections. For the dangerous viruses, like measles and influenza, vaccination is key to preventing illness and has led to major reductions in their incidence and mortality. Some cases of fever are due to bacterial infections and these often require antibiotics to help the immune system overcome the infection. Most of the common and dangerous causes of bacterial infection in children, like haemophilus and pneumococcus, are covered in routine vaccination series, and so we see much fewer cases of serious infection due to these bacteria nowadays.

What can I do for the fever?

Medications that can be used to reduce fever in children include Acetaminophen (Tylenol) and Ibuprofen (Motrin or Advil). These medications can be given together (yes you can given them at the same time) or in an alternating 4-hour cycle. For children under 6 months of age, only Acetaminophen is recommended as a fever reducer. It is important to check package inserts and dose these medications appropriately according to your child’s weight and package instructions. Aspirin should not be given to infants and children under age 16. As a general rule, you should focus on the way  your child looks, acts, and feels rather than what the thermometer says. Most kids will feel better when their fever is brought down. However, once the fever reducer wears off, your child’s temperature may climb back up as the underlying illness is still there. In addition to medications, a lukewarm bath or washcloth can temporarily cool down the fever. Cold water and ice baths should be avoided. Lastly, make sure that you encourage your little one to drink fluids in frequent and small amounts, particularly if they have vomiting or diarrhea, as elevated temperature and poor oral intake can lead to dehydration.

When to seek medical care

While most cases of fever in children are not dangerous and get better on their own, there are a number of scenarios which should alert parents and caretakers to something more serious and prompt urgent medical attention. If your child has a fever above 104°F, OR if you notice any of the following, you should seek prompt medical attention:

• Any child less than 3 months of age with a fever over 100°F
• Children who are short of breath, have blue lips or nails, or look like they are having a hard time breathing
• Children with chronic medical conditions like sickle cell disease, heart problems, cancer or immune disorders
• Any child with fever and a new skin rash, particularly ones that look purple or “bruisy-looking”
• Children with fever and complaints of pain while urinating or pain in the abdomen
• Neck stiffness, severe headache, or severe ear pain
• Drooling or inability to swallow
• Fever lasting more than 5 days
• Children that are exceptionally weak, limp, less alert or excessively sleepy
• Young children with fever that are inconsolable or will not stop crying
• Any child with fever and a seizure
• Fever after return from travel abroad

As young children are not always able to describe their symptoms, parents and caretakers should trust their instincts.  If you do not like the way your child looks or they appear “very sick” to you, it is advisable to call your doctor or seek medical care. Often times, particularly in pre-verbal children, a parent’s or physician’s instinct is paramount and can be key to early diagnosis and treatment. All that being said, most children who have a fever will get better in 2-3 days time, and just need a little love and care to get them through. As an ounce of prevention is worth a pound of cure, keep those little hands clean, get your children vaccinated, and keep their immune systems healthy with good nutrition and exercise.

Editor’s note: The Telluride Medical Center is the only 24-hour emergency facility within 65 miles. As a mountain town in a challenging, remote environment, a thriving medical center is vital to our community’s health.