Fever  

This Care Guide Covers:

  • Fever is the only symptom. Your child has a fever if:
  • Rectal, Ear or Forehead temperature: 100.4° F (38.0° C) or higher
  • Oral or Mouth temperature:  100° F (37.8° C) or higher
  • Under the arm (Armpit) temperature:  99° F (37.2° C) or higher
  • Caution: Ear temperatures are not accurate before 6 months of age
  • Caution: Forehead temperatures must be digital. Forehead strips are not accurate.

If not, see these topics
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Fifth Disease
Fifth Disease

When to Call Your Doctor

Call 911 Now (your child may need an ambulance) If
  • Not moving or too weak to stand
  • Can't wake up
  • Trouble breathing with bluish lips or face
  • Purple or blood-colored spots or dots on skin
  • You think your child has a life-threatening emergency
Call Your Doctor Now (night or day) If
  • Your child looks or acts very sick
  • Hard to wake up
  • Not alert when awake
  • Acts or talks confused
  • Stiff neck or swollen soft spot
  • Had a seizure with the fever
  • Trouble breathing
  • Great trouble swallowing fluids or spit
  • Age less than 12 weeks old with any fever. (Caution: Do not give your baby any fever medicine before being seen)
  • Fever more than 104° F (40° C)
  • Nonstop crying or cries when touched or moved
  • Won't move an arm or leg normally
  • Dehydration suspected. (No urine in over 8 hours, dark urine, very dry mouth and no tears)
  • Burning or pain when passing urine
  • Weak immune system. (Such as sickle cell disease, HIV, cancer, organ transplant, taking oral steroids)
  • You think your child needs to be seen urgently
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • You think your child needs to be seen, but not urgently
  • Age 3-6 months old with fever
  • Age 6-24 months old with fever that lasts more than 24 hours. There are no other symptoms (such as cough or diarrhea).
  • Fever lasts more than 3 days
  • Fever returns after gone for more than 24 hours
Call Your Doctor During Weekday Office Hours If
  • You have other questions or concerns
Parent Care at Home If
  • Fever with no other symptoms AND your child acts mildly ill
Causes & Health Information

Causes

  • Main cause: colds and other viral infections.
  • Fever may be the only symptom for the first 24 hours. This often occurs with a viral illness. The start of symptoms (runny nose, cough, loose stools) are often delayed. In the case of Roseola, fever may be the only symptom for 2 or 3 days.
  • Most often, you won't know the cause of the fever until other symptoms develop. This may take 24 hours.
  • Bacterial infections (as with a Strep throat or a kidney infection) also cause fever.
  • Teething does not cause fever.

Fever and Crying

  • Fever on its own shouldn’t cause much crying.
  • Frequent crying in a child with fever is caused by pain until proven otherwise.
  • Hidden causes can be ear infections, kidney infections, sore throats and meningitis.

Normal Temperature Range

  • Rectal. A reading of 98.6° F (37° C) is just the average rectal temp. A normal low can be 96.8° F (36° C) in the morning. It can change to a high of 100.3° F (37.9° C) late in the day. This is a normal range.
  • By mouth. A reading of 97.6° F (36.5° C) is just the average mouth temp. A normal low can be 95.8° F (35.5° C) in the morning. It can change to a high of 99.9° F (37.7° C) late in the day. This is a normal range.

Return to School

  • Your child can go back to school after the fever is gone. Your child should feel well enough to join in normal activities.
CARE ADVICE FOR FEVER

  1. What You Should Know:
    • Having a fever means your child has an infection.
    • It's most likely caused by a virus.
    • Most fevers are good for sick children and help the body fight infection.  
    • Use the ranges below to help put your child's level of fever into perspective:
    • 100°-102°F (37.8° - 39°C) Slight fever: helpful, good range
    • 102°-104°F (39 - 40°C)    Average fever: helpful
    • Over 104°F (40°C)          High fever: causes discomfort, but harmless
    • Over 106°F (41.1°C)       Very high fever: important to bring it down
    • Over 108°F (42.3°C)       Harmful fever: fever itself can cause brain damage
  2. Treatment for All Fevers:  Extra Fluids and Less Clothing
    • Offer your child lots of cold fluids to drink. Reason: Good hydration replaces sweat. It also improves heat loss from the skin.
    • For babies, dress in 1 layer of light weight clothing and sleep with 1 light blanket. Do not wrap in too many blankets. This may make the fever higher. Caution: Babies can get over heated easily. They can't take their clothes or blankets off if they are too hot.
    • For fevers 100°-102° F (37.8° - 39°C), fever meds are rarely needed. Fevers of this level don't cause discomfort. They do help the body fight the infection.
  3. Fever Medicine:  
    • Fevers only need to be treated with medicine if they cause discomfort. Most often, that means fevers above 102°F (39°C).
    • Give acetaminophen (such as Tylenol) or ibuprofen (such as Advil). See the Dose Tables.
    • Goal of treatment: Bring the temperature down to a comfortable level. Most often, the fever meds only lower the fever by 2° to 3° F (1 - 1.5° C). They do not bring it down to normal.
    • Do not use aspirin. Reason: Risk of Reye syndrome, a rare but serious brain disease.
    • Do not use both acetaminophen and ibuprofen together. Reason: Not needed and a risk of giving too much.
  4. Sponging:
    • Note: Sponging is an option for high fevers, but not required.
    • When to Use: Fever above 104° F (40° C) AND doesn't come down with fever meds. Always give the fever med first.
    • How to Sponge: Use lukewarm water (85 - 90° F) (29.4 - 32.2° C). Sponge for 20-30 minutes.
    • If your child shivers or becomes cold, stop sponging. Other option: You can also make the water warmer.
    • Caution: Do not use rubbing alcohol. Reason: Can cause a coma.
  5. Return to School:  
    • Your child can return to school after the fever is gone. Your child should feel well enough to join in normal activities. 
  6. What to Expect:  
    • Most fevers with viral illnesses range between 101° and 104° F (38.4° and 40° C).
    • They may last for 2 or 3 days.
    • They are not harmful.
  7. Call Your Doctor If:
    • Fever goes above 104° F (40° C)
    • Any fever occurs if less than 12 weeks old
    • Fever without a cause lasts more than 24 hours (if age less than 2 years)
    • Fever lasts more than 3 days (72 hours)
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.
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Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 9/1/2012

Last Revised: 1/13/2013

Content Set: Child Symptom Checker

Copyright 1994-2012 Barton D. Schmitt, M.D.