Fever -- its not the enemy

I am often asked "how high is too high" with regards to fever or "at what point do we take [our child] to the emergency room?



First the basics:

• Pediatricians do not consider anything below 100.4 (some use 100.5 F) a fever. We will not typically use the phrase "low grade fever" because fever is 100.4 F or above and everything else is just normal.

• The most accurate temperature in a child under 1 y.o. is taken rectally (and really up to 2 y.o. if you can manage it). After that, a tympanic (ear) thermometer will also give you reliable results. Adding or subtracting degrees with an axillary (armpit) or other type of thermometer is not an accurate way of guessing your child's temperature.

Fever is not the enemy



Any type of inflammation or infection in the body can cause fever -- whether it be viral (e.g. head cold, hand-foot-mouth disease) or bacterial (strep throat). Your child can have a high fever (103-105F) whether it is a viral infection or bacterial infection. The type of infection does not necessarily determine the level to which the fever will escalate - -that depends on your child's body and other factors. Furthermore, a fever can last several days regardless of the type (viral vs. bacterial) of infection.



Fever is the body's response to infection or inflammation. It is a GOOD thing because we want your child to fight off the infection. It is not the problem but rather part of the solution. So when you are treating your child for illness your goal should be to make your child comfortable NOT to eliminate fever. For example, if my daughter has a fever of 102F but she is still active and comfortable I don't give her anything. The truth is I have rarely checked my daughter's temperature since she was 1 y.o. because I am more concerned with her comfort level than I am with the "number."



That being said, fever in an infant younger than 3 months old is serious because it is an indicator of a potentially serious infection. In this case, you should not treat your young infant with Tylenol or wait. You should call your pediatrician right away. Again, the fever itself is not the problem but it is an indication of a problem.



What about "alternating Tylenol and Motrin?"



The concept of using both Tylenol and Motrin/Ibuprofen at alternating times to tackle fever came about due to concerns about febrile seizures (seizures caused by fevers). It was thought that keeping a child's temperature down could prevent a febrile seizure. This is incorrect -- a febrile seizure is not caused by high temperature but rather a rapidly escalating temperature. Actually, recent studies have shown that even in children with a history of febrile seizure using alternating Tylenol/Motrin did NOTHING to prevent a future febrile seizure.



What can I do to take care of my child?

• Use Tylenol or Motrin (if your child is older than 6 months) as needed.


• Encourage your child to take more liquids than they would normally


• Call/see your doctor immediately if your child is less than 3 months old with a fever.


• Call/see your doctor if your child has fever that is prolonged or accompanied by decreased appetite, coughing, serious discomfort/fussiness or if they're "just not themselves."


• Finally, although there is no "magic number" to which you should respond by rushing your child to the ER I would definitely call your doctor to discuss a temperature of 104F

Happy Holidays!

Sally Elias