Understanding Fever in Children

Father taking temperature of sick son
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What is a Fever

When does a child have a fever?

Although 98.6 F (37.0 C) has long been the standard for a normal body temperature, that doesn't mean that any number above 98.6 F is a fever.

Normal temperatures can range from 97.2 F (36.2 C) to 99.5 F (37.5 C), but it is important to keep in mind that those numbers are really just for adults. Children, especially younger children, can have slightly higher normal temperatures.

In fact, most experts don't consider a temperature to be a true fever in a child until it reaches 100.4 F (38 C).

Fever Symptoms

While fever is itself a symptom of other childhood conditions, such as the flu, strep throat, and some non-infectious conditions, such as juvenile rheumatoid arthritis, fever can itself cause recognizable signs and symptoms in children, such as:

  • Decreased activity
  • Trouble sleeping
  • Poor appetite
  • Irritability
  • Chills
  • Shivering
  • Headache
  • Muscle aches
  • Hallucinations
  • Sweating
  • Increased heart rate
  • Increased respiratory rate
  • Dehydration

These fever symptoms can make your child feel terrible.

When fever symptoms are altering a child's activity level, their ability to sleep, behavior, or appetite, then giving him a fever-reducing medication can be a good idea. As the American Academy of Pediatrics states, "a primary goal of treating the febrile child should be to improve the child's overall comfort."

Understanding Fever in Children

So, if your child has a fever but doesn't really feel bad and is sleeping well, is in a good mood, and is drinking well, then you don't necessarily need to give him a fever reducer. That is likely surprising to parents who have learned to treat fever like an illness, but it makes sense when you understand that fever is just another symptom, like a cough or a runny nose.

Most importantly, parents will more easily get over their "fever phobia" if they understand that their child's temperature doesn't tell them how sick their child is. A child could have a very high fever and have a mild illness or have a low-grade fever with a life-threatening illness.

Other symptoms, in addition to the fever, such as being lethargic, not eating or drinking anything, having symptoms of dehydration, having trouble breathing, or crying and being inconsolable, etc., would likely be better signs that your child needed immediate medical attention, instead of the number you got when you took his temperature.

Still, call your pediatrician right away if your baby who is under two to three months old has a rectal temperature at or above 100.4 F or if you are simply worried about your child's temperature.

Getting Over Fever Phobia

Fever phobia, an exaggerated fear of fever, is still common among parents, even though pediatricians have been trying to combat it for more than 30 years. Unfortunately, even pediatricians sometimes have fever phobia or complicate the problem by not doing a good job of helping their parents understand fever.

Parents can help to get over their fever phobia, and avoid problems with treating fevers, by understanding that:

  • Fever, even a 'high fever,' does not cause brain damage.
  • You shouldn't usually wake up a child at night to give them a fever reducer.
  • Fever may have beneficial effects in helping to fight infections.
  • Both acetaminophen (Tylenol) and ibuprofen (Motrin or Advil) are effective at reducing a child's fever. Aspirin should not be giving to children or teens because of the risk of Reye syndrome.
  • The AAP neither supports nor discourages alternating acetaminophen and ibuprofen every three to four hours, although they do think that it helps promote fever phobia, and state that parents should be careful about proper dosing intervals so as to not overdose on either fever reducer.
  • Parents should avoid cough-and-cold medications that include acetaminophen or ibuprofen so that they don't double up on ingredients if they also give their child a fever reducer which includes the same ingredient.
  • Febrile seizures, one of the fever symptoms that parents worry about the most when a young child has a high fever, are usually thought to be mild and not life-threatening. They also can't be prevented by giving a child a fever reducer.
  • When taking your child's temperature, just tell your pediatrician how you took the temperature (axillary, oral, tympanic, vs. forehead thermometer, etc.) and the reading of the thermometer, instead of worrying about adding or subtracting a degree.

Bottom line: Fever-reducing medications can be useful if the fever is affecting your child's well being. But if your child seems fine, there's no need to give medication just for the fever.

The latest "fever phobia" guidelines from the AAP aren't really to discourage all use of acetaminophen (Tylenol) and ibuprofen (Motrin or Advil), but instead to make sure parents don't overuse or misuse these drugs when kids don't really need them.

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Article Sources

  • AAP Clinical Practice Guidelines. Febrile Seizures: Clinical Practice Guideline for the Long-term Management of the Child With Simple Febrile Seizures. Pediatrics Vol. 121 No. 6 June 2008, pp. 1281-1286.
  • AAP Clinic Report. Fever and Antipyretic Use in Children. Pediatrics. 2011; 127:580-587.
  • Avner. Acute Fever. Pediatrics in Review. 2009; 30: 5-13.
  • May, A. Fever Phobia: The Pediatrician's Contribution. Pediatrics, Dec 1992; 90: 851 - 854.