Monday, September 12, 2011

What to do with a Fever

Fevers are common in children.  They are probably the number one reason for after hour phone calls to the doctor.  Many parents feel panicky when the thermometer indicates fever.  So what should you do? 

First, and most important, don't panic!  Keep trying to think logically and stay calm.  Your sick child needs you to be able to make rational decisions.  Understand that if the temperature is under 100.5 F, then it is not actually a fever, and you should simply monitor the situation.  Also remember that fever can be helpful in fighting some infections. 

Fever is a sign that your child's body is reacting to an infection.  When there is a fever we try to figure out if the infection is a serious one.  The fever itself won't hurt your child, but a serious infection can be a cause for concern.  If your child has a fever, but is older than three months of age and is looking and acting just fine, you do not automatically need to call the doctor.  Fairly normal behavior and energy level often mean the fever is caused by a more minor infection.

Here are some things to think about.  If your child is under three months of age and has a rectal temperature of 100.5 or higher, you should probably call the doctor.  You could consider unwrapping your baby, making sure that too many blankets isn't the problem.  In general, though, for an infant under three months old with a fever, you should call.

If your child is over three months of age, then her behavior and appearance are important in evaluating how serious of an infection it is.  There is no automatic temperature at which you should "panic" and rush to the ER.  103, 104, and 105 F are all "high" fevers.  When the fever is high you also need to consider how sick your child looks.  If they are very irritable or lethargic, it is more concerning.

When I am called about a child's high fever I frequently ask parents to give a dose of ibuprofen or acetaminophen, and then reassess their child in an hour.  If she feels and looks much better with such a simple intervention, then it may be ok to wait until the next day before bringing her in.  The goal of using anti-fever medicine is not to bring the temperature back down to normal, but to temporarily bring it down a little and to make your child feel better.  It is a good sign if something basic like acetaminophen or ibuprofen can make a big difference in how your child feels.

Giving a cold bath is kind of dramatic and old-fashioned.  I don't usually recommend it because I don't think it would be very soothing to already feel awful with a high fever and then get plunged into icy water.  Cool wet washcloths on the forehead and back of the neck will be much more comfortable for your child.

106 F or higher makes me think of heat stroke, so at that level you should call or take your child to the hospital.  103 F and higher, in addition to a lethargic or irritable child who does not improve with acetaminophen or ibuprofen, would be another reason to call or have your child evaluated right away.
In addition, with any level of fever (that's 100.5 or higher) when your child is also very irritable or lethargic and not improving with anti-fever medicines, you should consider calling or taking your child in.

A child who is lethargic and irritable is usually not smiling, not eating and drinking, is very sleepy or won't stop crying or moaning.  The child can be very restless or almost impossible to comfort and console.  When the doctor asks about "lethargic" she does not mean that your child just wants to sit around and watch TV, or that they seem a little more tired than usual.

When there is a fever, this is what you should do:

Before you call the doctor, take a few seconds to think clearly about your child and his fever.  What other symptoms does he have? What illnesses was he exposed to?  How long has he been sick?  Can you help him cool off by undressing him, using cool cloths on the forehead and neck, and giving him anti-fever medicine?  Did you give the right amount of ibuprofen or acetaminophen, and did you give the medicine enough time to work?  Was there improvement in his appearance, mood, discomfort, and energy level? 

If you are reassured by improvement in your feverish child's appearance, then you may be able to manage this at home for the time being.  You could make an appointment in the next day or two if the fever doesn't go away.  If you continue to be quite concerned and worried about your child even after trying some things to help them feel better, then don't wait to check in with the doctor.

Disclaimer:  As usual, my advice in this blog is general and may not apply to your specific situation, or to your child's special circumstances.  This blog is not intended to be a substitute for the personal attention your own doctor can provide.

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