Commonly Asked Questions About Fevers

November 7, 2013


Fever, one of the most commonly seen and treated symptoms in the emergency center (EC), oftentimes gets a bad rap. Although it makes all of us, adults and children alike, feel pretty miserable, fever is actually a helpful symptom that jump starts our body’s immune response.  And, here’s some more good news for healthy, “well appearing” infants and children, a trip to the emergency center or pediatrician’s office is usually not necessary for parents to safely treat their child’s fever at home! Let’s tackle some commonly asked questions about fever:

What is a fever?

A fever is a symptom of an underlying condition, not a disease.  It’s an abnormal elevation of the body’s temperature and is defined as:

  • Rectal (buttocks) temperature > 100.4°F/38°C
  • Temporal artery (forehead) temperature > 100.4°F/38°C
  • Tympanic (ear) temperature > 100.4°F/38°C
  • Oral (mouth) temperature > 100°F/37.8°C
  • Axillary (armpit)temperature > 99°F/37.2°C

Contrary to popular belief, fever in healthy infants (over 2 months old) and children is not a dangerous or life-threatening symptom.  Even if a child’s fever is very high, the actual temperature is not reflective of the severity of the illness…so, an ill-appearing child with a fever of 100.4°F is much more concerning than a well-appearing child with a fever of 104°F.  Although fatigue, muscle aches, chills/shivering, and transient elevations in breathing and heart rates commonly occur with fevers, most of these symptoms usually improve with fever-reducing medications and cool compresses.

What causes fever?

Although non-infectious illnesses, such as heat-related injuries (see blog post: here), certain drugs/medications, and some chronic diseases may cause an elevation in temperature, most fevers are caused by infections. There are many different types of infections, including bacterial, viral, fungal, and parasitic; however in most healthy patients, viral infections are typically the most common cause of fever.

Viral infections can cause a variety of symptoms, such as fever, congestion, runny nose, sore throat, vomiting, and diarrhea, and can be very frustrating for parents mainly because antibiotics do not cure and are not recommended for these types of infections.  In addition to preventative measures, such as vaccinating your infant/child (i.e., influenza vaccine), covering your mouth/nose with a tissue when coughing or sneezing, washing your hands frequently, and avoiding sick friends/family members, symptomatic treatment such as fever-reducing medications, rest, and plenty of fluids will help keep your child as comfortable as possible.

Does my child need blood work or xrays?

Luckily, most healthy infants and children with a fever do not require blood work and/or x-rays to diagnose the cause of fever.  However, newborns (under 2 months old) and infants/children with an abnormal immune system (from illnesses or medications/chemotherapy), abnormal or absent spleen (sickle cell disease and other blood-related disorders), transplanted organ(s), long-term central line/shunt/hardware, or other chronic diseases typically need to have laboratory testing done because they may be at increased risk for a serious bacterial infection.

Additionally, some doctors may order a blood test called a complete blood count (or CBC), to evaluate your child’s white blood cell (WBC) count.  It is typically used as a screening versus diagnostic test, since the WBC count cannot differentiate between the many types of infections that may occur in the body.  Unless the WBC is extremely low or high, most healthy infants and children do not need further laboratory or radiographic evaluation.  If you’re unsure of whether or not your child needs immediate medical evaluation and treatment, call your pediatrician or subspecialist for advice.

How can I care for my child at home? 

Fever-reducing medications, fluids/hydration, and rest are usually all that’s necessary to care for your child at home. There are a variety of fever-reducing medications available and understanding the differences between the various brands can become confusing.  There are 2 active ingredients found in most fever-reducing medications, and they are called acetaminophen and ibuprofen. Acetaminophen can be found in Tylenol and PediaCare, whereas ibuprofen is typically the active ingredient in Motrin and Advil.  Because they reduce fever in different ways, both medications can be safely given to your child.  However, whereas acetaminophen can be given every 4 hours to healthy patients of all ages, ibuprofen should only be given to patients over 6 months of age and given every 6 hours.  For dosing information, see here.

If your child has a chronic medical condition, such as liver or kidney disease, you should speak with your pediatrician or subspecialist prior to using these medications.

Caring for a sick child can oftentimes lead to parental exhaustion, stress, and anxiety.  Hopefully, after reading this article, some of your fears and concerns have been alleviated, and you feel a sense of empowerment with regards to caring for your child at home.  However, if your child ever has a fever AND severe headache, confusion/altered behavior, painful/stiff neck, shortness of breath or difficulty breathing, significant dehydration, or other serious symptoms, seek medical care immediately.

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