One of the most upsetting situations for a parent is when their child has a fever. We recently have seen viral illnesses giving children high fevers so this seems like a good time to review this issue!
What is a fever?
Fever is a temperature above normal. It is not an illness itself, but tells us that the child is fighting off an illness. Fevers are usually self-limited, cause no harm, and the fever itself doesn’t necessarily need treatment. Our body temperature is usually lowest in the morning and highest in the evening. If a child has a fever, it too may be highest in the evening.
When should I call the doctor?
For children less than 3 months with a fever (over 100.4 in this age group) we would like you to call within 24 hours (sooner if they are younger than one month of age, or not drinking, peeing, or acting normally). Younger children can get sick quickly and we will help you decide if they should come to the office. You do not need to call for a fever in a child who had vaccines in the previous 24 hours, unless they are not acting normally and you are worried. Older children can be watched at home for a few days with fever, especially if they are playful, drinking and urinating normally. You can call for advice and we can help you.
When fevers last a few days, we do try to find out the cause. Often in children, fevers are caused by viral illnesses for which there is no treatment. Sometimes there is an ear infection or urinary infection, for example, and an antibiotic is given to fix the illness which is causing the fever. Giving acetaminophen or ibuprofen to make the fever go away does not fix the illness itself.
Treating the fever:
We only need to treat the fever to make the child more comfortable. If a child has a fever but is playful and drinking well, we may not need to give them anything for the fever itself. The first thing to do is make sure they are drinking, and getting rest. They should not be in school or daycare, sports, or playdates!
If they are uncomfortable, especially if they are not drinking or resting, acetaminophen or ibuprofen can be given. The dose is based on their weight. You can check the KIDS FIRST web page for dosing information.
Acetaminophen is safe to give for fevers and can be given every 4-6 hours, but no more than 5 times in 24 hours. It works in about 30-60 minutes.
Ibuprofen should not be given to children younger than 6 months of age. It comes in TWO DIFFERENT liquid concentrations, so it is important to know what the dose is for the type you have. It can be given every 6-8 hours, and works in about 30-60 minutes.
Aspirin should NOT be given to children at all unless the provider has specifically told you to do so.
Often people ask about alternating acetaminophen and ibuprofen. This is generally not needed. Occasionally if one of the meds was given, and the child does not feel any better in one hour, a dose of the other medicine can be given. This should not however be done on a routine basis, because of risk of overdose. If the child is uncomfortable before the next dose, a cool (not cold) cloth can also be used to help them feel better.
Some people ask about giving both acetaminophen and ibuprofen at the same time. This is not recommended. Usually one or other of the meds, given at the correct dose, works well and giving both at the same time may lead to overdose.
Be careful to check labels if you give a cough or cold medicine. Often these contain ibuprofen or acetaminophen, and you may be giving an overdose without realizing it! Children do not need to be awakened to give them a dose of acetaminophen or ibuprofen! Let them sleep! This will help them get better!!
Remember, making the fever go away is not the same as fixing the illness. When a child has a fever, look at their overall appearance, fluid intake, activity level, and call us for advice!