Fever in Children –
Frequently Asked Questions
Fever is a very common reason
for children to be brought in for medical assessment. Below are answers to some
of the most common questions that caregivers have with respect to fever.
What causes fever?
Fever is the body’s natural
response to infection. Some infections are caused by
bacteria. Examples include strep throat, pneumonia, bladder and kidney
infections, cellulitis (infection of the skin), and meningitis. Other infections are caused by
viruses. The common cold, laryngitis, croup, and bronchitis are all viral
infections. In fact, viral infections are by far the most common reason for
fever in a child.
How can I tell if my child has a
fever?
Placing the back of your hand
on the child’s forehead is one of the easiest ways to see if a child has a
fever. Studies have shown that this tried and true method is surprisingly
accurate at determining if a child has a fever or not. Most decisions about
what to do with a fever are not actually related to the exact temperature – they
are more dependent on how the child looks and if they have any other symptoms.
As a result, this method is often all you need to use to determine if your child
has a fever.
If it is important to measure
the degree of fever, some alternatives are listed below:
Once a child reaches the age of
5 or 6, they can usually co-operate enough to obtain an oral temperature.
This is done by placing a thermometer under the tongue and having the child
close his or her lips around it. A temperature greater than or equal to 37.5
degrees Celsius (99.5 degrees Fahrenheit) is considered a fever.
Alternatively, tympanic or
ear thermometers can be used. A temperature of greater than or equal to
37.5 degrees Celsius (99.5 degrees Fahrenheit) is once again considered a
fever. It should be noted that the ear thermometers are NOT accurate in
children under the age of 2, and should not be used in this age group.
Checking the temperature
under the armpit is an alternative method. This method is easier but
unfortunately is not particularly accurate. A temperature over 37.0 degrees
Celsius (98.7 degrees Fahrenheit) is considered a fever.
A rectal temperature is
taken by inserting a lubricated thermometer probe in to the rectum. This is the
most accurate way to measure a temperature, and is usually used by the medical
team when assessing infants less than 3 months with a possible fever. A rectal
temperature of 38 degrees Celsius (100.4 degrees Fahrenheit) is considered a
fever.
How high of a fever is considered
dangerous?
There is no set temperature at
which fever is considered dangerous. What is most important is not how high the
fever is, but rather how your child looks and acts with the fever.
Particular signs that a child needs medical assessment include:
-
Fever in an infant less than 3 months
old. Infants do not have a mature enough immune system to fight infection
properly, and need to be seen right away with fever.
-
Fever associated with a lethargic
child. Lethargy refers to a child who not interested in his or her
surroundings, is excessively sleepy or drowsy, and simply looks very unwell.
-
Fever that is lasting for more than 4
days
-
Fever associated with severe headache
and/or neck stiffness
If you are suspicious there is serious
infection causing the fever. Sometimes you are just worried that there is
something more serious going on, and parental concern is a good reason for a
child to be seen. In particular, first time parents can have a hard time
telling if a fever is caused by something serious, and sometimes need assistance
in sorting this out. This is normal!
Reassuring signs in a child with a fever include:
How can I treat fever?
It is not always necessary to
treat a fever. In fact, it is believed that fever assists the body’s immune
system in fighting infection.
Having said this, giving a
child medication for fever can often help with relieving muscle aches or pain,
improving the child’s mood, and allowing the parents some much needed sleep!
Acetaminophen (also known as
Tylenol, Tempra) is the most commonly used medication to treat fever. Ibuprofen (Children’s Motrin,
Children’s Advil) is also used commonly, particularly in children above the age
of 2. Both of these medications work
well for fever. We find that children are often underdosed when dosed according
to the standard dosing tables found on the medication bottles.
Children’s Dosing for Acetaminophen
(also known as Tylenol and Tempra)
This dosing
chart is based on weight, not age, and therefore will provide a more accurate
dose of acetaminophen for your child. Acetaminophen can be used up to every 4
hours as needed.
|
Weight(Pounds) |
Weight(kilograms) |
Dosage(15mg/kg) |
Infant Drops(80 mg/mL) |
Children’s Suspension
(160 mg/ 5 ml) |
Children’s Chewable Tablets
(80 mg) |
Junior Strength Tablets
(160 mg) |
|
10 |
4.5 |
60 |
0.75 mL |
2 mL |
|
|
|
15 |
7 |
100 |
1.25 mL |
3.25 mL |
|
|
|
20 |
9 |
120 |
1.5 mL |
4 mL |
1.5 tabs |
|
|
25 |
11 |
160 |
2 mL |
5 mL |
2 tabs |
1 tab |
|
30 |
13.5 |
200 |
2.5 mL |
6.25 mL |
2.5 tabs |
|
|
35 |
15 |
240 |
3 mL |
7.5 mL |
3 tabs |
1.5 tabs |
|
40 |
18 |
280 |
3.5 mL |
8.75 mL |
3.5 tabs |
|
|
45 |
20 |
300 |
4 mL |
10 mL |
4 tabs |
2 tabs |
|
50 |
23 |
345 |
|
11 mL |
4.5 tabs |
|
Further information on
medication use can be obtained from your medical
team or pharmacist.
Does my child need antibiotics?
It is worth noting again that
most illnesses that cause fever in children are viral and get better on their
own. This is in particular true in the child who has undergone the routine
set of immunizations (vaccinations), which are very effective in preventing many
bacterial illnesses.
As infections caused by viruses
do not respond to antibiotics, and as
antibiotics have the potential for harmful side effects,
antibiotics are not used for viral infections.
Ear Infections are a
common reason for a visit to the doctor. They can be caused by a virus or a
bacteria. There is now a large and convincing body of evidence that suggests
that most ear infections in children over the age of 2 resolve on their own,
without treatment with antibiotics. In this age group, we now use antibiotic
treatment only for children who have persisting ear pain and problems for
more than 2 days.
Certain specific illnesses are bacterial, and do
benefit from antibiotic treatment. These include:
Strep Throat – usually
seen in children greater than 2 years old; presents with fever, sore throat,
swollen glands. Sore throat and fever can also be caused by a viral infection -
in particular an associated cough and runny nose would suggest more likely a
viral cause.
Pneumonia – children
have fever, cough, rapid breathing, and/or difficulty breathing. Many children
with a fever, cough and runny nose have a viral infection in the chest – a chest
x-ray is sometimes ordered to help distinguish a pneumonia requiring antibiotics
from a “bronchitis”, which does not.
Cellulitis – infection
of the skin causing a spreading redness or red streaking on the skin.
Urinary Tract Infection (UTI)
– Older children may complain of burning or irritation on urinating, back pain,
as well as fever. Nausea and vomiting can also be a part of a UTI. In younger
children and infants, the diagnosis of UTI can be difficult, and it is one of
the things that physicians will check for in a young child with a fever without
any other obvious symptoms.
Meningitis or Blood
Infection – Both of these illnesses are quite rare, but are very serious.
The most common thing associated with these diseases is simply that the child
looks very unwell. Lethargy, drowsiness, severe headache, neck stiffness, and a
rash that does not fade under pressure from a finger are all signs of a
potentially serious illness. The new Ontario immunization schedule has
immunizations specifically directed at reducing children’s risk of developing
these illnesses.
The above information is a brief overview of some of
the commonly asked questions with respect to fever. It is meant to give some
general advice on the topic, and shouldn’t replace a visit to the doctor if you
have any concerns about your child.
Many
thanks to Dr. Amit Shah, Emergency Physician at STEGH for preparing this
article: Fever In Children.