Fever

Symptom Definition

• Rectal temperature > 100.4°F (38.0°C)
• Oral temperature > 99.5°F (37.5°C)
• Axillary (armpit) temperature > 99.0°F (37.2°C)
• Pacifier temperature > 99.5°F (37.5°C). New digital electronic ones are accurate.
• Ear (tympanic) temperature > 100.4°F (if in rectal mode) or > 99.5°F (if in oral mode) (Note: Not reliable < 6 months old)
• Main cause: colds and other viral infections

See More Appropriate Topic

• Other symptom is present with the fever (see that topic) (e.g. COLDS, COUGH, SORE THROAT, EARACHE, SINUS PAIN, DIARRHEA, VOMITING, RASHES WIDESPREAD AND CAUSE UNKNOWN)

Call 911 Now (your child may need an ambulance) If

• Limp, weak or not moving
• Unresponsive or difficult to awaken
• Difficulty breathing with bluish lips
• Unable to swallow or new onset of drooling
• Rash with purple (blood-colored) spots or dots

Call Your Doctor Now (night or day) If

• Your child looks or acts very sick
• Any difficulty breathing
• Child is confused or has stiff neck
• Had a seizure with a fever
• Age less than 12 weeks with fever > 100.4°F (38°C) rectally
• Fever > 104°F (40°C) at any age
• Very irritable (e.g. inconsolable crying or cries when touched or moved)
• Won't move an arm or leg normally
• Signs of dehydration (very dry mouth, no urine > 8 hours, etc.)
• Chronic disease or medication that causes decreased immunity

Call Your Doctor within 24 Hours (between 9 and 4) If

• You think your child needs to be seen
• Age 3-6 months with fever
• Age 6-24 months with fever present > 24 hours but no other symptoms (e.g. no cold, cough, diarrhea, etc.)
• Burning or pain with urination
• Fever lasts > 3 days (72 hours)

Call Your Doctor during Weekday Office Hours If

1. You have other questions or concerns

Parent Care at Home If

• Probably viral fever with no complications and you don't think your child needs to be seen

Home Care Advice for Fever

1. Reassurance: Your child probably has an early virus infection. Most fevers are good for children and help the body fight infection. Use the following definitions to help put your child's level of fever into perspective:
   • 100-102°F (37.8 - 39°C) - low grade fevers and beneficial
   • 102-104°F (39 - 40°C) - moderate grade fevers and beneficial
   • > 104°F (40°C) - high fevers and cause discomfort, but harmless
   • > 105°F (40.6°C) - higher risk of bacterial infections
   • > 107°F (41.7°C) - the fever itself can be harmful
2. Treatment for All Fevers: Extra Fluids and Less Clothing
   • Give cold fluids orally in unlimited amounts (Reason: good hydration replaces sweat and improves heat loss via skin)
   • Dress in 1 layer of light weight clothing and sleep with 1 light blanket (avoid bundling) (Caution: overheated infants can't undress themselves)
   • For fevers 100-102°F (37.8 - 39°C), this is the only treatment needed (acetaminophen is unnecessary)
3. Fever Medicine: Give acetaminophen (e.g. Tylenol) or ibuprofen (e.g. Advil) for fevers above 102°F (39°C), if your child is uncomfortable. The goal of fever therapy is to bring the temperature down to a comfortable level. Remember, the fever medicine usually lowers the fever by 2 to 3°F. See the dosage charts.
   • Avoid aspirin. (Reason: risk of Reye's syndrome, a rare but severe brain disease)
4. Sponging: Sponge for fever > 104°F (40°C) that doesn't come down with acetaminophen or ibuprofen AND causes discomfort.
   • How to sponge: Use lukewarm water (85-90°F) (29.4° - 32.2°C). (Do not use rubbing alcohol.)
   • Always give fever medicine first. Sponge for 20-30 minutes. If your child shivers or becomes cold, stop sponging or increase the water temperature. (NOTE: Sponging is optional for high fevers, not required.)
5. Contagiousness: Your child can return to day care or school after the fever is gone.
6. Expected Course of Fever: Most fevers associated with viral illnesses fluctuate between 101° and 104°F (38.4° and 40°C) and last for 2 or 3 days.
7. Call Your Doctor If
   • Fever goes above 104°F (40°C)
   • Fever without a cause persists > 24 hours
   • Fever lasts > 3 days (72 hours)
   • Your child becomes worse or develops any of the "Call Your Doctor" symptoms