When your young child is not feeling well, a fever is often part of the package. As a parent, figuring out what should come next can depend on a lot of factors that sometimes go beyond what the thermometer is telling you.
It is important to remember that when your child has a fever, they are fighting an invader of some kind. A rise in temperature stimulates the body’s defenses and means your child’s white blood cells and other “fighter” cells are working to get things back to normal.
Brandon Meyer, M.D., is a Sanford Health pediatrician in Fargo, North Dakota, who treats sick children on a daily basis. We asked him to provide parents advice on what they need to do when their child’s body temperature becomes cause for concern.
What is a fever and when should you treat your child’s fever?
A temperature of 100.4 F or 38 C is classified as a fever. How parents treat it depends on the age of the child. If the child is under 3 months old and has a fever, it should be treated as a medical emergency unless they have been told otherwise by the child’s primary care provider.
If they’re older than that, it depends on how they’re acting.
“Not every fever needs to be treated with medication,” Dr. Meyer said. “Conversely, sometimes even if the child doesn’t have a fever by definition – let’s say it’s at 99 F – but they appear to be very uncomfortable, then I’d want to treat them. It’s all based on the child. If they look fine, they probably are fine. If your child is acting fussy, then I would treat them with fever medication.”
Taking your baby’s or your child’s temperature
Digital thermometers have replaced the old mercury thermometers as the best way to take a temperature.
If you need to take an infant’s or child’s temperature, you have 5 digital choices:
- Rectal (in the bottom) temperature. Several digital rectal thermometers are available for taking rectal temperatures. Parents worry about these because they think they may insert them incorrectly, but there’s little risk of injury if you use a thermometer made for taking a rectal temperature.
- Armpit (axillary) temperature. Any of the digital thermometers can be used in the armpit. A disk-shaped thermometer fits most comfortably. The whole disk is covered when the arm is brought against the chest wall. Make sure there’s nothing (such as clothing) between the child’s skin and the thermometer.
- Ear (tympanic) temperature. To get an accurate temperature, the thermometer must be pointed toward the eardrum. Earwax may make it hard to get an accurate reading. Ear thermometers may not be accurate for newborns and older infants. For this reason, they’re advised for babies older than 6 months.
- Forehead (temporal artery) temperature. This thermometer is very easy to use and may be less disturbing to a newborn, but factors like sunlight, sweating or cold temperatures can lead to inaccurate readings.
- Mouth (oral) temperature. Any digital thermometer can be used by mouth, but this method is advised for children age 4 and older because it can be hard for younger children to do. To get an accurate reading, place the tip of the thermometer under the child’s tongue. Then have the child close their lips gently around the thermometer.
When using any of the digital devices, read and carefully follow the directions.
What can you give your child for a fever?
If your child is 6 months or older, Dr. Meyer recommends children’s versions of acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) – usually in liquid form.
“They are both very safe to use if you’re older than 6 months unless there is a medical reason to not use them,” Dr. Meyer said. “For kids who are 3 to 6 months old, they should only use Tylenol.”
If your child is indicating they feel too warm, it may help to put a cool, damp towel on their forehead or give them a room-temperature bath.
“These things probably don’t actually bring a temperature down, but they may help the child feel better,” Dr. Meyer said. “Ultimately, that’s the goal, right? Sometimes, though, when you have a fever, you also have the chills. Then cold things don’t feel so great. If your child is old enough to communicate, you can offer some of those things and if they change their mind halfway through, it’s not that they’re upset, but maybe they’ve gone from feeling hot with a fever to getting the chills with a fever.”
When is a child’s temperature too high?
“If it gets up to 105 or 106, children should probably be evaluated,” Dr. Meyer said. “That’s especially true if your child is acting lethargic or they’re dehydrated. That could be something like heat stroke, for instance. At that point, you’re not evaluating the fever as much as you’re evaluating the other symptoms. I would say, though, that at 105 F, your antenna should definitely go up.”
What are the risks of leaving your child’s fever untreated?
A great percentage of fevers take care of themselves after a few days, but for children younger than 3 months old, special concern is warranted.
“For those children, a fever might be the only sign you’ll get that they have a serious bacterial illness like sepsis,” Dr. Meyer said. “So we really recommend medical attention for infants less than 3 months old who haven’t had their first vaccines and have a temperature of 100.4 F (38 C) or above.”
For older children, most often a fever is accompanied by an illness that has easily identifiable symptoms. A bad cough, a stomachache or vomiting are commonly accompanied by a fever, for instance.
“Fevers in children more than 3 months old usually take care of themselves,” Dr. Meyer said. “I would not tell a parent to ignore it, but I’d recommend they stay patient and see if any other things show up that will help them decide whether or not to seek medical attention.”
If you were summarizing how to deal with children’s fevers, what would you tell parents?
“For the vast majority of children, fevers are signs of something else, but in and of themselves aren’t that dangerous,” Dr. Meyer said. “There are rare complications that can happen with pretty high fevers, things like febrile seizures, which can be scary but we know what to do when they occur. If a febrile seizure happened, it would be very important to get your child evaluated that day.”
A febrile seizure, also known as a febrile convulsion or fever fit, is relatively common, affecting up to 5% of young children, and is usually not serious.
“Overall, it’s important to remember that fevers are a sign that your immune system is working,” Dr. Meyer said. “You shouldn’t be afraid of fevers except for very young children. If it’s been going on for four or five days, it might be time to get medical attention, but fevers are generally caused in children by mild infections that will get better on their own.”
Learn more
- Post febrile seizure, family grateful for care at Sanford
- Is it a cold or RSV? Know when to call your child’s doctor
- Infant colds: What’s normal and what’s not
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Posted In Children's, Family Medicine, Fargo
