Kids and Fever

What to do—and what mistakes to avoid If there’s one symptom of colds, flu, and other childhood illnesses that worries parents most, it may be fever. Nearly 30 years have passed since Denver pediatrician Barton D. Schmitt, MD, coined the term “fever phobia” to describe the overreaction of parents to fever symptoms in their children. In 2001 researchers reported in the journal Pediatrics that attitudes haven’t changed. Of 340 child caregivers interviewed, 56 percent were very worried about the potential harm of fever in children, 25 percent gave fever-reducing medication to their child for temperatures below 100°, and 44 percent gave ibuprofen at too-frequent dosing intervals. Clearly, the phobia persists. What Is a Fever? Not an illness, fever is rather a symptom of the immune system at work, responding to infection. Fever helps the body fight harmful bacteria and viruses by slowing their growth and triggering an immunological response. Parents should not assume that the temperature of a fever is an indication of how serious the child’s illness may be. A minor viral infection—such as a sore throat—may cause the patient’s temperature to rise dramatically, while a more serious strep throat may produce only a low-grade fever. It’s important to keep track of all symptoms, not just body temperature, and to discuss them with your healthcare provider. Pediatricians categorize fevers as follows: 100° to 101.9° Low-Grade Fever 102° to 103.9° Moderate Fever 104° to 106° High Fever Taking Your Child’s Temp Feeling your child’s forehead is the least reliable fever detection method, but neither forehead strip thermometers nor pacifier thermometers are likely to give accurate readings. The accuracy of ear thermometers, despite their convenience, remains a subject of controversy. The best measurements come from a rectal thermometer or the new digital thermometers, which display readings in a minute or less and are recommended for infants and toddlers. Under-the-tongue digital models work well for children who are old enough to hold the thermometer in its correct position for the required time. How to Treat Fever First and foremost, increase your child’s fluid intake, since fever can cause loss of body fluids. Offer water, 100 percent juices, and natural broths. “I generally do not recommend placing your child in a cold bath,” says Lylan Park, MD, a pediatrician at St. Luke’s Hospital in Duluth, Minnesota, “because this will cause your child to shiver, thus increasing the child’s body temperature.” A combination of ibuprofen and acetaminophen used at intervals reduces fever. Do not mix the medications. Rather, start with a dose of ibuprofen and then three hours later administer a dose of acetaminophen, alternating each medication. Keep a written log of each dose to avoid confusion or overdosing. Too much of these medications can cause toxic effects on the liver and kidneys. Sleep is vital for healing! Don’t wake a sleeping child to give medication. Do check on the child, however, to be sure that no new symptoms (like labored breathing, color changes, or unusual rash) have appeared. Waking a child once during the night to make sure he can be easily aroused is reasonable. One message that has gotten through to parents is that they should not give aspirin to children under age 16. That’s because of its link to Reye’s syndrome, a rare but potentially fatal condition. Always call your pediatrician in the following cases: • If the child is less than two months old and has a temperature greater than 100° • If a fever has lasted more than three days • If your child has a fever accompanied by a sore throat, ear pain, abdominal pain, pain during urination, or a seizure • If your child has symptoms of dehydration, refuses fluids, or is producing decreased amounts of urine • If your child is unusually irritable, refuses to be moved, has symptoms of a severe headache, complains of a stiff neck, repeatedly vomits, or has an unexplained rash • If your child has a fever of 104° or more • If you are worried about your child’s activity level, behavior, or other symptoms • If your child continues to breathe rapidly even after the fever has been lowered.