As a pediatrician (and a parent), many of the questions parents ask regard fever: “how high is too high,” “why does my child have one,” “is it harmful,” and so on. This column will address the topic of fever, discuss what constitutes a fever, and hopefully dispel some of the myths which appear to persist.

A good start would be to describe why we get fevers, and how to interpret them. Our brains respond to a variety of signals induced most commonly by infection (viruses, bacteria, etc), very similar to the way in which a thermostat adjusts the warmth of our homes. It is believed that our bodies raise our central body temperature to create an environment that is unfavorable for bacteria and viruses to thrive in. When provoked, the portions of our brains responsible for temperature reset themselves to a different set-point, resulting in a higher core body temperature, i.e., fever. Shivering with a fever is one way our bodies try to radiate heat; it is no surprise that the Latin translation of “fever” is “to warm.”

Now that we know why we get temperature elevations, what exactly constitutes a fever? We have all been told that 98.6 is right smack in the middle of the normal range. However, not all people (adults and children alike) have this as their “baseline” temperature- in fact, normal core body temperatures range from 96.8 to greater than 99, with kids tending toward a higher value as compared to adults. Although most of us probably do not know our children’s baseline temperature, it is helpful to be aware of these ranges. One standard we cannot waver from pertains to infants 3 months of age and under: if your baby is in this age group and feels warm to the touch, take his/her temperature with a rectal thermometer only; if it is 100.4 or greater, please call us immediately! Always take the temperature RECTALLY. A fever (defined as 100.4 degrees Fahrenheit or greater) in this age group can have significant implications for the baby being evaluated expediently, and possibly their treatment plan as well. To take a rectal temperature, lubricate the end of the thermometer (glass or digital) with Vaseline, insert it approx. ½ inch, and hold it in place for 2 minutes. Warning: baby’s rectums are very sensitive to this type of stimulation, so keep their bottoms covered if you can.

For the vast majority of infants and children, fever in and of itself is NOT harmful; rather, fever is a good sign that a healthy immune system is up and running and doing its best to fight off an infection (usually viral in nature). Fever (of any magnitude) is NOT associated with learning disabilities or brain damage. Every child has his or her own unique “thermostat,” that is, healthy children will likely demonstrate differing temperatures when afflicted with the same “bug.” One of the central reasons for treating a fever is to provide comfort to your child; remember the last time you had a fever of 100.7, and you thought there was no way you could feel any worse? Children have far more fever associated episodes, and it is amazing how well they tolerate them. A key point to remember is to evaluate the fever in the context of the child who houses it, i.e., how does you child appear (for children greater than 3 months of age).

Recently, several new methods of taking temperatures have evolved. Whereas temperatures used to be taken only orally or rectally, now we can place a probe in the child’s ear (more on this later) or stick an adhesive strip to their forehead to determine if a fever is present (this latter method is essentially worthless). The gold standard is still rectal; however, this is not always the most practical or well received route. As kids get older, they are “easier to read” and are more verbal; therefore, we as parents rely on other signs in addition to fever to decide how sick they are and our “comfort level” increases. Typically, the axillary (armpit) route is good for kids 1 year and up, and you can use either a rectal or oral thermometer. Hold it snug against your child’s body for about 2 minutes; this is usually about 1 degree lower that a rectal temperature, but may vary by up to 2 degrees. The oral route is utilized in children 6 years or so and up, but the child must be cooperative to do so; these reading are approximately ½ degree less than what you would find rectally, but can vary by up to 1 degree.

Parents-to-be are often bombarded with a litany of shower gifts, including the tympanic (ear) thermometer. This is a nifty device, but has no place in infants less than 6 months of age, and possibly up to 15-18 months of age. This tool relies upon a beam of light transmitted to the ear drum (tympanic membrane) in a straight, unobstructed line. An infant’s ear canal is tortuous, i.e., it twists and bends, making it difficult to get a “clear shot” at the ear drum, and subsequently an accurate temperature. This piece of equipment may be of value later in your child’s life, but not in infancy. Again, if you believe your infant may have a fever, please take their temperature rectally.

So when should you call the office? In general, fever is NOT an emergency (unless associated with the signs and symptoms listed below) and does not require a call or a visit. The majority of children who have a fever can be appropriately treated at home utilizing basic comfort measures (please see our chart detailing the weight appropriate doses of acetaminophen (Tylenol) and Ibuprofen (Motrin, Advil)). There are, however, a few exceptions which should prompt a call to our office immediately. As stated previously, those infants 3 months of age and younger who have a rectal temperature of 100.4 or greater must be brought to our attention immediately. Also, those children with a fever and a tiny pinpoint rash which does not fade when pressure is applied should also prompt a call to our office. Other than these two patient types, a few tips and a parent’s knowledge of their child will typically result in a more comfortable child.

The most important aspect is not the height of the fever but how your child looks and acts. If your child is acting “himself” then he is likely to not be uncomfortable and does not necessarily require Acetaminophen or Ibuprofen. On the other hand, if your child is quite uncomfortable or “grumpy” with a low grade fever, by all means give him a weight appropriate dose of either of these medications. Acetaminophen and Ibuprofen typically take 20-30 minutes to begin providing benefit, with their peak effects at approximately 45 minutes after administration of the dose. The vast majority of children will look and act more comfortable once their fever has been reduced. However, giving either may not render your child entirely fever-free.

Many children will have a decreased or no appetite when they have a fever. This is OK, as it is more important to assure that they are drinking adequate amounts of fluids, especially in infancy. A good way to assess this is by keeping an eye on the number of wet diapers they are having; if they have not had a wet diaper in an eight (8) hour period of time, please give our office a call. If an older child will not drink and/or has been making fewer trips to the bathroom to urinate, please give us a call so that we may discuss strategies for dealing with this.

Fever is one of the most common reasons why children are brought to the attention of their pediatric health care practitioner, yet the vast majority of cases are viral in nature and will resolve on their own. The main reason for treating fever in children is to make them more comfortable- they are no less entitled to pain control than adults are. The dosing charts for Acetaminophen (Tylenol) and Ibuprofen (Motrin, Advil) are easily found on our practice website (www.charlottekidsfirst.com), to assist parents in providing the proper dose of medication at the proper frequency to ensure that your child is kept comfortable during a febrile episode.