Fever in kids serves as the number one reason why parents in my practice call or text me. It often causes them great concern, especially when the number on the thermometer pushes triple digits. Thankfully, as an at-home pediatrician, I have the ability to reassure parents via text or see their kids quickly when they are ill.
Often, most pediatricians don’t stress about fever in kids. At the same time, we definitely get concerned under certain conditions.
How is our body temperature regulated?
Fever happens when our body’s internal set point resets to a higher temperature. In humans, a small area in the brain known as the hypothalamus regulates body temperature. In kids and adults with normal brains, the hypothalamus keeps our body temperatures around 98.6 ° F. Some people have higher set points while others have lower normal body temperatures.
What is considered fever?
Fever is defined as 100.4 ° F or higher in any and every person.
Humans have variability in our body temperatures throughout the day. Our temperatures may be higher in the morning and lower towards the evening. Additionally, environmental conditions and physical activity also affect our body temperature.
In the setting of illness, the temperature control center moves the “set point” temperature higher. This allows the body to increase its temperature which gives our immune system a leg up in fighting the germ that it is after.
It is important to know that in a person with a normal brain, the fever “set point” doesn’t generally go higher than 105° Fahrenheit.
Higher body temperatures occur in the setting of external factors such as the environment. An example of this would be a child that is locked in a hot car. Their body temperature can get above 105 °F as their cooling mechanisms are overwhelmed by the high indoor temperatures.
When to Check for a Fever
There are certain times when it makes a difference in your child’s care to know their actual body temperature.
Most pediatricians recommend checking your child’s temperature anytime they look ill or telling you that they are not feeling well. For a baby, especially under the age of 3 months, you should check their temperature when they feel warm to your touch or are not acting themselves. Often babies get sleepy, fussy, or refuse to eat when they are sick.
In kids that are school-aged and fully vaccinated, the actual number on the thermometer rarely matters. Fever in these kids is just another symptom, like a runny nose or cough. It helps us, pediatricians, to put together a full picture of what is going on to know that your child has a fever, but the number rarely matters.
There are many ways to check your child’s temperature:
Thermometers come in all sorts of sizes, shapes, and configurations. Really any thermometer is fine in a child older than 3 months of age.
In babies, we want you to use a rectal thermometer as it is the most accurate way to take a new baby’s temperature. Beyond three months of age, the number itself rarely matters and therefore the accuracy of the thermometer is not as important.
Oral, axillary, and temporal thermometers have varying degrees of accuracy. It all depends on your technique for taking the temperature and the device itself. Infrared thermometers have grown in popularity since the onset of the COVID-19 pandemic. These types of thermometers also have varying degrees of accuracy. Often, they tend to lean towards the cooler side of temperatures and seem less accurate in most cases than other thermometer varieties.
Medical grade thermometers have improved accuracy, but for the average family, these are not necessary.
How High is Too High?
Most of the time, fever is fever.
I don’t get very stressed about what the number is on the thermometer. I care more about how your child is acting. If your kid has a temperature of 100.4 and is acting truly lethargic, difficult to wake up, or not responding, I am very concerned. But, if you told me that your three-year-old had a temperature of 103 and he is running around playing like nothing is wrong at all, I am less concerned.
When to See a Doctor
In infants less than 3 months old, any fever is concerning. A low temperature (usually below 97 ° F) is also concerning in a baby this young. This situation warrants a call to your child’s pediatrician, and they will most often direct you to the nearest emergency room. A young baby can be really good at hiding a serious illness and needs to be fully evaluated by a medical professional (physician) any time their temperature is high or low.
If your older child has a fever, it’s important to let your pediatrician know if they have certain symptoms. Feverish children with vomiting or diarrhea, earache, severe abdominal pain, headache, stiff neck, sore throat, trouble breathing, pain when urinating, swollen joints, other localized pain, and a purplish/dark rash that does not fade when you press on it, needs to be evaluated. Otherwise, kids with cough, congestion, and runny nose accompanying their fever can be safely observed at home for a few days before alerting your pediatrician.
When could fever signal a more serious condition?
Another time to call your child’s doctor would be if he or she is not drinking enough to urinate every 4-6 hours or if they are difficult to wake. If your child is not acting like themselves, especially when their fever is down, it is also best to alert your pediatrician.
Additionally, any time your parental instincts are telling you to be concerned, we want to know. Kids are most often fine until they are not. The vast majority of kids with fever have nothing concerning, but we always want to be able to care for the kids who don’t fit into the majority. We are trained to distinguish the difference.
Often fever will last 2-3 days with most viral illnesses. If your child has a fever longer than 5 days or if they have a fever for a few days that goes away and then comes back, your pediatrician should know. It doesn’t always signal a serious condition, but it is something that we want to be more vigilant about.
How do you treat a fever?
Fever-reducing medications are the mainstay of treatment. Acetaminophen or ibuprofen (in a child > 6 months old) are the two main medications. They come in liquid, chewable, and pills. Acetaminophen also comes in rectal suppositories and is especially helpful for kids who are vomiting. The dosing for these medications is on the box for older kids, but not for young babies. The doses are weight-based and you can ask your child’s pediatrician if you have any questions about how much to give.
I rarely recommend alternating acetaminophen and ibuprofen throughout the day. It is best to just pick one medication and stick with it if you are using it to treat fever. It is easier to miscalculate and give too much medicine if you are alternating than if you are just using one medication.
There are other non-pharmaceutical ways to treat fever as well. A cool bath, a cool compress or a tasty popsicle can help your child to feel better in place of medication.
Do I always need to treat my child’s fever?
Another way to treat a fever is to not treat it at all!
Kids who have a fever, but who are acting happy and playful don’t need to be treated. A fever is not dangerous and treating it with medication is not necessary.
And PLEASE do not wake a sleeping child to check their temperature and give them medicine. If they are sleeping through it, there is no need to get them and risk not being able to put them back to sleep. Rest is the best way for our bodies to fight a viral infection.
Fever phobia
As a parent, fever in kids causes great fear and trepidation. Hopefully, this article will help to put your mind at ease the next time your child is dealing with an illness.
© 127 Pediatrics; July 2022
Dr. Andrea Wadley is the owner, pediatrician, and breastfeeding medicine specialist for 127 Pediatrics. She has an established house calls only pediatric practice in Colleyville, TX. We also have an at-home pediatrician serving the Aledo area. Dr. Wadley sees patients all over Tarrant county for concierge breastfeeding medicine consults, lactation consults, fourth-trimester care, tongue tie clipping, and medical ear piercing.
