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October 9, 2011 at 8:00 AMComments: 1 Faves: 0

When To Worry About A Child's Fever

By Jeffrey VanWingen M.D. More Blogs by This Author

Patients often call me with concerns about their temperature, but most of these calls result in reassurance about fever and there's no need for them to come and see me. 

You see, a fever is our body’s natural, healthy response to something amiss in our body.  The accepted definition of a fever is a body temperature at or above 100.4 degrees F (38 degrees C). 

What Causes a Fever in Child?

Fever occurs when an infection or an injury (known as a pyrogen) triggers an inflammatory response in our body.  In this response the hypothalamus signals the release of substances called "prostaglandins" which cause the body’s thermostat to rise. 

Different factors are responsible for different levels of response. 

A high degree of infection can lead to higher temperatures. A cold rarely causes a fever above 104 degrees F, but this is not uncommon for pneumonia and other non-infectious triggers. Overwhelming leukemia can cause temperatures in excess of 104 degrees F.

Teething can cause fever in infants, but will rarely produce a temperature above 101 degrees F. However, children are more sensitive in their fever response and are prone to higher temperatures for various triggers.

How Do I Take a Child's Temperature?

There are various ways to measure temperature in the body. 

THE TOOL YOU'LL NEED. While the gold standard tool is a mercury thermometer, use is waning due to health concerns over mercury.  Digital thermometers are now more common place. However, measuring a temperature is not an exact science and using a consensus between varied digital readings is fine.

WHERE TO USE IT.Once you've decided on your thermometer, there are also several options for where to take the temperature. Temperature can be measured in the ear (otic), arm pit (axillary), mouth (oral) or rectum (rectal).  The axillary temperature may be the most inaccurate and may be falsely lower than the true core temperature of the body.  It is common practice to drop a rectal temperature by one degree F. 

When Should I Worry About a Fever in a Child?

The following are reasons that a fever should generate significant concern: 

  • BEING BELOW TWO MONTHS OF AGE. Any infant below the age of two months with a fever should receive medical attention to address the possibility of sepsis (a systemic, overwhelming infection). 
  • NO EXPLANATION OR LONG DURATION. A fever that is unexplained, especially for an extended period such as two weeks or more, should prompt medical attention.  The list of causes of these “fevers of unknown origin” is broad and can range widely from a dental abscess to gout to malaria to cancer. 
  • ABOVE 104 DEGREES F. In regards to the magnitude of the temperature, I am usually more concerned about other symptoms in conjunction with a fever.  Yes, brain damage can occur with extremely high temperatures but this is exceedingly unusual with fever.  Scientific studies show that damage does not occur until the brain reaches 107.6 degrees F.  While this can occur in hyperthermia (exposure to heat), a fever rarely exceeds 105 degrees F.  To this end, I would recommend that a temperature above 104 degrees F should prompt medical attention.

If your child meets ANY of the above criteria, they should see their doctor as soon as possible.

Can Fever Be a Good Thing for a Child?

As stated above, extreme high temperature can be harmful in and of itself, but this is exceedingly uncommon in fever.  Should here are two sides to this issue. 

FEVER CAN FIGHT ILLNESS IN CHILDREN. On one side is the fact that a fever serves a purpose in the presence of infection.  Bacteria and viruses are thermally narrow in their ability to thrive and reproduce.  If the thermostat is raised, it slows an infection’s ability to progress.  Studies have shown that our white blood cells replicate quicker and are more effective at higher temperatures.  Thus a fever can help to combat illness. 

FEVER CAN BE UNCOMFORTABLE FOR CHILDREN.On the other side, fevers are uncomfortable.  Our body shakes in response to the fever in an effort to generate some heat.  More fluid evaporates from us as we radiate heat and we can get dehydrated.  Our hearts beat faster and we respire more making us feel exhausted.  Children are in general more fussy.  While higher fevers should be treated, treatment of more mild to moderate fevers is optional. 

How Do I Treat a Child's Fever?

Modern medicine first learned about treating fever from the Native Americans who chewed on White Willow bark.  This bark contains acetylsalicylic acid, otherwise known as aspirin. Today we additionally have acetaminophen and ibuprofen as fever reducers. Each of these medications works to hinder the process of the prostaglandin effect on the hypothalamus. 

ASPIRIN FOR A CHILD'S FEVER.In general, aspirin is not recommended in children due to the risk of Reye’s Syndrome.  If using a natural fever remedy for a child, make sure that it does not contain acetylsalicylic acid or White Willow bark.  

IBUPROFEN FOR A CHILD'S FEVER. Ibuprofen is no longer recommended in children under the age of six months. 

NATURAL REMEDIES FOR A CHILD'S FEVER. Other measures to treat fever include use of a tepid bath.  Make the bath at or slightly cooler than body temperature for submersion.  Fluid rehydration is very important with fever because of the risk of dehydration.  In fact, dehydration is the most concerning consequence of a fever in and of itself.

When faced with a fever, remember that it is a symptom of a problem and not the problem itself.  Treat the fever if it causes discomfort and seek medical attention if other symptoms warrant or if the fever persists. 

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1 Comment

  • Thanks Jeff, very informative

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