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Figuring Out Your Child’s Fever

Fever is the number one reason that children are taken to hospital emergency rooms. This is not surprising. Fevers are frequent in childhood, and they are often frightening to both parent and child. What follows is a set of questions and answers written to address that fear and to help parents know what to do when their child is hot.

Q: WHAT IS A FEVER?

A: A fever is a body temperature that is higher than normal ( 98.6 F or 37 C) as measured by a thermometer in Fahrenheit or Centrigrade degrees. Although they can help children to fight infections, fevers can also be uncomfortable and worrisome-depending on how high they climb and how old the child happens to be.

Q: HOW WILL I KNOW THAT MY CHILD HAS A FEVER?

A: Children with fever will feel hot and show certain changes in their behavior depending on their age. Newborns will be either fussier or sleepier than usual-or both; they will refuse the breast or bottle; and they are apt to have fewer, drier diapers than normal. Older babies and toddlers will be cranky, "clingy", and less energetic than usual. They will have no appetite but will seem especially thirsty. Finally, toddlers will either be quite listless and sleepy or very irritable and have difficulty falling asleep. Older children, over age 2, will be whiny and tired, will ask for drinks, and sometimes will complain of having chills or "hurting all over." If you note any of these changes in your child, no matter how old he is, it is smart to take his temperature.

Q: HOW DO I TAKE A TEMPERATURE?

A: There are so many different kinds of thermometer readily available for purchase at drug stores that it can be confusing to know which is best and for what age child. It might be smart to check with your pediatrician about her favorites especially since she knows your family well. Having said that, there are some tricks to choosing thermometers and to taking temperatures, as noted below:

o Best for Babies: A Rectal Temp
o Rinse your thermometer with cool water and then put petroleum jelly on the tip;
o With the baby on his tummy, put the thermometer into his rectum about one inch;
o Keep one hand on his back and the other holding the thermometer in place until it beeps.
o Expect your baby to cry but know that you are not hurting him; it is uncomfortable for him but not painful.

o Best for Preschoolers: An Axillary Temp
o Place the thermometer tip in your child's armpit and hold his arm next to his body until the beep.
o Axillary temps are usually about a degree cooler than rectal.

o Best for Big Kids: An Oral Temp
o Keep your child from drinking anything hot or cold for 20 minutes;
o Rinse the oral thermometer in cold water;
o Place its tip under your child's tongue until the beep.

If you take your child's temperature and then decide to call the doctor, make sure to explain what kind of thermometer you used. This will eliminate some of the confusion that sometimes arises about the reliability or meaning of a temperature reading. Also, please note that ear, pacifier and band-aid strip thermometers are not considered reliable for home use. Temporal artery thermometers are being developed, are expensive, and are still considered controversial.

Q: HOW CAN I HELP MY CHILD FEEL BETTER?

A: Fevers do not need to be treated, but children do. If your child is uncomfortable with his fever-feeling achy or having chills-then there are several tips to help him feel better.

o Give him medicine.
o Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) are highly recommended. Avoid aspirin, cold or cough medicine.
o Because Advil, Motrin and Tylenol come in many forms (like liquids or chewables) and many strengths, check with the pharmacist about the best choice and dose for your child. Generic medicines are fine and cheaper than "brands."
o Rectal suppositories are very helpful if your child is vomiting. Your pharmacist will have these behind his counter.
o Ibuprofen should not be used in children younger than 6 months or in dehydrated children.

o Give him a bath after giving him medicine as above.
o This is suggested for children with very high fevers and/or previous seizures with fever.
o The bath should be its usual warmth or slightly cooler, not frigid. Your child is not a polar bear!
o Do not add alcohol to the bath: alcohol can cause coma.
o Water evaporating from the skin cools your child. Gently wet (and rewet) his back and head with a washcloth to bring down his fever as he plays.

o Keep him cool.
o Dress him in a t-shirt or summer pajamas.
o Take the extra blankets off his bed.
o Make sure his room is cool.

o Give him extra drinks
o Fever increases your child's need for liquid.
o He is getting enough to drink if he urinates normally (wets his diapers well) and has lots of tears.

Many parents respond to their child's complaint that he feels cold by bundling him up, forgetting that his primary problem is fever. But he is already too hot! If your child has a fever, it is better to pretend that it is a hot summer day: water play, cool clothes and cool drinks will help bring down his fever.

Q: WHEN SHOULD I WORRY ABOUT A FEVER?

A: There are excellent pediatric guidelines about fever and when to worry as noted below. Call your pediatrician if:

o Your child's fever is over 100.4