Dr. MJ Bazos MD,
Patient Handout
Fever in
Children
What is a normal
temperature?
A normal temperature is
about 98.6° when taken orally (by mouth). Temperatures taken rectally (by
rectum) usually run 1° higher than those taken orally. So a normal
temperature is about 99.6° when taken rectally. But temperatures may vary
several degrees during the day, even in healthy children. Many doctors define a
fever as an oral temperature above 99.4° or a rectal temperature above
100.4°.
What’s
the best way to take my child’s
temperature?
You may think you can tell
if your child has a fever by touching his or her forehead. But this isn’t
an accurate way to tell. Fever strips, which are placed on the child’s
forehead, are also not accurate. A new type of thermometer takes the temperature
in the ear. This type of thermometer works by “taking a picture” of
the infrared heat given off by the eardrum. The most accurate way to take your
child’s temperature is orally or rectally with a mercury or digital
thermometer. (Temperatures taken from under the arm are not as reliable.) In a
child younger than about 4 years, take the temperature rectally. In an older
child, take it orally.
Here are
some tips for taking your child’s temperature:
- A mercury thermometer should show a temperature
lower than 98.6° before taking a temperature. You can run cool water over
the red end to lower the reading. Some thermometers must be shaken to lower the
reading.
- Don’t bundle your baby or child up too
tightly before taking the temperature.
- Never leave your child alone while taking his or
her temperature.
- Be sure you use the right thermometer. Rectal
thermometers are thicker than oral thermometers.
- If you’re taking your child’s
temperature rectally, coat the tip of the thermometer with petroleum jelly
(brand name: Vaseline) and insert it half an inch into the rectum. Hold the
thermometer still for two minutes. Never let go of the thermometer.
- If you’re taking your child’s
temperature orally, place the end of the thermometer under the tongue and leave
it there for 2 minutes. Don’t let your child bite on the
thermometer.
- After you’re done using the thermometer,
wash it in cool, soapy
water.
When
should I try to lower my child’s
fever?
Fevers are more frightening than
they are harmful. They’re usually just a sign that the body is fighting an
infection. The main reason to treat your child is to make him or her feel
better. When your child is achy and fussy, you may want to give him or her some
medicine.
How much medicine
is needed to lower a
fever?
Acetaminophen (brand names:
Children’s or Infants’ Tylenol) is a medicine that relieves pain and
lowers fever. How much acetaminophen your child may need depends on his or her
weight and age, as shown in the chart below. When the age and weight don’t
match, use the weight of your child as the main guide in figuring out how much
acetaminophen to give. The doses in the chart may be a little higher than
what’s on the medicine package. If you have any questions about the right
dose, ask your family doctor. Be sure to read the directions on the label
carefully. Acetaminophen comes in different forms: drops, elixir, chewable
tablets and caplets. The different forms have different strengths. To get the
same amount of medicine might mean using 2 dropperfuls of the drops but 1
teaspoon of the elixir. The chart below gives suggested doses in milligrams
(abbreviated as mg). One dropperful equals 80 mg; one teaspoon equals 160 mg;
one chewable tablet equals 80 mg; one caplet equals 160
mg.
Age Weight Acetaminophen
dose(every 4 hours)
0 to 3 months
Less than 13 pounds Ask your family
doctor
4 to 7 months 13 to 17 pounds 80
mg
8 to 18 months 18 to 23 pounds 120
mg
1.5 to 3 years 24 to 32 pounds 160
mg
4 to 5 years 33 to 45 pounds 240
mg
6 to 7 years 46 to 61 pounds 320
mg
8 to 9 years 62 to 78 pounds 400
mg
10 to 11 years 79 to 98 pounds 480
mg
12 to 13 years 99 to 131 pounds 640
mg
14 years or older 132 or more pounds
640-1,000 mg
Ibuprofen (brand
names: Children’s Advil, Children’s Motrin) is another
pain-relieving and fever-reducing medicine. Talk to your family doctor before
giving this medicine to your child. Your doctor will tell you the correct dose
for your child based on his or her age and weight. Never give naproxen (brand
name: Aleve) or ketoprofen (brand name: Orudis) to your child unless your doctor
says it is okay, and then follow your doctor’s directions
carefully.
Why not use
aspirin to lower my child’s
fever?
Aspirin can cause Reye’s
syndrome in children who have the flu or the chickenpox. Reye’s syndrome
is a serious illness that can lead to death. Because it may be hard to tell if
your child has one of these infections, it’s best not to use aspirin
unless your family doctor says it’s okay. Acetaminophen is a safer choice
to use in children with a
fever.
Tips on giving
medicine
• Don’t give more
than 5 doses in one day.
•
Don’t give a baby younger than 4 months old any medicine unless your
family doctor tells you to.
• Read
labels carefully. Acetaminophen comes in different forms and strengths. Make
sure you are giving your child the right amount of
medicine.
• Fill the dropper to the
line when using drops.
• For liquid
elixir, use a liquid measuring device to make sure you give the right dose. Get
one at your drug store or ask your
pharmacist.
Are there other
ways to help my child feel better?
Yes.
Here are a few:
• Give your child
plenty to drink to prevent dehydration (not enough fluid in the body) and help
the body cool itself. Check with your doctor before giving your child special
rehydrating formulas, drinks or
popsicles
• Keep your child quiet.
Moving around can raise the temperature even
more.
• Keep the room temperature at
about 70° to 74°.
• Dress
your child in light cotton pajamas so that body heat can
escape.
• If your child is chilled,
put on an extra blanket but remove it when the chills
stop.
Will a bath help
lower my child’s fever?
Used
together, acetaminophen and a lukewarm bath may help lower a fever. Give the
acetaminophen before the bath. If the bath is given alone, your child may start
shivering as his or her body tries to raise its temperature again. This may make
your child feel worse. Your doctor may suggest giving your baby a sponge bath
after giving acetaminophen if the fever reaches 103° or if your baby or
child has ever had a seizure during a fever. In a few children, seizures can be
caused by a fast rise in temperature. Don’t use alcohol for baths. It can
be absorbed through the skin. Also, don’t use cold water. It can cause
shivering.
When should I
call the doctor?
A saying doctors use
is, “Don’t treat the thermometer, treat the child.” This means
that your child’s behavior is more important than the number on the
thermometer. You can follow the guidelines below to help decide when to call
your doctor, but it’s important to call your doctor whenever you feel that
your child needs help or if you have any questions.
- Under 1 month old. Call your family doctor
right away if your baby’s temperature goes over 100.4° rectally, even
if he or she doesn’t seem sick. Your doctor may want to see your baby and
may want to put him or her in the hospital to find out what’s causing the
fever. Babies this young can get very sick very quickly. Also call your doctor
if your baby has any of the warning signs listed on page 5, even if he or she
isn’t running a fever.
- 1 to 3 months old. Call your doctor if
your baby has a temperature of 101.4° (even if your baby doesn’t seem
sick) or a temperature of 100.4° that has lasted more than 24 hours. Also
call if your baby has any of the warning signs listed on page 5.
- 3 months to 2 years old. If your child has
a fever of 101.4°, watch how he or she acts. Call your doctor if the fever
rises or lasts for more than three days, or if your child has any of the warning
signs on page 5. If the temperature is 103°, call your doctor even if your
child seems to feel fine.
- Over 2 years old. If your child has a
fever of 101.4°, watch how he or she acts. Call the doctor if the fever
rises or lasts more than three days, or if your child has any of the warning
signs listed on page
5.
Call your doctor
if your child has any of these warning signs:
- Changes in behavior
- Constant vomiting or diarrhea
- Dry mouth
- Earache or pulling at ears
- Fever comes and goes over several
days
- High-pitched crying
- Irritable
- Not hungry
- Pale
- Seizures
- Severe headache
- Skin rash
- Sore or swollen joints
- Sore throat
- Stiff neck
- Stomach pain
- Swelling of the soft
- spot on the head
- Unresponsive or limp
- Wheezing or problems
- breathing
- Whimpering