Many of the phone calls to our office during and after hours are from parents who are concerned because their child has a fever. A little information might make this common problem less anxiety provoking.
What is a fever?
A fever is a temperature over 100.4 and is the body’s protective response to an infection (a good thing). There are many ways to take a temperature but under three months of age, we prefer it taken with a digital thermometer rectally. Axillary or armpit temperatures are a good estimate of rectal temperature and can be useful after 3 months of age. They are abnormal if they are above 100.0. Though ear thermometers can be used for children over 6 months of age, they may be less accurate because of earwax. Simply touching the child’s forehead to assess fever can lead to both over and under estimating temperature and we do not recommend doing so.
Well, your child has a fever. What is your next step?
If your child is under 3 months of age, they will need to be examined immediately. An infant under 1 month of age will almost always be hospitalized for treatment and observation. For infants between 1 to 3 months of age, a careful examination and some testing may, or may not, result in a decision to observe the baby at home.
When infants and children are over 3 months of age, a fever means it is time for you to assess them. It will be reassuring if they are playful at times, if they are eating and sleeping normally, and have not been recently exposed to anyone with a known serious illness. However, you should contact your physician if your child is irritable or lethargic, short of breath, has a rash or signs of dehydration (dry mouth, less tears or decreased urine output).
You can choose to treat your child’s fever with medication. It will not treat the infection causing the fever, but may make your child more comfortable. Under the age of 6 months, only acetaminophen is approved for use. Over 6 months of age, you may use either acetaminophen or ibuprofen. We discourage parents from alternating these medications for two reasons. First, parents may inadvertently make an error that leads to the child receiving too much of a single medication. Secondly, we prefer that a parent’s efforts go more into assessing additional symptoms, than in trying to treat the fever.
Your child’s fever may or may not come down after giving these medications. Failure of the fever to come down is not, in of itself, a bad sign. Remember, it is much more important to contact your doctor when fever is associated with other symptoms of the child not doing well.
What can you expect from your doctor visit when you bring your child in with a fever?
Like all medical visits, your doctor will take a history and perform a thorough medical examination. Often this will result in a definitive or likely diagnosis. Other times, some medical testing may be needed. This could include:
- a throat culture to confirm or rule out strep throat
- a urine culture to rule out a urinary tract infection (especially in young children with high fever and no source of infection on examination)
- a chest X-ray in children with fever and cough
- a blood count (CBC) to assess the likelihood of a viral or bacterial infection
If the diagnosis is one of a bacterial infection, antibiotics maybe indicated. If the diagnosis is a viral infection, usually close observation is sufficient. Always remember to call back if the infection lasts longer than your doctor indicates it should, or if your child develops new symptoms.
For more information, visit www.essehealth.com.
By Pediatrician Richard Lazaroff, M.D.
Creve Coeur Pediatrics
11630 Studt Avenue, Suite 200
Creve Coeur, MO 63141