Pediatricians deal with fever probably more than any other symptom.  Fever is the most common source for parental anxiety, office visits and after hour phone calls. The following tid bits may be helpful in getting parents through an illness with fever as a symptom.

          We are frequently asked the best method for taking a temperature.  No method is actually the best; a rectal temp can measures the temperature of the stool, a tympanic (ear) thermometer measures the temperature of the eardrum (if placed in the ear canal correctly), an oral temp is not accurate if the child does not have the mouth tightly closed, and a forehead strip temp is completely unreliable.  Thus, none of these is the best, yet taking a temp gives you a general idea if fever-control is needed.  By the way, a fever is a temperature of 100.4 degrees or higher; under that number is NOT a fever.    In young infants, less than 4-6 months of age, we recommend a rectal temperature and in older infants/toddlers an ear temperature is usually adequate.

            Here are a few things to remember about fever. The ONLY exception to these is an infant under two months of age (especially under one month of age): a temperature, taken rectally, of 100.4 or higher, constitutes an emergency call and visit to our office or emergency room that day.  If your infant or child is greater than two months of age, remember the following:

1)  Fever is our friend!  Fever is a symptom that helps to identify a disease, usually an infection (and almost always a self limited viral infection).

2)  Fever helps the body fight infection.  It does some wonderful things in terms of our ability to fight these illnesses.  Lymphocytes and white blood cells work better, and track to the site of infection much better in the presence of fever.  Fever “kick-starts” the body’s ability to fight disease.

3)  Fever is NOT HARMFUL!

4)  Fever does NOT cause brain damage.

5)  Fever alone, with no “other symptoms”, may be tolerated for 48 – 72 hours before needing an office visit.  (“Other symptoms” include cough, congestion, fussiness, irritability, difficulty sleeping, vomiting, or specific pain complaints such as ear pain, throat pain, or headache.)

6)  Fever may increase a child's loss of water through their skin, so most importantly is to watch for signs of dehydration and offer lots of fluids to orally rehydrate your child.

WHAT TO DO ABOUT A FEVER?

--DON’T  ALTERNATE  ACETAMINOPHEN (Tylenol) and IBUPROFEN (Motrin or Advil) even for what you think is a “high” fever.  Regardless what you may have heard in the past, this method of fever control is NOT RECOMMENDED.  Please start with the dose of Tylenol appropriate for your child’s weight (always indicated in a chart on the back of every “well-child care sheet” given out at your child’s checkup from our office).  Acetaminophen dose is 15mg/kg of weight, given every 4 hours.  Ibuprofen is 10mg/kg every 6-8 hours.  Continue using the same medicine, and again, do not alternate.  Medicines in excess can have liver and kidney side effects and alternating increases the chance of an error.

--Hydrate!  Increase fluids by more than twice normal intake.

--Decrease a child’s activity

--Don’t over-dress (or under-dress)

--You DON’T have to re-take the temperature to see if the medication is working.  The goal of medication is to make/keep your child comfortable, and not necessarily to bring down the temperature.