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Fever

Fever in Babies 3 months old or younger

In young babies the cause of a fever is difficult to determine. Children under I month of age or who weigh under 10 pounds should be evaluated promptly by a physician or nurse practitioner for rectal temperatures of 100.5o or greater (99.5o or greater under the arm). A rectal temperature of 101.5oF (100.5o under the arm) in an infant 2 or 3 months of age also needs a prompt evaluation. Whenever possible, check a rectal temperature on an infant, as it is the most accurate. Ear thermometers are not very reliable in children under one year of age. Pacifier thermometers or temperature tapes applied to the forehead are also not accurate.

Fever in Older Babies and Children

Fever is a sign that the body is fighting infection. Fever is rarely dangerous and it is extremely useful in that it alerts us to the fact that an infection is present. Uncontrolled high fever can cause a convulsion, but this is an unusual occurrence.

Normal body temperature varies daily, roughly between 97.5o and 100.5o. When you report fever, please give actual numbers on your thermometer and how the reading was taken. Most low fevers are the result of minor viral infections, heavy clothing, high outside temperatures, or, occasionally, teething. High temperatures (103o or more) usually mean a more serious infection is present and require an office visit. A thermometer, if properly used, is accurate. Do not depend on the warmth of the child's skin to tell you if fever is present. Studies have shown that the skin temperature is less than 50% accurate in determining fever. If you do not know how to use a thermometer, be sure to ask a member of our staff to teach you.

Many authorities say that nothing should be done for fever. It is a symptom which should be observed. While most physicians do not agree with this opinion, they do believe that fever by itself is rarely dangerous. If you do give medicine to treat a fever, use acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Do not use aspirin, even baby aspirin, for children as aspirin use has been associated with a rare but very serious illness called Reye’s Syndrome. Remember that fever medicine will lower a child’s fever a by a degree or two, and the child will likely feel better, but the fever will probably not go away completely.

Fever drives parents crazy. Parents' most common fears are brain damage and seizures. Brain damage, when it occurs, is usually due to whatever initially caused the fever, such as heat stroke, dehydration, aspirin poisoning or meningitis.

Seizures may be related to fever. However, 50% of fever-related seizures occur as the temperature is rising during the early stages of an illness. In these children, by the time parents note the fever, the seizures have already occurred. Most other fever-related seizures occur in children with a temperature over 102.5o (taken under the arm) or in a child who has had febrile seizures in the past.

Whether to do anything about a fever is often determined by other factors related to an individual child's illness. If there are no other symptoms and your child is watching T.V. or playing, nothing needs to be done. On the other hand, if a child is delirious, screaming and/or incoherent, we trust that no parent would do nothing about that fever. Notice that we did not mention the degree of fever as this is not the issue. The issue is how the fever, no matter how high or low, affects your child.

When considering the importance of fever, a parent and doctor must consider the other problems which may be occurring at the same time - rash, cold, diarrhea, sore throat, child's age, a relative's or a friend's contagious illness, headache, stiff neck, and time of the year or day and so forth.

Sponging

Sponging is a time-honored method to reduce your baby's temperature. It requires time and patience to do it well. We will not go into "don'ts" about sponging but we will mention one. Do Not use alcohol. The alcohol available is rubbing alcohol and its use can cause serious problems.

When you do sponge to reduce fever, it is not the lower temperature of the water that reduces your baby's temperature. It is the evaporation of water which does it. Picture yourself running from the shower for the telephone, or swimming on a windy day and you will know what is meant.

The smaller a child is the more effective sponging will be. If your child is 10 pounds, your baby's temperature can easily become subnormal. if your child is over 30 pounds, sponging becomes less effective unless your child is thin.

When sponging, use tepid or lukewarm water. Cold water can cause shivering which in turn may raise the body temperature. When you sponge your child, set him or her in a shallow tub of water or on your lap. Wipe all exposed parts of the body. Wait until the skin is almost dry. This usually takes 2-3 minutes. Wipe again. Repeat this procedure for at least 30 minutes and take the temperature again. If the temperature is not less than 102o, continue for 15 more minutes and stop. You have all had enough for a while. If your child is acting sleepy or “out of it” do not put him or her into a cool bath, especially if there is a chance that you will not be continuously present, as this can be a drowning hazard.

It is recommended that if you need to sponge your child give Ibuprofen just prior to sponging. Also, if your first attempt is not successful, try using a fan so that the water evaporates faster.

If after all this work your child's symptoms have not diminished, or you cannot lower the temperature, you need to call for help.
The Clinitemp Tape and the Thermoscan ear thermometer, which are presently popular, tend to be unreliable, especially in infants, and should not be used unless there is no alternative. Glass and mercury thermometers can be difficult to read, and are becoming difficult to obtain due to safety concerns. A simple digital thermometer often works best and is inexpensive.

Suggestions

1. Encourage your child to drink plenty of cool liquids (water, tea, Gatorade, juice, caffeine-free soft drinks).

2. Keep your child cool. Use a minimum of clothing.

3. Always take temperature every 4-6 hours when giving medicine.

4. Thermoscan not recommended for ages 1 year or younger.