What are signs that my child may have a fever and when should I be checking for a fever?
We recommend looking at the whole picture of a child, including how they’re acting. You only need to check a child’s temperature is if they look sick or if they are feeling really warm. The way most people check for a fever in a child is to feel their forehead. We recommend all new parents have a thermometer – that’s the one thing parents should come home from the emergency department with. A lot of times a child may feel warm, but their temperatures are okay. I do want to draw a clear line, though, that in older children, fevers can often be managed at home, but in babies, especially in those less than three months old, a fever higher than 100.4 or less than 97 degrees can be an emergency and the pediatrician should be called immediately.
What is the best way to take an infant's temperature, and a child's temperature? What is considered a fever?
I recommend downloading Washington University’s Kid Care app. It’s free and available on iPhones and Androids. It’s really easy to use. It contains a section on the most reliable way to take a temperature. In babies, the most reliable way to take a temperature is rectally. In older kids, you can use the forehead thermometers – they are fairly accurate. It’s been shown that taking it under the tongue in older children is also very reliable. The new thermometers are safe to have around the home and don’t contain mercury like the older thermometers do.
Usually, pediatricians consider a true fever to be anything over 100.4.
Are there treatments at home that I can give my child, like over the counter medications?
Absolutely. Sometimes a dose of Tylenol or Motrin can make all the difference in how a child’s feeling. One thing I see all the time is how miserable children feel when they have a fever. Children get in a cycle where their fever makes them feel awful, that means they don’t want to drink fluids, that makes them feel worse, then they have less energy and get even more dehydrated. One of the first things we do in the emergency department is give them a fever reducer. A lot of times their fever will start to wane and they’ll take an interest in drinking fluids again. For kids, especially young ones, you have to go by their weight to determine the right dosage. You can find the dosage on the Kid Care app, but you can also call your pediatrician’s office and the nurses have a weight-based dosing system, and they can tell you over the phone how much medicine you should give your child.
What other conditions should be considered? (fluids, wet diapers, skin color, etc)
For me, it’s hydration, hydration, hydration. You have to look at the whole picture of how kids are doing, and keeping the child hydrated is the cornerstone of that and managing them when they have fevers. As long as kids are drinking enough to make 4 wet diapers a day, they are probably hydrated enough that if they came to the emergency department, we wouldn’t need to give them IV fluids.
Look for other signs – are they tugging on their ears, indicating there may be an ear infection? Are they having a stomach ache, or is it in their lower right part of their belly, which could be appendicitis? Is the child vomiting or exhibiting flu symptoms? Really, keeping them hydrated with popsicles, Pedialyte or juice is the most important way to keep them healthy when they have a fever.
Are fevers always a bad sign?
No, a fever is not always a bad sign. It’s a sign that your child’s immune system is working and fighting off an infection. I recommend to parents that if your child feels warm and is running a fever, but they are still drinking great and running around and feeling okay, you don’t even have to give them the medicine. It’s really about how they’re acting overall. But for babies less than three months old, temperatures higher than 100.4 or less than 97, those are the ones to call your pediatrician about and probably the baby will need to go to the emergency department to be evaluate.
I know children who have experienced febrile seizures. Can these be prevented? If they happen, what are the best steps to take?
Febrile seizures are so scary for families. Children are at higher risk for febrile seizures if they have a family history of parents or siblings that have seizures. Studies show that with kids that have febrile seizures, it’s not the fever that causes the seizure, it’s the illness itself. So there’s not a great way to prevent the seizure except to practice good hand hygiene and keeping the child away from other sick kids. It’s very reasonable to do Tylenol or Motrin for those children. I would say that in otherwise healthy kids, fevers higher than 105 can be dangerous and you should talk to your pediatrician.
In general, when a child is having a seizure, have someone call 9-1-1. Make sure your child is breathing and place them on their side. Don’t put anything in their mouth. In most cases, febrile seizures will stop on their own. I recommend taking CPR classes – even if you never use it for your child, you may be able to help someone else’s child in a scary situation.
When it is best to call the doctor or take my child to the emergency room?
We’re really fortunate to have a lot of great pediatricians in our area. I recommend that the first thing parents do is call their pediatrician’s office. Sometimes they can schedule the child for an appointment, or they may say to take the child to the emergency department. I’m happy to see the children and help them feel better.
Dr. Valerie Gribben is a Pediatrician from St. Louis Children’s Hospital and Washington University in St. Louis, seeing patients in the Progress West Hospital Emergency Department, inpatients and nursery.