One morning your five-year-old seems unusually sleepy, although usually an early riser. You notice that she feels warm to the touch, so you take her temperature. The thermometer reads 102 °F. What should you do?
First, it is important to understand what a fever is and what it is not. A fever is defined as an elevated temperature reading of 100.4 °F or higher. A rectal temperature of 103 ° or an oral or ear temperature of 102 ° is considered a significant fever.
When something is wrong, usually an infection within the body, the hypothalamus at the base of the brain acts as a thermostat, increasing the body’s temperature. However, the degree of a fever is not necessarily indicative of how sick a person is. A fever is rarely harmful; in fact, it plays a key role in fighting against infections.
Because the fever itself is not a disease, some doctors do not recommend any treatment of fevers under 102 ° unless the child exhibits discomfort or irritability. The main reason for treating a fever is not so much to bring it down (thus defeating its purpose of fighting infection) but to make the child as comfortable as possible.
This can be achieved by making sure that the child is not overdressed or resting in an overheated room. Remove extra clothing and dress the child lightly, using only a sheet to cover, and cool the room as needed. Give the child plenty of cool fluids to bring down the fever and to avoid dehydration. The child may be given a sponge bath using lukewarm (not cold) water to help lower body temperature, especially if she has a history of fever-related convulsions or seizures.
Over-the-Counter Fever Reducers
For a fever of 102 °F or higher, acetaminophen or ibuprofen may be given to reduce the fever. Follow the directions carefully, continuing to monitor the child’s temperature, and repeating the dosage only as necessary to control the fever. Do not give ibuprofen to children under six months of age. For infants under the age of three months, call the doctor when her temperature reaches 100.4 °F or before giving any fever-reducing medication including acetaminophen.
Important: Never give aspirin to a child with a fever or an illness such as chickenpox, flu, or any other suspected viral infection. Aspirin is associated with a rare, sometimes fatal disorder called Reye’s Syndrome.
When to Call the Doctor
A fever is a symptom of a viral or bacterial infection and is an indication that the body is reacting to it normally. As the child rests comfortably, the fever will often run its course; in fact, a feverish child may eat, sleep, and play normally. However, it is important to closely monitor the child’s condition and call the doctor in the event of any of the following symptoms:
A fever of 100.4 °F or greater in a child younger than three months.
A fever of 102 °F or higher in a child older than three months, or a fever that lasts longer than 48 to 36 hours.
A fever that is accompanied by unusual or persistent whimpering or crying.
A fever accompanied by other symptoms such as vomiting, diarrhea, a stiff neck, or skin spots or rash.
Difficult, noisy, or labored breathing; blue lips; a hacking cough; or thick yellow or green mucous
Tugging or pulling at the ears, or inability to swallow.
Loss of appetite, especially clear liquids, and fewer wet diapers than normal.
Any time you feel uncomfortable with your child’s appearance or behavior.
Fever convulsions or seizures, sometimes called fits, are not uncommon in children ages six months to five years old. Caused by a rapid rise in body temperature, seizures can last less than a minute to five minutes or longer. Signs of a seizure include involuntary movements of the extremities, glassy or rolled-back eyes, drooling, difficulty breathing, and unconsciousness.
In the event of a seizure, take immediate action to protect the child from injury and to cool her down. She should be placed on her side to prevent breathing in vomit, and if the seizure is severe or lasts longer than a few minutes, call 911 or rush the child to the emergency room.
A seizure that is brief or mild may be harmless, but a serious condition such as meningitis must be ruled out. Contact the doctor for an immediate appointment as soon as possible; do not delay.
Childhood Illnesses Marked by Fever
When a child has a fever, the underlying reason may be a simple cold or flu or other viral infection that clears up on its own. Indeed, you may never know what caused the fever before your child is up and feeling perfectly normal.
However, there are many childhood illnesses that are symptomatic of fever including chickenpox; croup; ear infection; German measles; hand, foot, and mouth disease; measles; mumps; rheumatic fever; strep throat; and whooping cough. It is important to watch for any of the symptoms noted above, as these may be signs of serious illness.
Other Causes of Fever
Although a temperature of 98.6 °F is considered normal, there is usually no need to worry if a temperature ranges from 97 °F to 99 °F. In addition, a fever of up to 100.4 °F may normally occur after strenuous exercise or in overdressed infants and children. Body temperature also varies with age, activity (or lack thereof), and can be lower in the morning and higher in the late afternoon.
Beware, however, if your child’s temperature climbs as high as 105 °F during a hot summer day or sitting in a closed vehicle or another hot place. This is not a true fever but a dangerous condition called heat stroke, which requires immediate medical attention.
So, getting back to our feverish five-year-old
Make sure she is not dressed too warmly. Cover her lightly with a sheet, and ventilate the room if necessary. Give her a clear cold drink such as water or apple juice and encourage her to drink it throughout the day. Let her rest comfortably.
You may wish to call the doctor, or you may wait until later in the day to observe her further. Does she have an appetite? Is she lethargic or listless, or does she want to get up and play? Does her temperature remain constant, or does it change?
It is not always easy to determine the source of a fever. That’s why it is so important to know what other types of symptoms to look for and when it’s time to call the doctor. Remember, when the symptoms of an illness are caught early, treatment can begin sooner.