INSIDE
1 Understanding Fever
and Fever Fears
2 Treatment of Fevers
3 How to Measure Body
Temperature
4 Medication Dosing
Insert
Medication Dosing Chart
and
When to Call the Pediatrician
Fever - an increase in body
temperature - is one of the body's
normal defenses against attack
from an infection or another
disease. It is therefore a symptom,
not a disease itself.
A part of the brain that acts as
the body's thermostat controls body
temperature by balancing hot and
cold signals throughout the body.
Factors that influence body
temperature are infections; vaccines
and medications; and injury. Body
temperature increases also occur
with exercise, excessive clothing, a
hot bath, or hot weather.
Fever may actually play a role in
fighting infections and shortening
their course by turning on the
body's immune system, thereby
increasing the release and activity
of white blood cells and other
germ-killing substances. The usual
fevers (100° to 104°F) that all
children get are not harmful. Most
are caused by viruses and may last
3 to 5 days. In general, the height
of a fever doesn't relate to the
seriousness of the illness. How sick
your child acts is what counts, and
that should determine whether he
or she needs a doctor's attention.
Dear Parents,
Fever is probably the most common of all pediatric complaints, affecting millions of infants and children throughout childhood.
While many of you may become concerned, even anxious, when your child develops a fever, you can be reassured that this most
natural of symptoms usually indicates that your child’s immune system is alive and functioning well.
This brochure was designed to put fever in perspective by providing you with the facts about fever and some helpful advice on
fever management. We hope that the content will be both informative and useful, empowering you to take charge of your child’s
fevers whenever they arise.
Understanding Fevers
Fever Fears
The following are some
commonly held fears regarding
fever:
• MY CHILD WILL HAVE A
CONVULSION (SEIZURE)
WITH FEVER.
Only a small percent of children
have a seizure caused by a fever.
These usually occur in children
between 6 months and 6 years of
age. It is not only the height of the
fever but also how rapidly the
temperature rises that puts a child
at risk for a seizure. Although these
seizures are frightening for parents,
they usually are without serious
long-term consequences. If you
think your child has had a seizure
during a fever, you should call your
doctor
immediately. If
your child has had
a seizure from a
fever, your doctor will
discuss strategies
to help you
avoid
future
sudden
high
fevers.
• HIGH FEVER IS A SIGN
OF MENINGITIS.
Meningitis can cause a high fever,
but meningitis is very rare. The vast
majority of high fevers are caused by
common childhood illnesses that are
not dangerous.
MEDICATIONS
Remember that fever is helping
your child fight infection, so use
fever medications only if the fever
is in the moderate range (over
102°F) and your child is uncomfortable.
In general, fever
medications are overused, and, as
with all medications, there is a risk
of dangerous side effects from
giving them too frequently. Simply
undressing the child and offering a
cool drink can reduce mild fevers. If
fever medications are to be used,
be sure to give the correct dosage
for your child's weight and within
the appropriate time interval. The
table included in this brochure
provides all the information you
will need about medication dosing.
Fever medications usually work
within about an hour after they
are given and will reduce a fever
by 1.5 to 2°F. Don't expect the
medication to bring the
temperature down to normal
unless the fever was low-grade to
begin with. Repeated doses may be
needed to manage fever
fluctuations as the illness runs its
course, which may take several
days. If your child is sleeping
comfortably, it is not necessary to
awaken him to administer a fever
medication. If the fever is high
enough to require medicine, your
child will usually awaken on his own.
Remember that the response, or
lack of response, of the fever to
fever medication tells us little
about the severity of the infection
that caused it. If your child is
smiling, playing, and drinking
adequate fluids, you usually do not
need to worry about the fever.
• ACETAMINOPHEN PRODUCTS
(TYLENOL, TEMPRA)
Children two months of age
and older can be given one of the
acetaminophen
products for fever. Give
the correct dosage for
your child's weight
every 4 hours but not
more frequently.
Remember that these
products are made in
several different
strengths (infant's and
children's) and
formulations (liquid and tablets), so
be sure to choose the appropriate
product for your child's age. For
assistance in determining the
correct dosage, see the dosing
table included in this brochure.
• IBUPROFEN PRODUCTS
(MOTRIN AND ADVIL)
Children six months of age and
older can be given one of the
ibuprofen products. Like
acetaminophen products, ibuprofen
comes in several strengths and
formulations, so be sure to choose
the appropriate product for your
child's age. As with acetaminophen,
ibuprofen should be used only if
the fever is over 101.5°F and your
child is uncomfortable. Ibuprofen is
longer acting than acetaminophen
and should be given every 6 to 8
hours but not more frequently.
Again, see the table included in this
brochure for assistance with dosing.
• CAUTIONS ABOUT ASPIRIN
The American Academy of
Pediatrics has advised that all
children (through 21 years of age)
not take aspirin products. This
recommendation is based on
several studies that have linked
aspirin to Reye's Syndrome, a rare
but serious disease affecting the
brain and liver following viral
infections. Most pediatricians have
stopped using aspirin for fevers
associated with any illness.
Treatment of Fevers
CLASSIFICATION OF FEVERS*
MILD: 100°F - 102°F
MODERATE: 102°F - 104°F
HIGH: >104°F
(*rectal temperature)
Please note: If your child is 3 months of age or less, a
temperature of 100.4°F or greater (taken rectally or
under the arm) is considered a high fever, and you should
call your doctor immediately. See insert for other
symptoms associated with fever that would require a call
to the doctor.
Obtaining an accurate
measurement of your child's
temperature with a thermometer
requires some practice. If you have
questions about this procedure, ask
your pediatrician or office nurse to
demonstrate how it is done and to
observe you taking your child's
temperature.
A rectal measurement is the
most desirable and the most
accurate, especially in an infant,
because it reflects the body's
central ("core") temperature. Oral
temperatures are also reasonably
accurate if performed properly.
Axillary (underarm) temperatures
are the least accurate, but better
than no measurement at all.
TYPES OF THERMOMETERS
1. Digital--These record
temperatures with a heat sensor
that runs on a small battery. They
measure quickly, usually in less than
30 seconds, and can be used for
rectal, oral, or axillary readings.
They usually "beep" when the
measurement is complete, and then
display the temperature in numbers
on a small screen. These
thermometers are inexpensive and
are recommended as the most
reliable by pediatricians.
2. Glass--These come in two
versions, rectal (with a round tip)
and oral (with a thinner tip)
although they can be used
interchangeably if well-cleaned,
and can also be used under the
arm. They are the least expensive
type of thermometer but also the
slowest (usually requiring two to
three minutes for a measurement)
and the most difficult to read.
Mercury thermometers should not
be used. We encourage parents to
remove mercury thermometers
from their homes to prevent
accidental exposure to this toxin.
3. Ear Thermometers--These are
infrared devices that read the
temperature of the eardrum, which
provides a measurement that is as
sensitive as a rectal temperature.
Although they are the fastest
reading thermometers (less than
two seconds), they are expensive
and often inaccurate and therefore
unreliable.
4. Other thermometers--Liquid
crystal strips and temperaturesensitive
pacifiers have been found
to be inaccurate and unreliable and
should be avoided.
SPONGING
Although helpful, sponging
(artificially cooling the skin surface)
is usually not necessary to reduce
fever. Never sponge your child
without first giving a fever
medication. Sponge immediately
only in emergencies such as heat
stroke, delirium (acting very
confused) from fever, a seizure
from fever, or any fever greater
than 106°F. In other cases, sponge
your child only if the fever is over
103°F, the fever has stayed that
high when you take the child's
temperature 45 minutes after
giving medication, or your child is
uncomfortable from the fever. Until
the medication has taken effect (by
resetting the body's thermostat),
sponging will only cause shivering,
which is the body's attempt to raise
the temperature.
If you choose to sponge your
child, use lukewarm (85-90°F)
water. Sponging works much faster
than immersion, so seat your child
in about two inches of lukewarm
water and wet the skin surface
continually over about 20 minutes.
If your child shivers, warm the
water slightly, or wait for the fever
medication to take effect. Your
goal should be to reduce the fever
by a few degrees, not to eliminate
it entirely. Never use rubbing
alcohol either alone or in the
sponging water. The skin can
absorb it, and it can cause coma if
inhaled. And please remember
never to leave your child
unattended in the tub.
EXTRA FLUIDS
Because body fluids are lost
due to sweating during fevers,
encourage your child to take some
extra fluids to replace those losses,
but do not force him to drink. Your
child may especially prefer popsicles
or iced drinks during the fever.
LESS CLOTHING
(BUNDLING CAN BE DANGEROUS)
Since most body heat is
eliminated through the skin
surface, your child's clothing
should be kept to a minimum
during a fever. Bundling a child can
cause a higher fever; be especially
careful with infants who cannot
shed extra layers if they become
overheated. During a fever,
dressing the child in a single layer
should be adequate. If at any time
your child feels cold or develops
shivering ("the chills"), offer a light
blanket or a warm drink.
How to Measure Body Temperature
RECOMMENDATIONS BY AGE
FOR THERMOMETERS*
Newborn to three years - digital
rectal (measure axillary
temperature if unable to take
rectally)
Over three years - digital oral,
axillary, or rectal
*Ear thermometers, though
frequently unreliable, can be used
in children 18 months of age and
older. When using this type of
thermometer, two consecutive
readings may help to ascertain
reliability.
TAKING THE TEMPERATURE
WITH DIGITAL AND GLASS*
THERMOMETERS
1. Rectal
- Have your child lie stomach
down on your lap.
- Apply a small amount of
lubricant (petroleum or KY jelly)
to the tip of the thermometer.
- Gently insert the thermometer
past the anus into the rectum
about 1/2 to 1 inch; never force
it in. Hold your child still until
the digital thermometer "beeps"
or the glass thermometer takes
the reading (one to three
minutes.)
2. Axillary (Underarm)
- Place the tip of the thermometer
in a dry underarm.
- Close the underarm by holding
the elbow against the chest for
three minutes (for glass
thermometer) or until the digital
thermometer "beeps."
- If you're uncertain about the
result, compare it with a rectal
reading.
3. Oral
- Be sure your child has not taken
a cold or hot drink within the
last 10 minutes.
- Place the thermometer under
one side of the tongue and
toward the back. An accurate
temperature reading depends on
proper placement.
- Have your child hold the
thermometer in place with the
lips and fingers (not the teeth)
and breathe through the nose,
keeping the mouth closed. If
your child cannot keep his
mouth closed because his nose is
blocked, suction out the nose.
- Digital thermometers will
"beep" when the temperature is
read; glass thermometers should
be left in the mouth for three
minutes.
*Before insertion, glass thermometers
should always be shaken until
the liquid is below 98.6° F. To read
a glass thermometer, rotate the
thermometer until you can see the
line. The line ends at the number
that represents the temperature.
Medication Dosing
The chart insert shows our
recommended dosing regimen for
acetaminophen (Tylenol/Tempra)
and Ibuprofen (Motrin/Advil).
The factor that best determines
the correct dose of medication for
your child is his or her weight. If
you are unsure of the exact weight,
you may use the child's age, but
this method is not as accurate:
larger-than-average children for
their age will be under dosed;
smaller-than-average children risk
overdose. Our chart provides both
weight and age parameters, but we
recommend that you use weight to
arrive at the most appropriate dose
of medication for your child.
This Fever Facts brochure was developed by Affiliated Pediatric Practices
(APP) - The benchmark of excellence in pediatric health care.
Your practice is a member of Affiliated Pediatric Practices - an organization
working for the health and safety of your children.
©Copyright APP, 2003
* IBUPROFEN SHOULD NOT BE USED IN CHILDREN UNDER THE AGE OF 6 MONTHS
ACETAMINOPHEN (TYLENOL)* DOSING
MAY BE GIVEN EVERY 4 HOURS AS NEEDED • DO NOT EXCEED 5 DOSES IN A 24 HOUR PERIOD
WEIGHT OR AGE INFANT DROPS LIQUID SUSPENSION/ELIXIR CHEWABLE TABS JR.STRENGTH CAPS/TABS
80mg/0.8 cc(dropperfull) 160mg/5cc(teaspoon) 80mg/tab 160 mg/tab (or capsule)
6-8 lbs* 0-2 mos* 1/2 dropperfull*
9-10 lbs* 0-2 mos* 3/4 dropperfull*
11-12 lbs* 2-3 mos* 1 dropperfull* 1/2 teaspoon
13-15 lbs 4-5 mos 1 1/4 droppersfull 1/2 teaspoon
16-18 lbs 6-8 mos 1 1/2 droppersfull 3/4 teaspoon
19-20 lbs 9-10 mos 1 3/4 droppersfull 3/4 teaspoon
21-25 lbs 11-20 mos 2 droppersfull 1 teaspoon 2 tabs 1 tab/cap
26-30 lbs 21-30 mos 1 1/4 teaspoons 2 1/2 tabs 1 tab/cap
31-35 lbs 3 yrs 1 1/2 teaspoons 3 tabs 1 1/2 tabs/caps
36-41 lbs 4-5 yrs 1 3/4 teaspoons 3 1/2 tabs 1 1/2 tabs/caps
42-47 lbs 6 yrs 2 teaspoons 4 tabs 2 tabs/caps
48-53 lbs 7 yrs 2 1/4 teaspoons 4 1/2 tabs 2 tabs/caps
54-59 lbs 8 yrs 2 1/2 teaspoons 5 tabs 2 1/2 tabs/caps
60-65 lbs 9 yrs 2 3/4 teaspoons 5 1/2 tabs 2 1/2 tabs/caps
*FOR FEVER GREATER THAN 100.4 IN AN INFANT < 3 MONTHS, CONTACT YOUR PHYSICIAN FIRST.
IBUPROFEN (MOTRIN or ADVIL)* DOSING
MAY BE GIVEN EVERY 6-8 HOURS AS NEEDED • DO NOT EXCEED 4 DOSES IN A 24 HOUR PERIOD
WEIGHT OR AGE INFANT DROPS LIQUID SUSPENSION CHEWABLE TABS** CHEWABLE TABS**/CAPS
50mg/1.25 mls 100mg/5cc(teaspoon) 50mg/tab 100 mg/tab (or caplet)
6-8 lbs* 0-2 mos*
9-10 lbs* 0-2 mos*
11-12 lbs* 2-3 mos*
13-15 lbs* 4-5 mos*
16-18 lbs 6-8 mos 1.875 mls 3/4 teaspoon
19-20 lbs 9-10 mos 1.875 mls 3/4 teaspoon
21-25 lbs 11-20 mos 2.5 mls 1 teaspoon 2 tabs 1 tab/cap
26-30 lbs 21-30 mos 1 1/4 teaspoons 2 1/2 tabs 1 tab/cap
31-35 lbs 3 yrs 1 1/2 teaspoons 3 tabs 1 1/2 tabs/caps
36-41 lbs 4-5 yrs 1 3/4 teaspoons 3 1/2 tabs 1 1/2 tabs/caps
42-47 lbs 6 yrs 2 teaspoons 4 tabs 2 tabs/caps
48-53 lbs 7 yrs 2 1/4 teaspoons 4 1/2 tabs 2 tabs/caps
54-59 lbs 8 yrs 2 1/2 teaspoons 5 tabs 2 1/2 tabs/caps
60-65 lbs 9 yrs 2 3/4 teaspoons 5 1/2 tabs 2 1/2 tabs/caps
**REMEMBER: IBUPROFEN CHEWABLE TABS COME IN TWO DIFFERENT STRENGTHS (50MG AND 100MG)
* We have found that generic versions of these medications are as effective as the brand versions and may save you money. We encourage the use of generic medications.
When to call your pediatrician if your child has a fever
Please note that the following are guidelines only. Your child's general appearance and the way he or she is acting are usually more
important indicators of illness than the height of the fever. You should always call if your child looks or acts significantly ill for any period
of time or if you are concerned about worsening health.
Call immediately if:
• Your child looks or acts very ill for any period of time.
• If you think your child has had a seizure.
• Your child is less than three months old and has a temperature greater than 100.4°F.
• Your child is over three months and less than three years old, and the fever is over 102.5°F and he or she is not acting well.
• Your child is over three years old, feverish, and does not look well, and does not perk up significantly after an appropriate dose
of fever medicine.
• Your child is crying inconsolably.
• Your child cries if you touch him or move him.
• Your child is difficult to awaken.
• Your child complains of a stiff neck and cannot touch the chin to the chest without pain.
• Purple spots are present on the skin, and these do not blanch (whiten) when pressed firmly.
• Breathing is labored and no better after the nasal passages are cleared.
• Your child is unable to swallow anything and is drooling saliva.
• Your baby's fontanelle ("soft spot") is bulging when he or she is sitting up quietly.
• There is redness or swelling around the eye or pain with eye movements.
• There is redness, tenderness, or swelling over an arm or leg.
• Your child walks with a limp or refuses to move a leg joint.
• Your child has a compromised immune system (e.g., the spleen has been removed, the child is undergoing chemotherapy or is
HIV-positive) or sickle cell anemia.
• You have any other concerns about fever that make you feel an immediate call is necessary.
Call within 24 hours if:
• Your child suffers from a burning sensation or pain during urination.
• Your child complains of ear pain.
• Your child complains of sore throat and any of the following: swollen glands, headache, abdominal pain, rash, or joint pain.
• Your child voids dark urine 3 or 4 weeks after a sore throat.
• Your child's fever lasts more than 48 hours without any obvious cause or infection.
Call during regular office hours if:
• Your child's fever is greater than 101.5°F for more than 72 hours.
• The fever has been normal for 24 hours and then returned.
• Your child has a history of seizures with fever, and you wish to review fever management.
• You have other concerns or questions regarding fever.