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Health blog

Children and Fevers

What parent hasn’t been awakened at night by a crying baby or a cranky toddler only to discover that the child has a fever? The ever-present parental worry machine kicks into gear. Is the fever too high? Is it dangerous? Do you need to take your child to an urgent care clinic or hospital emergency room? Should you call the doctor? Or is it safe to treat the fever at home?

Many parents are very worried when their children develop fevers. Yet fever itself is not an illness, but rather a symptom of an illness. A fever is a normal physiological response to a disease-causing infection. Fever slows down the growth and reproduction of bacteria and viruses, making it easier for the body to overcome the infection. The American Academy of Pediatrics (AAP) says that fever is not in itself known to endanger a generally healthy child, and in fact, may benefit the child’s recovery.

Fevers are extremely common in children. Pediatricians say a third of children seen in their offices have fevers. Many parents believe they must banish the fever entirely so the child’s temperature returns to normal. It may be neither possible nor advisable to do this. What is a fever and when is it necessary to treat it? Most medical authorities say a fever is present if the child’s temperature is at or above 100.5° rectally or 99° by mouth. And most pediatricians say it is not necessary to treat a fever until it’s higher than 101° or unless the child is very uncomfortable. Note that this may differ in newborns, children with a history of febrile seizures, children with weakened immune systems, or children with other medical conditions.

Years ago, parents often used alcohol baths to lower fevers. Today, doctors say that is not a good idea because of the potential for a child to absorb alcohol through the skin. Tepid sponge baths, i.e., wiping a child with a cloth soaked in lukewarm water, is safer and more effective.

What about medications? Generally, it is safe for infants older than three months to take acetaminophen (Tylenol and similar products), and for children six months and older to take ibuprofen (Motrin and similar products). A child’s doctor may recommend one or the other for a particular reason, so parents should clarify this with their pediatrician. Studies have shown that alternating acetaminophen and ibuprofen is more effective at reducing fever than either medication given alone.

The medication dose is based on the child’s weight, not age. Ideally, parents should discuss fevers and their treatment with pediatricians before they happen. According to the AAP, up to half of all parents give incorrect doses of medications, while 15% give doses that are far too high. Also, about 85% of parents wake children from a sound sleep to give them medication for fever. Eight out of ten pediatricians do not recommend waking a child for the sole purpose of giving them medications.

What about aspirin? The Surgeon General, Centers for Disease Control, and the AAP say that aspirin and products containing aspirin are not to be given to children under 19 years of age for fevers unless a doctor advises otherwise. Reye’s syndrome is a rare and potentially fatal disorder linked to taking aspirin during viral illnesses such as influenza and chickenpox. Liver and brain damage may occur within a few days. Reye’s syndrome usually affects children between 4 and 16 years old. Many over-the-counter products, such as Alka-Seltzer, Pepto-Bismol, and cold and sinus remedies contain aspirin. Read labels carefully. The list of ingredients may include acetylsalicylate or salicylic, other names for aspirin.

Many health insurance companies and health maintenance organizations offer a 24-hour nurse advice line to their insured customers. These are staffed by registered nurses who have a wide variety of resources at their fingertips. Try calling your nurse advice line first if the service is available to your family. Before calling a nurse or doctor about a child’s fever, be sure you know the current temperature, what you’ve tried, and what other symptoms the child has. This helps the nurse or doctor give you the best possible advice. You’ll find that in many cases, you can safely treat your child’s fever at home.

References: American Academy of Pediatrics children’s health at www.healthychildren.org National Reye’s Syndrome Foundation at www.reyessyndrome.org, and “Fever and Antipyretic Use in Children,” Pediatrics, 2011.127(3):580-587.
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