Fever is a symptom, not an illness. Recently, research has shown that fever is a normal, helpful part of your child’s immune system. Fever increases your child’s metabolic rate which helps the body put out more white blood cells to help fight infections. Fever is one of the body’s normal, necessary defense mechanisms against a variety of illnesses, most commonly, viral infections.
Facts About Fever
The medical definition of fever is temperature above 100.3 degrees. A temperature less than that is in the normal range (98-100.2). Fever in children with viral infections, which constitute the vast majority of causes of fever in children (75% or more), is usually in the range of 101-104. Fever itself causes no brain damage or other harm unless it reaches 107 degrees. Because the job of fever is to increase your child’s metabolic rate in order to produce and release more cells that can help fight off an infection, for every degree of fever above 101, your child’s heart rate may beat 10 times per minute faster than normal and their breathing may increase 5 breaths per minute faster—simply from the presence of fever alone.
Because fever is a healthy, necessary part of our immune response to an infection, it is not necessary to treat low grade fever (below 101) unless it seems to be making your child feel bad. In fact, low grade fevers often do not bother your child at all. It is appropriate with low grade fever to simply “let the fever do its job” and just observe for other symptoms or higher fever. Fever of 102 or above DOES tend to add to your child’s discomfort and we recommend treatment at this range. The recent habit of alternating acetaminophen (Tylenol) or ibuprofen (Advil/Motrin) to treat fever has not been studied much in children for either its benefits or its possible side effects of stressing the liver or kidneys by the use of both of these medicines. That pattern is a by-product of a nation that was led to be afraid of fever. I believe that it is much safer to initiate fever medicines with one product or the other for the first 12-24 hours and only add the second if the first medicine is not bringing the fever down 1-3 degrees after each dose.
Often the first 12 hours of fever is the least helpful time for us to see your child in the office, as it is often during the second 12-24 hours of the illness that additional symptoms develop that explain the specifics of the illness. For example, your child may have low-grade fever alone for 12-18 hours, then develop clear runny nose and cough which let us know that the fever was simply the onset of an “URI” or common cold. Or after a few hours of fever, your child might have vomiting and diarrhea that leads us to consider a stomach flu. Because most fevers which occur in childhood are simple viral infections, if fever is the only symptom, it is okay to observe your child and treat the fever at home for the first 12-24 hours. Exceptions to this are listed below.
If any of these are noted, your child needs to be evaluated immediately:
- Your infant is less than 6 months old
- Your child has a stiff neck
- Your child is crying inconsolably
- Your child has a seizure
- Your child is having difficulty breathing
- Your child is acting very sick
- Your child is confused, delirious, or lethargic
- Your child is difficult to awaken
- Your child has significant abdominal pain
- Your child has a severe headache
** Any infant less than 8 weeks old with a rectal temp of 100.4 or higher must be seen IMMEDIATELY.
Once therapy is initiated with either acetaminophen or ibuprofen, it is not necessary to continue therapy every 4-6 hours if your child is otherwise acting well. I encourage you to “treat your child, not the fever!” Often a 2 year old can have a fever to 102.5 and be running around the room eating Cheetos – this child may not need anti-fever medicine at all. It is not necessary to wake your child from sleep to give them medicine; often if a fever spike occurs in the night, it will cause your child to be restless or awaken from sleep, at which time you can give medicine as needed. Children overall tend to get higher fevers will illnesses than adults and tend to tolerate them better adults.
Corinth Family Medicine & Pediatrics
Karri Dutton, MD