Ten Things Parents Should Know About Fever

A fever can cause anxiety for parents and be unpleasant for children. When is a fever dangerous and when is it not worrisome? It really depends on the age of the child, other associated symptoms, and how long it is lasting. Below are important facts to keep in mind when your child has a fever.

1. There is no height of fever that can cause brain damage or seizures. Children between the ages of 6 months to 6 years can get febrile seizures but these are not from a fever being high.

2. Fever can be treated with Tylenol or Motrin to help a kid feel better, but is not necessary to prevent problems.

3. Fever in babies under 3 months of age, even without any other symptoms, can be a sign of serious bacterial infection like meningitis, kidney infection, or bloodstream infection. Giving Tylenol at this age can mask a fever so check with your doctor before giving Tylenol.

4. Taking a rectal temperature is most accurate for babies. Forehead scanners can overestimate temperature. There is no reliable formula for converting oral or axillary temps to a true temperature, because these measurements are difficult to take and unreliable in babies.

5. All babies under 1 month old that have a rectal temp of >100.4 should be seen right away and have their blood, urine and spinal fluid checked for bacteria, even if they don’t seem sick. I have seen babies this age get very sick very quickly. There may be only a small window to start treatment. A doctor should test blood, urine, perform a lumbar puncture and admit to the hospital for IV antibiotics until an infection is ruled out. Babies that are a little bit older but less than 3 months can just have blood and urine checked, and possibly a lumbar puncture and admission depending on how the labs look.

6. Some of the above infections can be prevented by giving babies their shots at 2 months. This prevents pneumococcal and haemophilus bacteria. Testing pregnant women for Group B strep (GBS) also helps prevent infection.

7. One out of 4 babies will develop fever after getting their shots. This is just a sign the shots are doing their job and the immune system is producing antibodies to fight off those bacteria. The fever can make the baby feel crummy and therefore act fussy, but is not worrisome.

8. Giving Tylenol immediately before or after giving shots can actually make the shots less effective, so it’s not recommended to give tylenol after shots until a small amount of time has passed. If the baby gets fever or is fussy, then tylenol can be given then if desired.

9. For older children, a fever helps the body fight off infections. Inflammatory proteins within the body called cytokines get released by inflammatory cells when the body is fighting off an infection. These cytokines cause the body to raise its temperature and stimulate the immune system.

10. Most viruses will cause a fever during the first 1-2 days of an illness with symptoms of cough and/or runny nose and nasal congestion. A fever that begins after several days of viral symptoms or that lasts longer than 4-5 days could be the sign of a bacterial ear infection or pneumonia on top of the virus. A fever without any other symptoms could be a sign of a urinary tract infection.

When in doubt, parents can always call and check with the clinic’s on-call provider about whether they need to be seen or watch and wait.