Part 1 in our 4-part series on fever in children

Fever in Children: When to Worry, What to Doby James Hubbard, MD, MPH

A common call I get from parents and grandparents is about their child’s fever: They can’t get it to go down. They want to know if it’s too high, what to do, and why the medicine they’re giving isn’t getting it back to normal.

It used to happen all the time after I’d seen a child with strep throat, until I got smart enough to explain at the visit that with strep, no matter what we do, the fever is usually going to hang around for about 72 hours. It’s going to get worse at night. Even taking acetaminophen or ibuprofen sometimes won’t bring it down to normal. If the child is drinking fluids and not looking a lot worse, they’ll just have to be patient and wait for the immune system, with the help of antibiotics, to have time to fight it off.

And still, I get the calls. But I understand. Because fever in children can be scary—doubly so if you don’t know the cause and can’t get expert advice when you need it.

Fever’s Good Side

In itself, fever can actually be a good thing. When we’re invaded by a bacteria, virus, or fungus infection one of our body’s ways of fighting is to increase our core temperature.

Just like most living things, germs thrive within a certain temperature range. The body is simply trying to change the environment so the germs won’t thrive as well.

Of course, one of the side effects of this is the increased temperature makes us more uncomfortable. But as a rule, except in extreme cases and in hyperthermia caused by a hot environment (a child left in a hot car, for instance), fever itself does not harm.

Instead, think of it as the body’s way of warning us that something’s wrong.

Tips for When a Child Has a Fever

If there’s fever, look at the child overall. For instance:

  • Do they look sick?
  • Are they drinking fluids? Playing? (These are clues the infection may not be that bad.)

Exceptions: Even if you’re in a disaster situation and getting professional medical help right away is difficult, make every effort to do so if:

  • The child is 3 months old or under with a rectal temperature of 100.4 F or above.
  • The child’s temperature rises to around 106 (very rare).
  • The child has a petechial rash.

If calling a doctor is an option, here some more guidelines from the American Academy of Pediatrics. To summarize some of the recommendations, call the doctor if your child has a fever and looks sick, or if your child is younger than 12 weeks and the fever is 100.4 or higher. Also call the doctor if the fever:

  • Is over 104 in any child
  • Lasts over 24 hours in a child under 2 years old
  • Lasts over 72 hours in a child 2 or older

But read the guidelines for more specifics, and ask your child’s doctor next time you go in to see if he/she agrees with them or would like to add anything else.

Now, I’m not discounting a parent’s intuition. In fact, I suggest not ignoring it. But if a child is drinking fluids pretty well, is playing, and runs away when you get out the acetaminophen or ibuprofen, fever or not, they’re probably doing well enough to not need that fever medication. Most of the time, the only reason to try to get the fever down is to make the child feel better.

The bottom line is, if you can’t get to or even call a doctor or nurse, you can consider how the child is actually doing before getting out in that blizzard to go to the emergency room.

What about you? What’s been your experience with children and fever?

Stay Tuned! Coming up: how to get a fever down, the 6 most likely reasons your child has a fever and mistakes people make when using a thermometer. (Subscribe to updates below.)


Photo: Flickr/MikeWebkist.