Fevers/ When to worry/How to manage |
Fevers tend to get parents very worried, but an elevated temperature is only one of the factors that you need to consider when evaluating a sick child. I am actually more interested in your child's overall mood and behavior than I am in any specific number on a thermometer. An adult with a high fever is usually more miserable and needs to be evaluated sooner to figure out what is going on. For kids, fevers are a right of passage. There are advantages for them to get a degree of immunity from all the common illnesses when they are young. All of you parents who caught hand foot mouth from your kids because you somehow avoided it growing up, are nodding vigorously. There are many methods out there for measuring body temperature. I personally don't feel the need to invest in any expensive thermometers. I am generally quite satisfied with digital underarm reading. The important thing is that however you measure it, your thermometer seems accurate. Test it on yourself or other family members and take your child's temp when they are healthy to make sure you trust it as well as to establish what the normal baseline is for your child; 98.6 is not the "normal" temperature for everyone. I don't have a favorite brand. This link gives a good description of some of the options available. I have found that some of the ear thermometers tend to read high when there is a fever. If the high temperature correlates with symptoms and your child looks quite ill, then take appropriate action. If your child looks fine, please don't let a number on the thermometer freak you out. Instead, take a deep breath and look at your child! If they are grinning at you and singing, that is not someone I am terribly worried about. Temperatures can be measured in either Fahrenheit or Celsius Here is a quick conversion chart. 98.6 F=37 C 99.5F=37.5C 100.0F=37.8C 100.4F=38C 101F=38.4C 102F=38.9C 103F=39.5C 104F=40C 105F=40.6 For this post, I will be referring to the temperatures on the Fahrenheit scale. However you take it, the route of measurement is important data to your reporting. 99 degrees under the arm is not the equivalent to 99 degrees rectal. Underarm temps can be roughly a degree lower on some kids. I am still perfectly fine using that method. Most of the time I am just getting a sense of the range. There is no clear consensus, but most doctors would consider any temp below 100.4 to be low grade. For any child older than 3 months As long as your child is active and happy, I generally don't feel the need to "treat" a fever unless it is over 101.5 or so. I am much more concerned about the lethargic, whimpering child who has a normal body temperature than I am the singing child with 104. But, here is: “Nurse Judy's rule’ about fevers:
If a fever higher than 100 degrees lasts for more than 3 days, even with a happy child, I consider it time to have a look so that we can make sure there isn't an infection source (like ear infection, urinary tract infection, strep throat or pneumonia.) I would allow five days for low grade temps before taking them in. Fussy kids who are inconsolable need to be seen sooner than that, fever or not. During flu season, sometimes there are kids with fevers that are hanging on for five days or longer. If there is a known virus actively circulating in your area, your doctor may be okay ‘watching and waiting’ for another couple of days before asking you to come in for a visit. This would likely depend on if your little one is managing (drinking, peeing, easy breathing, consolable, fever responds to medications.) Many viral syndromes "wave goodbye" with a rash. Roseola is a classic example. When I have a happy kid with a high fever, it is pretty common at day three for the fever to be gone. Now you have a fussy kid with a rash on your hands, but you also have an answer. Time is the great fixer here, there is no need to be seen. With most rashes, including roseola, when you push on the skin the area should lighten. This is called blanching. A purple rash that does not get lighter when you press is always worth calling your doctor about. Any fever that comes along with a purplish rash could be an emergency like meningitis. Don’t wait to be seen. I remind you that your child’s activity and energy level are still the biggest clues. Generally with something serious it is clear that something is wrong. These kids are not running around babbling and playing. They are sick, and it is obvious. It is useful for you to know that when children are in the process of spiking a fever, it is not uncommon for them to tremble and look shaky. This is normal. Children with fevers may have a higher respiration and pulse rate. When fevers are breaking it is common to have lots of sweating. They can soak right through the sheets! It is also important to be aware that about 4% of children can have something called a febrile seizure. This is not the same as the trembling that I mentioned above. Febrile seizures can be terrifying to watch, but they usually stop within 5 minutes. They cause no permanent harm. Trust me, if you have never heard of this, watching your child have a seizure has been reported as the scariest experience EVER. Having the prior knowledge that they do happen once in a while and are generally harmless should help keep you from freaking out. If your child is having a seizure they may have large jerky motions and their eyes may roll back. Make sure their airway is open. It is perfectly reasonable to call 911. Your job is to stay calm. If your child has had even one febrile seizure, your medical team is likely to be more aggressive with fever control and will advise you to treat even a low grade fever. It is important to talk with your doctor about this so that you have a plan in place that you are comfortable with. Fortunately, most kids grow out of seizures by the time they are 5 years old. If your infant is under 3 months of age, notify your doctor if there is any fever! There are a few common causes: *over bundling.... Seriously, When I was working at Noe, sometimes the new babies would come into the office with piles of blankets wrapped around them even on a warm day. I know that many of us have the tendency to bundle up an infant but the best rule of thumb is to dress them in one layer more than you are wearing. If your baby was indeed over bundled, get some of those layers off and re-check the temp in about 10 minutes to see if they have cooled down. *dehydration... Sometimes if mom's milk isn't in yet, babies can be simply dehydrated and need to get some fluids. This is the time that you need to squirt some milk or formula directly into your baby's mouth. You can use a syringe or a dropper. In some cases the elevated temperature will normalize fairly quickly from some fluids. If there is no obvious cause for an elevated temperature, and it doesn't resolve within 15 minutes, your baby needs to be evaluated. Giving a fever reducing medication to a newborn should only be done under strict guidance from your pediatrician. With the younger babies, it is always better safe than sorry. Certainly there is no down side for calling and checking in with your doctor just to be on the safe side. Some general fever facts:
Bonus tidbits from Dr Ted: I have to reiterate everything that Nurse Judy has said above! Fevers are a difficult concept for a lot of parents to wrap their heads around, especially the first time they see one. It’s useful to remember that everybody’s immune system is different, and the exact same virus can cause a fever to 104 in one kid and pass without symptoms in another. An increase in body temperature is the body‘s response to “inflammatory cytokines“, chemicals released by your body's healthy tissues when they are under stress, like being attacked by a virus. Some bodies release more of these chemical signals than others, which is why different bodies have different temperatures to the same viruses. Immune systems also have different abilities to fight off different viruses within the same family, which is why some viruses pass without any symptoms at all in some children and the same virus can wreak havoc in others. Parents always asked me, “at what temperature do I panic?“ My answer is 106. If you can trust that your child’s temperature is truly at or above 106, using Nurse Judy‘s techniques above, you must go to the emergency room. Anything below that is a question should be based on the child’s appearance. |
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