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Facts and advice about fever in children – information written by pediatricians.
Often, when children’s body temperature reaches 104F (40C), many parents become highly concerned. However, for a pediatrician 100.4F is not always concerning. There are no “magical” limits.
Let us guide you through what to do when your child has a fever, and how to distinguish between a dangerous fever and harmless fever.
When is a fever dangerous?
Fever itself is not dangerous, even if it rises to 106-107F (41-42C). A fever occurs when the body is responding to an acute inflammation. In other words, it’s the immune system’s way of fighting an infection. Infections in children are usually self-limiting. This means that most of the time, infections in children resolve by itself. But, of course, in isolated cases, infections in children can be dangerous and require immediate treatment in the pediatric emergency room.
Signs of a serious infection in children with fever
A child with a serious infection will look ill. This sounds obvious, doesn’t it? Let me explain. They may be tired, dull and have little to no energy. This is when should go to the pediatric emergency department for assessment. Infants are more difficult to read. As a rule of thumb, an infant who has lost interest in eating, must go to the pediatric emergency department for assessment immediately. This may be a sign of a serious infection.
All children get tired during their fever peaks. But it’s the ones who do not perk up between the fever peaks that we should be worried about.
The combination of headache, sensitivity to light, vomiting and fever may be signs of a meningitis; an infection that can be serious and require immediate hospitalization.
Infants with fever
Babies under three months have small margins and can be difficult to assess for the inexperienced. Don’t be shy about going to the pediatric emergency room with your feverish infant. The older the baby gets, the easier it is to read them. However, a 6 month old baby with a cold, who eats and pees, does not need to be admitted to the children’s emergency room. In this case, the health center or local emergency room is a better option if you feel your baby needs an assessment.
Colds are the most common cause of fever in children
The most common cause of fever in children is the common cold. If your child has a congested nose, sore throat or moderate cough, then they are likely to have the cold. As long as your child is still drinking and peeing, the wisest thing to do, is to wait at home. It’s better to keep your children away from all germs at healthcare centers and let them rest at home.
High fever may be a urinary tract infection
Kidney infections are not entirely uncommon in children, especially in children under one. Kidney infections require antibiotic treatment, even though children may not appear particularly ill or have any symptoms from the urinary tract. So a child with a temperature over 38.5C (101F) for more than 24 hours, without any cold symptoms, needs to give a urine sample for assessment. You can do this at a medical center or a local emergency hospital. For infants, the children’s emergency department is the most appropriate.
Fever and a swollen eye may be a sign of sinusitis
Fever and a unilaterally swollen eye, are often signs of a nasal infection, aka an ethmoid sinusitis, in children. Children may not be particularly ill or affected, but antibiotic treatment (often intravenous) is required. Often, even an X-ray examination of the eye socket may be required to detect possible complications.
Fever and difficulty breathing
High fever and difficulty breathing or intense coughing, may be due to intrinsic asthma, pneumonia or the flu. Seek a medical center, emergency room or child emergency depending on the severity of breathing the child has.
What is a fever?
Over 38.5C (101.3F) we say go to the children’s emergency room.
38.0-38.4C (100.4-101.12F) is borderline.
Under 38.0C (100.4F) is not a fever.
Although 100.4F is not always concerning for pediatricians, we do have absolute temperature limits. But we diagnose the child in context with/ without other symptoms. We do not compare the “fever” with their normal temperature, although we know that children’s body temperatures can vary.
High temperatures above 39C (102.2F) during the winter months are often a flu.
When should I give anti-pyretic medications?
Fever itself is not dangerous for the child, even if it is very high. Therefore there is no need to give anti-pyretic medications (acetaminophen and ibuprofen) just because your child has a fever. It’s good to know, also, that anti-pyretics do not protect against febrile seizures, even though it was said to have previously.
I give anti-pyretic medications to my children and to the children in the pediatric emergency room in the following cases:
1. If the child is dull and uninterested in their surroundings. I give anti-pyretics to see if the child perks up in order to distinguish between a serious and less seriously illness.
2. If the child is so tired from the high fever that they are unable to drink liquid, often anti-pyretics help.
3. If the child is upset or says they have a sore throat, sore ear or sore body, I give acetaminophen or ibuprofen. It’s not to lower the temperature, but to relieve the pain.