Children and Fever

Fever (temperature higher than normal) is common in children but is not necessarily harmful, nor is it always evidence of an illness. A fever is a special cause for concern, however, in infants younger than 3 months of age. In young children, even a slight elevation of temperature can mean there is a problem. In newborns, a drop in temperature below what is normal (below 95 degrees rectally) is a sign of a problem. For children of any age, parents and caregivers should be as or more attentive to changes in eating or sleeping habits, coughing, pain or other marked changes in a child's behavior.  

Fever symptoms include rapid breathing and heart rate, glossy eyes and flushed skin.

What to Do

Temperature can be taken in the ear (otic), mouth (oral), armpit (axillary) or rectum (rectal). Oral temperatures are not appropriate for infants and children too young to keep the thermometer in the mouth for an appropriate time or without biting it. Taking an infant's otic temperature is fast, painless, safe and satisfactory for determining if the infant has a significant fever and if it is necessary to call the doctor.  Digital otic, oral, rectal and axillary thermometers are widely available. New technology has made possible safer rectal thermometers with shorter probes so that an infant cannot be injured, as well as more accurate axillary thermometers and very quick response times. These digital thermometers can be read in less than one minute. Otic thermometers typically measure temperature the instant the button is pushed. Glass thermometers are no longer sold because they contain mercury. 

An accurate temperature reading is especially important during the first 3 months of your child's life. During this time, a rectal thermometer remains the most accurate way to measure your child's temperature, although an otic thermometer provides adequate information and is safer.  Digital rectal thermometers come with disposable plastic covers to cover the probe.

To get an accurate rectal temperature, first be sure the child is not overdressed or warm from activity, a hot bath or hot weather. To take a rectal temperature, lay the baby on your lap, bottom up, with legs hanging down. Be sure to support the baby's head. If the baby is too squirmy, lay the child on a firm, flat surface such as the floor. Be sure to use a rectal thermometer. Lubricate the disposable cover as instructed and insert the thermometer no more than one inch into the rectum. Stop insertion immediately if there is any resistance and retry. When the signal sounds, read the temperature off the digital display. A normal rectal temperature is between 99 and 99.6.

Call the doctor immediately if a child younger than 3 months has a rectal temperature of 100.4 degrees or higher. A rectal temperature of 101 degrees or higher is considered a fever in older infants and children.

Using an otic thermometer is adequate (and safer) for infants, children, adolescents and adults. Because there can be some variance between readings, the temperature should be repeated at least once after the initial reading. Follow the directions for your particular brand of otic thermometer. Oral thermometers are difficult for young children and should be reserved for older children (8 and older), adolescents and adults. Oral temperatures can be altered by warm or cold food or drink and shouldn’t be taken within 30 minutes of eating or drinking.

A child older than 6 months with a fever under 101 degrees, or even higher, usually does not need to be treated. The exceptions would be if your child is uncomfortable, appears acutely ill, complains of a headache and stiff neck, has had convulsions (seizures) related to a fever or has a chronic disease. The more important yardstick for treatment is your child's behavior. If your child is eating and sleeping well and feels somewhat playful, treatment probably isn't needed.

Self-Care Steps for Fever

Give plenty of fluids -- water, juice, soup, flavored gelatin, ice pops -- to prevent dehydration. A desire for solids usually decreases with a fever.

• Use acetaminophen if your child's temperature is more than 102 degrees. Be sure to follow the package's instructions for your child's age and weight. Do not give children and teenagers aspirin or aspirin-containing products, because they have been linked to Reye's syndrome, a serious condition that can lead to coma and death.

• For high fevers, give infants and children a sponge bath in lukewarm water. Do not use cool or cold water, which may cause shivering.

• Dress the child lightly and use lighter bedclothes to avoid overheating. Cover the child with a blanket if chilled.

• When calling your child's doctor about a fever, tell him or her if you took your child's temperature rectally, orally or with an ear thermometer, the time of day you took it and how your child is behaving (eating, sleeping and playing).

• Children between 6 months and 5 years of age sometimes have seizures or "fits" (called febrile seizures) when they have a high fever. These seizures are seldom harmful. During a seizure, protect children from hurting themselves by keeping them away from nearby objects and making sure they are breathing freely. Report the seizure to your child's doctor. If the seizures continue, go to the emergency room.