What is it? Fever is one of the body’s best tools to keep us safe from infection. Normal average body temperature is about 98.6 degrees Fahrenheit, but it can fluctuate up to around 100 and still be considered normal. Fevers start at 100.4 and higher. In children, fevers can safely range up to 105-106 degrees, and the amount of fever doesn’t necessarily correlate with how sick your child is, so don’t worry too much about what the number is - pay attention to how your child looks. Please read on to find out if your child's fever warrants concern, and what you can do to help comfort your child during fever.
How high is too high? Contrary to popular belief, damage to the body or brain does not occur from routine childhood fevers, which can easily be as high as 105-106. Unsafe body temperatures only occur from external source of heat, like getting lost in the desert, so you don’t need to worry about this with fever. What matters most for a child's safety are the other symptoms and signs that accompany the fever, and we’ll get into that in a little bit.
Should I worry about febrile seizures? Nope! As frightening as these sound and look, they are fairly common and not harmful. Despite what you may have heard, you cannot prevent them by giving your child Acetaminophen (Tylenol®) or Ibuprofen (Motrin®). This is a common misconception, even by health professionals. Why don’t these medications help? Because seizures are not caused by a high temperature, they are caused by a rapid change in temperature. By the time your child has developed a high fever, the seizure would have likely already happened if it was going to happen at all. Bringing the fever down with medication only gives it another chance to rise again, so treating high fevers with medication may actually increase your child’s risk of having a febrile seizure!
Checking your child’s temperature
The most accurate way to check is either rectally (affordable) or via the fancy forehead scanners by Exergen (pricey). Any other method is less accurate, but that's ok for most uses. Do not add a degree when you report temps to a health professional - this can lead to confusion. Just report the number and where you took it (e.g. “102.3 in the armpit”). Whenever an important decision rides on a precise temperature (like whether to take a newborn to the ER), take an accurate temperature before calling.
How do I manage the fever? The most important point to remember is that fever is what keeps the body safe from an infection, and ideally we don’t want to change it at all. I can’t emphasize this point enough. However, this is not always practical. If your child is up all night miserable with discomfort, is getting dehydrated, or looks lethargic, it is reasonable to intervene. But unless your child’s fever is accompanied by signs of a more severe illness that requires evaluation by a physician (see box at bottom of page), you can manage most fevers by following the simple comfort measures outlined here:
- Make sure your child is well hydrated.
- Comfort your child and reassure them. Much of their discomfort is from fear - let them see that you are calm, and they are more likely to feel calm in return.
- Choose comfortable, breathable clothing. Do not bundle them up or strip them down. If they want more layers because of the chills, that’s OK - let them choose the amount of layers they want to wear.
- If they become very uncomfortable with the fever, try a cool washcloth to the forehead or back of the neck. At first this may not feel good to them, but eventually it will be soothing. You can also wet your hand in water and run it through their hair from time to time.
- Another option is a lukewarm bath (not too cold, not too warm). They may not like the feel of a bath at first, but soon they will feel better when their fever is a bit lower.
- Don't try to make the fever go away, only bring it down a tad if they are uncomfortable.
- If all else fails and they remain miserable despite the above attempts, you may opt to give a dose of acetaminophen (Tylenol®) or ibuprofen (Motrin®) to help them sleep. Why not use the medication right off the bat? For one thing, reducing the fever makes it less effective at getting rid of the illness. Secondly, all medications have side effects, and these are no exception. For more on the use of these medications, including dosage, click here.
When does a fever need to be evaluated by a physician?
Go to the ER right away if:
- Your infant is less than 3 months old
- Your child looks very ill (won’t respond, won’t stop screaming, profusely vomiting, etc.)
- Your child has any of the following: purple spots, stiff neck, difficulty breathing, severe cough, severe abdominal pain, unable to walk, unable to swallow.
- If your child (3 months or older) has cold symptoms and is only mildly ill, call for an appointment if their symptoms are not resolving by day 3 - 4. (It is OK to call me on weekends for this issue).
- If they have more significant symptoms, call our clinic for a daytime appointment as soon as possible.
- If your infant or toddler (3 months to 2 years) doesn’t have any cold symptoms, and the fever lasts more than 48 hours, call to be seen that day. (It is OK to call me on weekends for this issue).
For urgent needs, same-day appointments are available Monday through Friday. Please call as early in the day as possible, the more notice we have the easier it is to fit everyone in.
Need help outside of office hours?
Firstly, if your child has an emergency, please call 911 or go directly to the ER - they will contact us if needed once your child has been evaluated.
Urgent Care centers can also be helpful when something needs to be seen outside of office hours but it's not an emergency.
For our list of preferred Urgent Cares and ERs, see our resources page.
And if you have something that might need urgent attention but you're not sure/don't know what to do, we can help: