Nothing induces more anxiety and fear in a parent than their child running a temperature. I am no exception. I remember in my second year of pediatric residency, my precious 13-month-old son started running a 104.8 fever at 10 o’clock at night (as usual, these things always happen late). He had no other symptoms except for the sudden high temp and the shivering that accompanied it (we call these “rigors”). Although he was fussy, but awake and drinking from his sippy cup, I was convinced his body was being ravaged by some horrible infection. So, I did what any good parent would do at 10 o’clock at night with a sick kiddo, I called the pediatrician on call. Yes, I was training to be a pediatrician myself, but, somehow I lost all ability to be objective when it came to my own child (the very reason why it is taboo for doctors to care for their own family members). The very nice pediatrician said to give him some ibuprofen and call in the morning for him to be seen if he was acting sick. I knew I was supposed to do that, but hearing it from a more experienced mentor eased my fears.
The next afternoon my son began breaking out in red spots all over his trunk, and immediately I knew what it was… roseola! That silly virus that causes high spiking fevers followed by a rash a day or two later. Of course, he recovered fine and I learned a little bit about how it felt to be on the other side.
Like the reason for my son’s fever, most temperatures are caused by viral infections and not horrible life-threatening diseases. In the age of vaccines, we can breathe easier knowing it is unlikely that our child has measles or polio. There are hundreds of viruses that cause all kinds of symptoms but most also come with a fever.
What is a fever? I often have parents tell me their kid has a fever of 99 degrees (“Her body temperature runs around 97 usually, so 99 is high for her,” they say.). A small bump in core body temperature can occur for a variety of reasons. These low temps from 99-100 can happen because of mild inflammation like teething, being overheated, etc. Teething cannot cause a 104 temp, however, no matter how much your mother-in-law tries to convince you. A real fever is anything 100.4 or higher.
You might wonder how high is too high? As a pediatrician, I am not as concerned by the actual reading on the thermometer as how the child is looking with their fever. If they appear mildly ill, fussy, have a decreased appetite but drinking, and somewhat clingy but will still slide off their mother’s lap to reach for a favorite toy…I am reassured. If they are sleeping all day, have altered consciousness, labored breathing, or not wanting to take anything by mouth, then I’m worried, no matter what the thermometer reads. Generally if a fever is 105 or higher, it is considered too high. If it is not coming down with a dose of Tylenol, then the child needs to be seen. Also, if a temperature consistently runs over 100.4 for more than 72 hours the child should also be seen by a doctor. Any fever in a baby less than 2 months old should be evaluated.
How can you safely bring a fever down? Typically a dose of acetaminophen or ibuprofen (see table) will work. Giving your child extra fluids (pedialyte for infants and water for children is best) and a lukewarm bath will help them feel better. Having a fever is actually a good thing. It means their immune system is intact and riding it out a few days is okay. But, if other symptoms tip you off to a possible treatable condition (horrible sore throat without other symptoms—strep throat, urinary frequency or pain—bladder infection, severe abdominal pain with vomiting—appendicitis), waiting 3 days is probably not appropriate. If you are ever in doubt, there is always someone there to talk you through it, even at 10 o’clock at night!