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When to Fret a Fever

Fevers are a normal part of life, especially when we’re young and our immune systems are still learning how to combat the various germs and viruses that exist in our world. Children tend to experience fevers with regularity, often leaving parents wondering if they should worry, wait or rush the child in to the doctor, urgent care or emergency department.

Knowing what to do when a child runs a fever means understanding what a fever is and when you need to start looking up the doctor’s office in your contacts list.

Fevers are a symptom, not an illness.

This may seem like semantics, but it’s important in understanding the nature of a fever. A child is not sick from a fever; he or she is sick from something that’s causing a fever.

Fevers are a way our bodies respond to infection. Raising our body temperature creates a hostile living situation for the bacteria or viruses that are making us sick, giving our immune system a bit of an edge in battling back the illness.

Since many illnesses can cause a fever, you have to look for other symptoms the child may have to get to the root of what’s making the child sick. Nausea, congestion, aches and pains and more are unpleasant, but they also help pinpoint what’s making us sick.

Get an accurate temperature.

Many parents will bring a child to the doctor’s office on the basis that the child “feels warm.” While intuition is an important part of parenting, “feels warm” isn’t terribly useful in guiding clinical diagnosis. You really need to know precisely what the child’s temperature is.

There are a lot of innovative solutions on the market now that promise to help you take your child’s temperature quickly and easily. Unfortunately, many of these nifty solutions — such as forehead and ear thermometers — are pretty unreliable for home use, especially for babies and toddlers.

For babies and toddlers up to 3 years of age, the American Academy of Pediatrics recommends taking the temperature rectally with a good, old fashioned digital rectal thermometer. You can purchase one with a flexible tip for comfort and use probe covers to keep the device clean.

To take a rectal temperature using a digital thermometer:

  • Place a bulb cover on and then lubricate the bulb of the thermometer.
  • Place the baby across your lap or his or her changing table, facing down. Separate the baby's buttocks with your thumb and forefinger.
  • Using your other hand, gently insert the lubricated bulb end of the thermometer one-half to one inch, just past the anal sphincter muscle.
  • Hold the thermometer with one hand on the baby's buttocks so the thermometer will move with the baby. Use the other hand to comfort the baby and prevent moving.
  • Hold thermometer until it beeps or signals, then remove the thermometer.
  • Read immediately and record the displayed temperature.
  • Clean the thermometer with soap and water or rubbing alcohol.

Taking the temperature under the arm, called axillary measurement, is useful in screening a child for a fever, but not for getting an accurate measurement of the child’s temperature. If it shows a fever, recheck with a more accurate method. Other types of thermometers, such as tympanic thermometers that you stick in the child’s ear, may not be accurate for newborns under three months of age. These require careful positioning to get a precise reading. Skin strips that are pressed on the skin to measure temperature also are not recommended for babies and may give inaccurate results even for older children.

Children older than 3 may be able to have their temperature taken orally, holding the thermometer under their tongue.

Not every elevated temperature is a fever.

Most children (and adults, too) have a typical body temperature of around 98.6 degrees Fahrenheit. When a child first wakes up in the morning, his or her body temperature may be as low as 97.4 degrees, and it can rise during the day to more than 99 degrees just with regular activity — and to over 100 degrees from exercise or even just dressing too warmly.

Strictly speaking, a fever is a temperature of 100.4 degrees or higher. If the temp is 99, you might still be fine. Low-grade fevers are common after a child receives immunizations. A child may run a fever for up to three or four days and still behave, eat and drink normally. Over-the-counter fever reducers, such as acetaminophen or ibuprofen, might provide all the relief the child needs, but make sure you carefully follow the dosing instructions.

When should you worry?

Generally speaking, there are several factors that should encourage you to call your child’s medical provider:

  • The child is under 3 months of age and has a temp of 100.4 degrees or higher (taken rectally);
  • The child has recently been in a hot environment, such as the passenger compartment of a car;
  • The fever is accompanied by vomiting, diarrhea or a rash;
  • The child is unresponsive or has experienced seizures from the fever;
  • The child is unable to make tears, wet a diaper, has a dry mouth or other signs of dehydration;
  • The child is at an increased risk of illness because of an immune system or blood disorder;
  • The child has not received his or her routine immunizations;
  • And last but not least, you just think you need to seek medical attention.

That last factor is important — no one knows your child like you do. Parents often bring in children not because they can pinpoint any specific complaint, but because they just know something is wrong, and that’s perfectly OK. If you just think your child needs to be evaluated, make an appointment with his or her primary care provider, visit a local urgent care or, if necessary, bring him or her to a nearby hospital emergency department.

Tanner Healthcare for Children, a Tanner Medical Group practice, is located in Carrollton. For more information, visit TannerHealthcareForChildren.org or call 770-834-0606.

Children's Health Care




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