Fever: What Parents Need to Know

Dr. Grant

When should a parent worry about a fever in their child? With the flu and cold season lurking just around the corner, now is a good time to know how to treat a temperature and when to report it.

First of all, some basic information is good to know. Fever is a normal response of the body’s immune system, and everything designed to kill infection works better when the core temperature of the body rises. When we sense a foreign invader, our “thermostat” resets to a higher temperature—101.5 taken rectally usually being the cut-off. (Remember that rectal temps are better indicators of core temperature and will generally run about a degree higher than one taken under the arm.)

It is important to note that very few fevers are dangerous, the rare exceptions being a “broken thermostat” which only happens in severe hyperthermia (heat stroke) and malignant hyperthermia (a rare condition brought on by anesthesia). As a matter of fact, many children go on with their normal routine and act happy.

So when do you treat fever? When the child is uncomfortable or it becomes difficult to determine just how sick they are. For instance, I only gave anti-pyretics to my kids when they looked sick—never simply in response to what the thermometer read. In these instances, Tylenol (acetaminophen) is the drug of choice, Ibuprofen as a second line drug. (Aspirin is never used in children because of the risk of Reye’s syndrome.)

It is important to be more aggressive when the diagnosis underlying the fever is in question—always in infants under two months of age. Also, because a child with a high fever can look very ill, observing what happens when the fever is brought down reassures us that nothing serious is going on in terms of infection. So, always call for fever in an infant under two months, and in children who don’t respond to anti-pyretics.

To Summarize:
• Most of the time fever is beneficial, helps us to get rid of the infection
• Treat only for comfort and to help aid in the diagnosis
• Call for any fever in children under two months, and also in children who you think may be ill (fever lasting more than a couple of days, or children who don’t respond when the fever comes down)
• While anti-pyretics such as Tylenol and ibuprofen are safe, they are not always necessary
• Always call if you are unsure about what to do!

Dr. Ron Grant
Pediatric Hospitalist
Meriter Hospital

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