The mother of one of my patients called me today about her 15 month old who has had a fever for 2 days. As usual, this wonderful mother of three had done all the right things and had all the right answers…she just needed some Sunday evening reassurance.  But the conversation inspired me to write about this entity called fever that strikes fear in every parent’s heart.

This fear is deeply ingrained in us, as for generations, a high fever indicated the possibility of a very serious and untreatable illness. We have all heard stories, read books and seen movies in which children succumb to an illness with fever.  Fortunately, today, the risk from these illnesses are significantly lower, thanks to the discovery of antibiotics and vaccines.

I always explain to parents that fever is a symptom, not a disease.  As the bacteria or virus enters the body, a healthy body will increase its temperature in an attempt to break down the infectious agent. The body essentially tries to “cook” the enemy.  In addition, a fever will alert the rest of the immune system, such as white blood cells and antibodies, to begin replicating and fighting against the invaders.

What temperature is considered a fever?

The normal body temperature is 98.6 degrees F, although there is great variation throughout the day. A normal core body temperature can be as high as 100.4 degrees F, therefore a  fever is considered to start at 100.4 degrees F. There are a few exceptions, such as immunocompromised children. Often, parents will be very fearful of fever causing brain damage. This will only happen at temperatures over 107, and the body rarely lets itself go above 105 or so. Seizures from fever are also a fear of parents, and I agree, they are quite scary to watch. It is important to remember that they are not harmful to the brain, and leave no lasting effects. They typically happen in the first few hours of the illness, as the fever is going up rapidly, and occur in about 2-5% of children ages 6 months to 6 years.  If your child suddenly looks out of it and has seizure-like activity, call your doctor immediately. If a febrile seizure lasts over 15 minutes, call 911.

Do fevers need to be treated?

As fever is considered a helpful response to an invading virus or bacteria, I like to let fevers rise slightly before treating them. In general, if the child is behaving well, drinking fluids, and acting playful, there is no need to treat him or her. If she suddenly becomes cranky and achy and lies down on her playroom floor, or vomits, then maybe it is time to giver her some medicine! The reason to treat a fever is to help your child feel better. Acetaminophen (Tylenol) or Ibuprofen (Motrin) should bring it down, although they may not bring it down to normal. Remember that a little fever is not a bad thing when trying to fight off a virus. Tylenol may be given every 4-6 hours, and Motrin may be given every 6-8 hours. Never use Motrin in a baby under 6 months. Consult with your pediatrician for proper doses and use of Tylenol and Motrin.

When your child has a fever, keep him in loose, cool clothing. Although he may act cold, keep just a light blanket over him. A lukewarm bath may help bring the temperature down as well. Place him in the bath for about 5 minutes, then take him out, only lightly patting him dry. The body cools down as the water evaporates off the skin. Do not use cold water or alcohol.

When should I see the doctor?

Any baby under 3 months of age with a temperature over 100.4 degrees F should be seen immediately by a doctor. Between 3 and 6 months of age, the baby should be seen within 24 hours of having a fever. Children 6 months and up should be seen by the doctor if they have fever over 48 hours without other symptoms, or over 72 hours if they have runny nose and cough. If they are playful, drinking plenty of fluids, and comfortable, they can wait even longer.

Any child at any age who has fever of 105 degrees F should be seen, and any child with a fever who is confused, lethargic, has trouble breathing, has seizure activity, or any other worrisome signs should be seen immediately.  In addition, children with fevers lasting more than 5 days should be examined by a physician.

Remember that fever is a symptom, not a disease, and be thankful that the vaccinations you have given your child are protecting them against the diseases that caused the dreaded fever just a few generations ago. Most fevers today indicate a minor viral illness, and will go away after a few days.  Keep your child hydrated and have some medicine on hand. You know your child best, and call your doctor if you are concerned…that’s why we’re here.