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Relax, most fevers in kids are normal

Kevin Hatcher-Ross, MD

While fevers can make parents worry, they are extremely common in kids. We chatted with clinic pediatrician Dr. Kevin Hatcher-Ross about why fevers occur and how to treat them.

Q: What is a fever?
A fever is a temperature of 100.4 degrees or higher. Ear, skin, and armpit thermometers tend to run a bit low, so we will often call temperatures taken with those devices a fever if they’re 100 degrees or higher. Rectal thermometers are the most accurate for infants. Oral thermometers are highly accurate for older children.

 Q: What causes fevers?
A fever is a sign of an infection. Usually, it’s a harmless, self-resolving infection such as a viral cold or stomach bug. However, it may also be a more significant bacterial infection such as pneumonia, strep, or a urinary infection. Vaccines can also cause a fever, but it’s never a reason not to get vaccinated.

Q: Are fevers harmful?
Unlike heatstroke, fevers are harmless, other than in children with significant heart disease. A fever is created by the child’s own immune system when it fights an infection. The fever itself is not dangerous, even if it’s high, and may even make it easier to fight the infection by signaling the body to produce more bug-destroying white blood cells. At the same time, the higher temperature prevents bad microbes from reproducing.

Q: How can parents treat a fever at home?
Acetaminophen and ibuprofen can help lower a fever. If a child is comfortable, they do not need medicine, but if the fever is making them uncomfortable, then it is reasonable to give medication. No children should be given aspirin, and there’s no need to wake up a child who is sleeping to give them a fever medicine.

Q: Should parents alternate fever medicines?
If a child is still feverish and uncomfortable 30 to 60 minutes after receiving a dose of either Acetaminophen or ibuprofen, then it is okay to give them the other one. However, it generally isn’t worth switching back-and-forth between the two.

Q: Should parents give medicine to prevent a fever-induced seizure?
While medicines are effective at lowering fevers, they don’t help prevent febrile seizures. Luckily, while these types of seizures can be scary to witness, they are rare, harmless, and unrelated to epilepsy. If a seizure does occur, have your child evaluated by a provider once it’s over. (However, call 911 if it lasts more than five minutes.) The best prevention is help avoid infections through good sleep and regular handwashing.

Q: When should a fever be looked at by a doctor?
A baby who has a fever and is under 3 months old should always be evaluated by a doctor. If the baby is under 1 month old, they should be seen in the emergency room. If a fever has lasted more than three days, that’s also a sign that a child should be looked at. Finally, if a child with a fever seems very sick—especially if they are having trouble breathing, are in severe pain, have purple spots, have other concerning symptoms, or are unable to stay hydrated—then it’s time to see a doctor.