By David Meduna, MD, FAAP
Fever is a common and distressing problem among children. We often get calls about fever, and there is a lot of confusion about when to be concerned and when not to be concerned when your child has a fever.
Normal body temperature can range from 97 to 100.3 degrees Fahrenheit. Doctors consider body temperature over 100.3 degrees Fahrenheit a fever. Some school systems consider temperatures over 99.9 degrees Fahrenheit to be a fever. Fever is a normal body reaction to many infections. It slows the reproduction of many types of bacteria and viruses and thus helps us get over these infections. Fevers over 103-104 degrees Fahrenheit really do not have any more benefit for the child then fevers under this level; therefore, treatment of fevers in healthy children can usually be held until fevers are over 102 degrees Fahrenheit. Treatment is indicated in children with heart, lung and other chronic conditions, as it may make these conditions worse. Discuss how to treat fevers with your health care provider.
A long held myth is that a high fever will somehow damage the brain. Fevers need to really get up to around 106 degrees Fahrenheit to cause brain damage. Fevers due to infections very rarely get this high. The exception is in children who have too many clothes/blankets on, which can stop heat from leaving the child. This is why we tell parents to open children’s clothes and remove extra blankets with high fevers. Sometimes a sponge bath with lukewarm water is also appropriate. Fevers due to heat stroke and certain medication reactions can get high enough to damage vital organs and are a medical emergency.
The real question to ask regarding a fever is what is causing it. Fever can be caused by anything from mild, temporary viral infections to severe life threatening infections. Here are a few points to keep in mind:
When to notify your healthcare provider of a fever depends on your child’s age, as the type and severity of infections that children can get varies by age. If your child is:
- Birth-3 months: Call right away with any fever over 100.3 degrees Fahrenheit.
- Older than 3 months: Call right away with any fever over 105 degrees Fahrenheit.
In addition, always call your healthcare provider if any of the below apply:
- You are very concerned about your child.
- Fever is associated with shortness of breath, severely decreased activity, severe cough, or stiff neck.
- Your child has a fever with a very sore throat and/or known exposure to strep throat.
- Your child’s symptoms seem different from ordinary cold symptoms.
Fevers due to viruses usually start at the beginning of an illness and typically are gone by about 3 days. Even though fevers resulting from viral illness can rarely last up to a week, it is important to rule out serious infection, so if your child has a fever for more than three days or develops a new fever after several days of illness, he or she should be seen by a healthcare provider. The healthcare provider can decide when further follow-up should occur.
Here are some final thoughts about fever:
- Athletes should not train when they have a fever.
- A child with a viral illness is more likely to spread the virus when fever is present, and that is why we ask children with fevers to stay home from school until the fever is gone.
- Fevers will often break in the morning and return at night.