Now that fever is well defined, we can discuss what steps are needed if any to take when a child has a fever. This is largely determined by how old a child is. Generally speaking, the younger a child is the more attention fever deserves. Under 3 months of age, fever is considered to be an emergency. At this age, infants’ immune systems are still in the early stages of development. Hence it is important to have your child seen immediately if your newborn or young infant has a temperature greater or equal to 100.4 °F (38 °C) even if it means taking him or her to the emergency room. It is very important to have children in this age group assessed to rule out the possibility of serious infections that can affect their blood streams or central nervous systems.
In older children aged 3 months to about 5 years of age, the definition of fever is the same, but the need for assessing is a little less urgent. Generally, if children in this age group are alert, responsive, make eye contact, do not have severe headache or stiff neck, are not overly lethargic, and can drink small amounts of fluids without vomiting then they can be treated at home supportively with fever medications. Acetaminophen (the generic name for Tylenol) can be given to children of all ages. Ibuprofen (the generic name for Advil and Motrin) can be given to children older than 6 months.
Using both classes of fever medications by alternating one with the other has fallen out of favor in recent years due to increased risk of overdosing one medication or the other. Acetaminophen (Tylenol) should not be given more than 5 times in a 24 hour period as this can cause liver damage. If ibuprofen (Motrin or Advil) is over used it can cause abdominal pain or impact the kidneys. For these reasons, we generally recommend you stick with either acetaminophen or ibuprofen but not both. Also, these medications are based on your child’s weight, so follow the official dosing chart supplied by the drug manufacturer or check with your child’s healthcare provider for dosing. You can also use a cold compress or lukewarm bath to bring down the temperature. Never use ice cold water or put rubbing alcohol in bathwater for fever control as this could be dangerous.
You can treat your child’s symptoms of fever as described above if they appear uncomfortable. However, if they are acting or playing normally during the fever you really do not have to give any medication. Fever is part of the body’s natural defenses against infection. When the body detects an infection, it raises its core temperature to better deal with the infection.
Children six years of age or older are treated similarly to those in the 3 month – 5 years of age group, except that their doses of fever medication will be higher because they weigh more than the previous group. Usually older children are better able to verbalize what may be bothering them. This helps in their assessment and can give parents and healthcare providers a better sense of how urgently they need to be seen.
Severe headache, frequent vomiting, stiff neck, extreme fatigue, difficulty breathing, or confusion are red flags to have your child seen promptly in the emergency room. If your child does not have these signs but is just feeling a bit under the weather, you may be able to treat supportively at home. However, if fever persists for more than 24 hours, we recommend that you bring your child into the office for a sick visit to assess his or her symptoms.