Fever

We have a Fever video available on YouTube: https://www.youtube.com/watch?v=D96e6XI7ouY

First and foremost, remember that a fever itself is not dangerous. It is simply a sign that your child has an infection.  Do not be afraid of the height of a fever.  We commonly see children with 104-105 fevers.

ALWAYS accurately record temperatures with a thermometer. For kids younger than one year the best place to check is in the rectum.  For kids older than one, refer to the thermometer article attached to this handout.  When measuring a temperature, we recommend not adding or subtracting a degree, but reporting it as shown by the thermometer.  Other information that can be helpful include: serially measured temperatures, when they were taken, where they were measured, and when the last time a fever reducing medication was given.  A simple chart documenting these items can be very helpful.  Fever is defined as any temperature > 100.4 degrees F.

 Taking a Rectal Temperature

• Lubricate the tip of the thermometer with a lubricating jelly.
• Place your baby face down across your lap, supporting his head, or lie him down on a firm flat surface such as a changing table.
• Press the palm of one hand firmly against your baby’s lower back to hold him still.
• Using your other hand, insert the lubricated thermometer through the anal opening, about 1/2 to 1 inch (about 1.25 to 2.5 centimeters) into the rectum. Stop at less than 1/2 inch (about 1.25 centimeters) if you feel any resistance.
• Steady the thermometer between your second and third fingers as you cup your hand against your baby’s bottom. Soothe your baby and speak to him quietly as you hold the thermometer in place.
• Wait until you hear the appropriate number of beeps or other signal that the temperature is ready to be read. Read and record the number on the screen, noting the time of day that the reading was taken.

If febrile, a lukewarm sponge bath for 15-30 minutes may be soothing (26-28 degrees Celsius or 78.8-82.4 degrees Fahrenheit is optimal). Repeat this every 2 hours, as needed.

NEVER use aspirin in children as it is associated with a dangerous condition known as Reye’s Syndrome.

For children younger than 6 months, only use Tylenol (also known as acetaminophen) as Ibuprofen is not as safe in children younger than 6 months.

For children older than 6 months, Ibuprofen (name brands include Motrin/Advil, but any brand of ibuprofen is fine) generally works better to keep the fever down. If you are using a single medication, you can give Ibuprofen every 6 hours as needed or you can also use Tylenol every 6 hours.  If you desire greater fever control, you can choose to use both medications staggering Tylenol and Ibuprofen.  For example:  Give Ibuprofen at 12:00, then Tylenol at 3:00, then Ibuprofen at 6:00, then Tylenol at 9:00, and so forth.  Although you can stagger the medications as detailed, it is safest to use a single medication whenever possible.

Remember that it takes about 30-45 minutes for the medications to start working. Sometimes, even if you give your child medication, a fever may not immediately drop (even after 30-45 minutes).  With time however, most fevers will break (often sooner than later).

If the fever is not improving or your child is becoming sicker or the fever lasts >2 days, please call us or make an appointment immediately.

Acetaminophen/Ibuprofen Dosing Charts (Liquid)

Generic versions of acetaminophen and ibuprofen work well.  Brand names of acetaminophen include Tylenol.  Brand names of ibuprofen include Motrin and Advil.  Weight is a better measure than age in determining medication dosage.  Infants’ Acetaminophen Concentrated Drops (80mg/0.8mL) are no longer being offered, so please refer to the chart below for new dosages.

* DO NOT TAKE ACETAMINOPHEN MORE THAN 5 TIMES IN 24 HOURS

** DO NOT TAKE IBUPROFEN MORE THAN 4 TIMES IN 24 HOURS