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.

Infants’ Acetaminophen UNCONCENTRATED Drops (brand name: Tylenol) Children’s Acetaminophen Suspension Liquid (brand name: Tylenol)
Weight Age 160mg/5mL 160mg/5mL
6-12 lbs 0-6 months 1.25mL*
12-17 lbs 6-11 months 2.5mL* 2.5mL*
18-23 lbs 12-23 months 3.75mL* 3.75mL*
24-35 lbs 2-3 years 5mL* 5mL*
36-47 lbs 4-5 years 7.5mL* 7.5mL*
48-59 lbs 6-8 years 10mL*
60-71 lbs 9-10 years 12.5mL*
72-95 lbs 11 years 15mL*

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

Infants’ Ibuprofen Concentrated Drops (brand name: Motrin or Advil) Children’s Ibuprofen Suspension (brand name: Motrin or Advil
Weight Age 50mg/1.25mL 100mg/5mL
N/A Under 6 months Not recommended Not recommended
12-17 lbs 6-11 months 1.25mL** 2.5mL**
18-23 lbs 12-23 months 1.875mL** 3.75mL**
24-35 lbs 2-3 years 2.5mL** 5mL**
36-47 lbs 4-5 years 3.75mL** 7.5mL**
48-59 lbs 6-8 years 10mL**
60-71 lbs 9-10 years 12.5mL**
72-95 lbs 11 years 15mL**
96+ lbs 12+ years

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

Children’s Acetaminophen Soft Chews Chewable Tablets Junior Strength Chewable Tablets
Weight Age 80mg each 160mg each
6-12 lbs 0-6 months
12-17 lbs 6-11 months 1 tablet*
18-23 lbs 12-23 months 1.5 tablets*
24-35 lbs 2-3 years 2 tablets* 1 tablet*
36-47 lbs 4-5 years 3 tablets* 1.5 tablets*
48-59 lbs 6-8 years 4 tablets* 2 tablets*
60-71 lbs 9-10 years 5 tablets* 2.5 tablets*
72-95 lbs 11 years 6 tablets* 3 tablets*

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

Children’s Ibuprofen Chewable Tablets Junior Strength Ibuprofen Chewable Tablets Junior Strength Ibuprofen Caplets
Weight Age 50mg each 100mg each 100mg each
N/A Under 6 months Not recommended Not recommended Not recommended
12-17 lbs 6-11 months 1 tablet**
18-23 lbs 12-23 months 1.5 tablets**
24-35 lbs 2-3 years 2 tablets** 1 tablet** 1 caplet**
36-47 lbs 4-5 years 3 tablets** 1.5 tablets** 1.5 caplets**
48-59 lbs 6-8 years 4 tablets** 2 tablets** 2 caplets**
60-71 lbs 9-10 years 5 tablets** 2.5 tablets** 2.5 caplets**
72-95 lbs 11 years 6 tablets** 3 tablets** 3 caplets**
96+ lbs 12+ years 4 tablets** 4 caplets**

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

Consumer Reports September 2016

Oral thermometers are tops for temps

Flu season is on the way, as is a “burning” question for coughers and sneezers: Which type of fever thermometer is best? We asked 24 adults and 21 children ages 5 to 14 to test eight oral, ear, and forehead thermometers and found:

  • The oral ones proved best overall.
  • Price and performance don’t correlate. The best cost less than $15. A $30 children’s ear thermometer was only fair.
  • Simple as thermometers are, some have bells and whistles–beeps that tell you when they’re in the right spot or when they’re finished, or soft or curved tips–that can add to convenience.

We based our Ratings primarily on precision, or how widely the thermometers’ results varied from those of our control, the accuracy of which we verified.

Quick Ratings Digital Stick thermometers
In performance order. 

Name Price Score
CVS Flexible Tip Digital $15.00 77
ReliOn Rigid 60 Second (Walmart) $3.00 74
Up&Up 30 Second (Target) $4.50 67
BD Flexible Digital 524034 $10.50 65
Walgreens 10 Second Quick Read $10.00 60
Vicks Comfort Flex V966F-24 $15.00 29
Use Feverall Suppositories in a child who is unable to take Acetaminophen (Tylenol) or Ibuprofen (Motrin/Advil) as a result of vomiting.

Age Infants’ 80mg Children’s 120mg Jr. Strength 325mg
Under 6 months Do not use Do not use Do not use
6-11 months 1 suppository every 6 hours. Maximum 4 doses in 24 hours. Do not use Do not use
12-36 months 1 suppository every 4 to 6 hours. Maximum of 5 doses in 24 hour period. Do not use Do not use
3-6 years 1 suppository every 4 to 6 hours. Maximum of 5 doses in 24 hours. Do not use
6-12 years 1 suppository every 4 to 6 hours. Maximum 5 doses in 24 hours.
12 years and over 2 suppositories every 4 to 6 hours. Maximum of 6 doses in 24 hours.

How to use Feverall:

  1. Gently clean the area around the buttocks with a warm, wet towel.
  2. Detach one suppository from the strip.
  3. Remove wrapper before inserting suppository by holding suppository upright and carefully peeling wrapper evenly down both sides of the suppository. Avoid excess handling as the suppository is designed to melt at body temperatures.  Suppositories should not need to be refrigerated if stored at temperatures below 80 degrees F (27 degrees C).
  4. Position the child flat on their back or on one side, with anal opening exposed.
  5. Gently insert the suppository well into the rectum. Use fingertip to complete insertion.
  6. If necessary, hold the buttocks together for 30-60 seconds to keep the suppository in place.
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