Call our office or page operator (after hours) if your baby is younger than three months of age and develops a fever (rectal temperature of more than 100.4°F).  Do not give Tylenol to a baby less than three months old without talking to us first.  The medicine can confuse the situation by altering the fever’s course.

For older infants, we are more concerned about how your baby looks and acts rather than the height of the fever.  For any age, a child with fever that looks ill and has other symptoms (stiff neck, bad headache, seizure, sore throat, ear pain, foul smelling urine, burning with urination) which cause you to worry, please call the office.  We handle fever differently based on your child’s age and the context of the fever.  We are happy to teach you on an individual basis how we think fever should be handled.  The scope of detailed fever management is beyond the capabilities of this booklet.

Always accurately record temperatures with a digital thermometer.  The best place to check is in the rectum (especially for babies less than three months old) or axillary if > one year old.  Write this number down on a piece of paper and show it to your doctor.  Fever is defined as any temperature more than 100.4° F for infants less than three months old.  For older children (children older than three months), we consider 101° F a fever.

Taking a Rectal Temperature

  • Lubricate the tip of the thermometer with a water-soluble lubrication. (KY, Vaseline, etc.)
  • Place your baby face down across your lap, supporting their head, or lie them 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 them still.
  • Using your other hand, insert the lubricated thermometer through the anal opening, about 1/2 to 1 inch into the rectum. Stop at less than 1/2 inch 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 them 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.

Treatment for Fever

Fever is not harmful itself. Fever is usually a symptom of an infection.  It is a sign that your child’s body is fighting the infection.  Treatments for fever offer only temporary relief.  The decision to treat a fever should revolve around how the fever is affecting your child.  If your child has a fever and feels great, medication is probably not necessary.  Medicine might be warranted if your child feels achy and weak or if your child also has a headache or sore throat.  Please do not treat the fever of a child less than three months old.  We need to know about it.  Should you decide to treat a fever, we recommend the following measures:

  • Acetaminophen (Tylenol, for children any age) and ibuprofen (i.e. Advil or Motrin, for children older than six months of age) are excellent medicines for fever treatment. Studies have shown that selecting a single medicine and using it appropriately controls fever as well as alternating medicines.  Therefore, we recommend using a single fever reducer every six hours. In general, ibuprofen is preferable as a first line medicine for fever because it lasts longer and controls aches and pains better than acetaminophen.  If the fever returns before it is time to give ibuprofen again, you can then use acetaminophen to bridge the gap, if necessary.  Again, do not use ibuprofen for children less than six months old.
  • Do not use aspirin to treat a child’s fever.
  • If your child vomits the fever medication, you can use rectal acetaminophen (Feverall) sold over-the-counter at the pharmacy.
  • You also can give a lukewarm sponge bath for ten to twenty minutes (26-28C° is optimal) for comfort purposes. Repeat this every two hours as needed. Evidence shows this does not reduce fever, however it can be done for your child’s comfort.

Be certain that you are giving the right dose of medicine. This can be confusing as seen below:

Infant’s Unconcentrated Acetaminophen Drops*                160mg/5ml

Children’s Acetaminophen                                                             160mg/5ml

*Concentrated Infant Acetaminophen drops (80mg/0.8mL) are no longer available

Infant’s Ibuprofen Drops                                                                50mg/1.25ml

Children’s Ibuprofen                                                                        100mg/5ml

Do not use ibuprofen any closer than every six hours and do not use acetaminophen any closer than every four hours.

You can safely follow the dosing on the box.  If you want to be safe and want to double check the dose, the general dosing of acetaminophen is 15mg per kg per dose or 7mg per pound per dose (2.2lbs = 1kg).  The dosing of ibuprofen is 10mg per kg per dose or 4.5mg per pound per dose.