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Northside Pediatrics

Fever: What it is, what to do about it, and when to worry.

Introduction
Fever is a symptom, not a disease. In recent years, research has documented that many human host defense mechanisms are helped by fever, and that fever even enhances the action of antibiotics.

Most fevers are due to viral illnesses with the onset of fever indicating the start of an infection, and the disappearance of fever often marking the end of an illness. Most fevers associated with viral illnesses range from 101 to 104 and last for several days. In general, the height of the fever does not relate to the seriousness of the illness. Much more important is how sick the child acts.

Definition of Fever
Fever is defined as a temperature above the normal range. The body's average temperature is usually around 98.6 degrees to a high of 100.6 degrees in the late afternoon. Mild elevations in temperature can be caused by exercise, warm clothing, hot weather, or warm food or drink. If one of these causes is suspected, it should be eliminated and the temperature should be retaken in approximately 1/2 hour.

Facts About Fever
The fevers that children usually experience in the range 101-104 are not harmful. A high fever may be defined as one greater than 105 degrees. Fever by itself causes no brain damage or other harm unless it reaches at least 107 degrees. Even then, the cause of the fever may be more important than the height of the fever in possible injury that may occur. Untreated fever in children with viral infections, which constitute the vast majority of causes of fever in childhood do not tend to exceed 105 degrees. The thermostat in the brain that controls body temperature keeps fever in a safe range.

Taking the Temperature
In general, in a child who has an illness accompanied by fever, the temperature should be taken only at the major times of day (morning, afternoon, and evening) when he or she seems sick; but as the illness appears to resolve, a once a day temperature is quite adequate.

Instructions for Parents Taking a Child's Temperature

Where to take the temperature

1. In children less than 5 years of age: axillary (armpit) temperature for screening: if axillary temperature is 99 degrees F., check with a rectal temperature.

2. In children 5 years and older: oral temperature

Taking axillary temperatures

1. Place the tip of the thermometer in a dry armpit

2. Close the armpit by holding the elbow against the chest for 4 minutes or until the thermometer beeps

3. If you're uncertain about the result, recheck it with a rectal temperature

Taking rectal temperatures

1. Have your child lie stomach down on your lap

2. Lubricate the end of the thermometer and the child's anal opening with petroleum jelly

3. Carefully insert the thermometer about 1 inch, but never force it

4. Hold your child still while the thermometer is in, and press the buttocks together to stabilize the thermometer

5. Leave the thermometer inside the rectum for 2 minutes or until the thermometer beeps

Taking oral temperatures

1. Be sure your child has not recently drunk a very cold or hot beverage

2. Place the thermometer tip beside the tongue inside the cheek

3. Have your child hold the thermometer in place with the lips and fingers (not teeth)

4. Have your child breathe through the nose with the mouth closed

5. Leave the thermometer inside the mouth for 3 minutes or until the thermometer beeps

6. If your child can't keep the mouth closed because the nose is blocked, take an axillary temperature

A Fever That Requires Calling the Physician
Most fevers that occur in childhood are simple viral infections; and if fever is the only symptom present, the child should be observed for other problems which are much more important than the presence of fever alone. How sick the child looks is much more important than the level of fever.

Only in the very young infant is a single above normal temperature, without any other symptoms, an indication for a call to the physician.

Telephone guidelines for parents of child with fever

Call immediately if:

a. Your child is less than 3 months old

b. Fever is greater than 105 degrees

c. Your child is crying inconsolably

d. Your child is difficult to awaken

e. Your child is confused or delirious

f. Your child has a seizure

g. Your child has a stiff neck

h. Your child has purple spots on the skin

i. Breathing is difficult and your child does not feel better after the nose is cleared

j. Your child is acting very sick

k. Your child has an underlying risk factor for serious infection (sickle cell disease, cystic fibrosis, splenectomy, immunizations are not up-to-date)

Call during office hours if:

a. Your child is 3-6 months old

b. Fever is between 104 and 105 degrees especially if your child is under 2 years of age

c. Burning or pain occurs with urination

d. Fever has been present for more than 72 hours

e. Fever has been present for more than 24 hours without an obvious cause or location of infection

f. Fever went away for more than 24 hours and then returned

g. Your child has a history of febrile seizures

h. You have other questions

Treating a Fever
Mild and moderate temperature elevations in children do not need to be treated. Children with fevers greater that 102 degrees may experience some discomfort, and one might consider treatment of the fever in these children. Once therapy for fever is begun, it is not necessary to continue giving medicine every four hours if the child seems well otherwise. Also, it is not necessary to wake a child from sleep to give medications to reduce fever; medicines that reduce fever do not always lower the temperature to normal, and will not keep the fever from recurring after they are administered.

In summary, should your child have fever that is in the range of 102 or more, and experience some mild symptoms from this, it is reasonable to give acetaminophen (Tylenol).

ACETAMINOPHEN DOSING CHART
Dose is every 4-6 hours. 

Weight:

Milligram Dosage

Infant drops
80mg/0.8ml
1 dropper= 0.8ml 
½ dropper= 0.4ml

Children's liquid
160mg/5ml

Children's soft chews
80mg each

Junior strength
Caps or chews
160mg each

6-8 lbs

40mg

½ dropper

(0.4ml)

¼ tsp

(1.25ml)

N/A

N/A

9-11 lbs

60mg

¾ dropper

(0.6ml)

1/3 tsp

(1.8ml)

N/A

N/A

12-17 lbs

80mg

1 dropper

(0.8ml)

½ tsp

(2.5ml)

N/A

N/A

18-22 lbs

120mg

1 ½ dropper

(1.2ml)

¾ tsp

(3.75ml)

N/A

N/A

23-28 lbs

160mg

2 droppers

(1.6ml)

1 tsp

(5ml)

2 tablets

1 tablet

29-34 lbs

200mg

2 ½ droppers

(2ml)

1 ¼ tsp

(6.25ml)

2 ½ tablets

 

35-40 lbs

240mg

3 droppers

(2.4ml)

1 ½ tsp

(7.5ml)

3 tablets

1 ½ tablet

41-46 lbs

280mg

3 ½ droppers

(2.8ml)

1 ¾ tsp

(8.75ml)

3 ½ tablets

 

47-58 lbs

320mg

4 droppers

(3.2ml)

2 tsp

(10ml)

4 tablets

2 tablets

59-69 lbs

400mg

Use liquid or

tablets

2 ½

tsp(12.5ml)

5 tablets

2 ½ tablets

70-81 lbs

480mg

 

3 tsp

(15ml)

6 tablets

3 tablets

82-93 lbs

560mg

 

3 ½ tsp

(17.5ml)

7 tablets

3 ½ tablets

94-99 lbs

640mg

 

4 tsp

(20ml)

8 tablets

4 tablets

>100 lbs

Give

Adult

Dosage