Fever in Children

Info and Tips to Manage

By Lynette Wohlgemuth, RN, NP November 9, 2017

What is a fever?

Fever is the body’s normal response to a variety of conditions, usually infection caused by common viruses or bacteria. It occurs when the body’s thermostat rises to higher than normal by the brain. It is normal for temperature to vary; fever usually means a temperature greater than 38C/100.4F. Some immunizations can cause a fever. Bundling your infant in too many clothes can cause a higher temperature. Teething is not proven to cause a fever.

How to take a temperature.

Use a digital thermometer (most accurate). Rectal measurement is most accurate. For kids older than four years of age, measuring temperature in the mouth (place under the tongue) can be as accurate. For younger kids, you can take an armpit, forehead, or in the ear temperature; if it is higher than 37.2C/99F, then it should be confirmed either by mouth or rectally. Feeling the child’s skin (tactile temperature) is NOT accurate!

How to manage your child’s fever:

In most cases, it isn’t necessary to treat fever if kids are older than 3 months with a rectal temperature less than 38.9C/102F, who’s otherwise healthy, and is acting normally. If a child is uncomfortable, treatment may be helpful but not necessary. Treatment is recommended if the child has an underlying medical problem or if they’ve had febrile seizures in the past. Strategies include:

  • Medications: Acetaminophen (Tylenol) every four to six hours as needed (but no more than five doses/24 hrs and not for under three months of age) OR Ibuprofen (Advil/Motrin) every six hours as needed (not for under six months of age). Dose is calculated by the child’s WEIGHT not age. Do not give once bothersome symptoms have stopped.
  • Increase Fluids: Fever increases the risk of a child becoming dehydrated. Encourage fluids like milk, water, formula, popsicles, jello, soup (NOT Gatorade!). They may not be hungry; this is normal. Fluids are MOST important.
  • Rest: Usually kids feel tired and achy. Ensure they are able to rest AS MUCH AS they want! Once the temperature has been normal for a day, they can return to play and school. Sponging or Baths: It isn’t usually very effective for bringing down a fever, but may increase the comfort level of the child.

When to see a Health Care Provider:

  • Infants less than three months of age with a rectal temperature 38C/100.4F or greater regardless of how they look​.
  • Infants over three months to three years of age with a rectal temperature 38C/100.4F or greater for more than three days, or who appear ill.
  • Children three to 36 months of age with a rectal temperature of 38.9C/102F or greater.
  • Children of any age whose oral, rectal, inner ear, or forehead temperature is 40C/104F or greater; or underarm
    temperature is 39.4C/103F or greater.
  • Any age child with a febrile seizure; body convulsions with a temperature greater than 38C/100.4F.
  • Any age child with recurrent fevers for more than 7 days, even if they only last a few hours.
  • Any age child with a fever and a chronic medical disorder.
  • Any age child with a fever and a new skin rash.

Info provided by:​ Lynette Wohlgemuth, RN and Paediatric Nurse Practitioner
Reflections Nurse Specialist Services
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