The P.A. Pulse – Fever

FEVER

The word fever is derived from the Latin fovere, meaning to warm, and commonly means an increase in body temperature. A fever is a body temperature that is higher than normal. While the average normal body temperature is 98.6°F (37°C), a normal temperature range is between 97.5°F (36.4°C) and 99.5°F (37.5°C). Most pediatricians consider a rectal temperature above 100.4°F (38°C) as a sign of a fever.

Your child’s normal temperature will vary with his or her age, activity, and the time of day. Infants tend to have higher temperatures than older children, and everyone’s temperature is highest between late afternoon and early evening and lowest between midnight and early morning. By itself, fever is not an illness. Rather, it is a sign or symptom of sickness. is a physiological mechanism that has beneficial effects in fighting infection In fact, usually it is a positive sign that the body is fighting infection. Fever stimulates certain defenses, such as the white blood cells, which attack and destroy invading bacteria.

Signs and Symptoms

  • Warm to the touch
  • Flushed appearance
  • More thirsty than usual
  • Heart and breathing rates will speed up
  • Sweating
  • Chills and shivering
  • Headache
  • Muscle aches
  • Loss of appetite
  • Irritability
  • Dehydration
  • General weakness
  • Quiet/Cry
  • Changes in sleeping or eating habits
  • Have seizures

Some children feel fine when they have a fever. However, most will have symptoms of the illness that is causing the fever. Your child may have an earache, a sore throat, a rash, or a stomach ache. These signs can provide important clues as to the cause of the fever.

Don’t Confuse Fever with Heatstroke

A rare but serious problem that is easily confused with fever is heatstroke. This is not caused by infection or internal conditions, but by surrounding heat. It can occur when a child is in a very hot place—for example, a hot beach in midsummer, it can occur if a baby is overdressed in hot, humid weather or an overheated closed car on a summer day. Leaving children unattended in closed cars is the cause of several deaths a year; never leave an infant or child unattended in a closed car, even for a few minutes.

Under these circumstances, the body temperature can rise to dangerous levels (above 105 degrees Fahrenheit [40.5 degrees Celsius]), which must be reduced quickly by cool-water sponging, fanning, and removal to a cool place.  After the child has been cooled, he or she should be taken immediately to a pediatrician or to the emergency room. Heatstroke is an emergency condition.

Febrile Seizures

Febrile seizures (seizures caused by fever) occur in 3 or 4 out of every 100 children between six months and five years of age, but most often around twelve to eighteen months old.  A febrile seizure usually happens during the first few hours of a fever. The child may look strange for a few moments, then stiffen, twitch, and roll his eyes. He will be unresponsive for a short time, his breathing will be disturbed, and his skin may appear a little darker than usual. After the seizure, the child quickly returns to normal. Seizures usually last less than 1 minute but, although uncommon, can last for up to 15 minutes. While febrile seizures may be very scary, they are harmless to the child. Febrile seizures do not cause brain damage, nervous system problems, paralysis, intellectual disability or death.

Managing the Fever

A fever can’t always be detected by feeling your child’s forehead. It’s usually necessary to take his temperature as well. Although there are numerous thermometers on the market that measure temperature in different areas, parents should use rectal thermometers with their babies for the most accurate reading. Always use a digital thermometer to check your child’s temperature. Mercury thermometers should not be used. The American Academy of Pediatrics (AAP) encourages parents to remove mercury thermometers from their homes to prevent accidental exposure and poisoning.

Primary goal should be to help the child feel more comfortable, rather than to maintain a “normal” temperature.

  • Focus on the general well-being of the child.
  • Observe the child for signs of serious illness
  • Maintain appropriate fluid intake.
  • Parents should not wake up a sleeping child to administer a fever-reducer. Antipyretics must be stored safely to avoid accidental ingestions.
  • Parents should be aware that the correct dosage is based on the child’s weight, and that an accurate measuring device should always be used.

Treatment Suggestions for Fever

  • Keep the child’s room and your home comfortably cool, and dress him lightly. If the room is warm or stuffy, place a fan nearby to keep cool air moving.
  • Encourage the child to drink extra fluid or other liquids. A fever will also cause a child to lose fluids more quickly, so offer plenty of fluids to avoid dehydration. Signs of dehydration include crying without tears, a dry mouth, and fewer wet diapers.
  • Have children’s acetaminophen or ibuprofen on hand. Giving a child acetaminophen or ibuprofen will usually reduce a fever. It is important to make sure you give the right dose to your child.
  • Other practices to reduce fevers such as an alcohol bath, ice packs, etc. are no longer recommended and can actually have adverse effects on your child
  • Your child does not have to stay in his room or in bed when he has a fever. He can be up and about the house, but should not run around and overexert himself.
  • If the fever is a symptom of a highly contagious disease (e.g., chickenpox or the flu), keep your child away from other children, elderly people, or people who may not be able to fight infection well, such as those with cancer.

Sponging

In most cases, using oral acetaminophen or ibuprofen is the most convenient way to make your feverish child more comfortable. However, sometimes you may want to combine this with tepid sponging, or just use sponging alone.

Sponging is preferred over acetaminophen or ibuprofen if:

  • Your child is known to be allergic to, or is unable to tolerate, antipyretic (anti-fever) drugs (a rare case).

It is advisable to combine sponging with acetaminophen or ibuprofen if:

  • Fever is making your child extremely uncomfortable.
  • He is vomiting and may not be able to keep the medication in his stomach.

To sponge your child, place him in his regular bath (tub or baby bath), but put only 1 to 2 inches of tepid water (85–90 degrees Fahrenheit, or 29.4–32.2 degrees Celsius) in the basin. If you do not have a bath thermometer, test the water with the back of your hand or wrist. It should feel just slightly warm. Do not use cold water. Seat your child in the water—it is more comfortable than lying down. Then, using a clean washcloth or sponge, spread a film of water over his trunk, arms, and legs. The water will evaporate and cool the body. Keep the room at about 75 degrees Fahrenheit (23.9 degrees Celsius), and continue sponging him until his temperature has reached an acceptable level. Never put rubbing alcohol in the water; it can be absorbed into the skin or inhaled, which can cause serious problems, such as coma. Usually sponging will bring down the fever by one to two degrees in thirty to forty-five minutes.

When to Call the Pediatrician

Call your child’s doctor right away if your child has a fever and

  • Looks very ill, is unusually drowsy, or is very fussy
  • Has been in a very hot place, such as an overheated car
  • Has other symptoms, such as a stiff neck, severe headache, severe sore throat, severe ear pain, an unexplained rash, or repeated vomiting or diarrhea
  • Has immune system problems, such as sickle cell disease or cancer, or is taking steroids
  • Has had a seizure
  • Is younger than 3 months (12 weeks) and has a temperature of 100.4°F (38.0°C) or higher
  • Fever rises above 104°F (40°C) repeatedly for a child of any age

Also call your child’s doctor if

  • Your child still “acts sick” once his fever is brought down.
  • Your child seems to be getting worse.
  • The fever persists for more than 24 hours in a child younger than 2 years.
  • The fever persists for more than 3 days (72 hours) in a child 2 years of age or older.
2019-01-14T09:37:11+00:00 January 14th, 2019|The PA Pulse|0 Comments

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