Fever

Fever is very common in childhood. When evaluating fever in a child, it is important to look at several factors. These factors include: age of the child, method by which the reading was obtained, & the general state of health of the child.

Officially, fever is defined as a body core temperature of greater than 100.4 degrees. The normal body temperature is approximately 98.6 degrees. Fever, in itself, is not harmful to the body. It simply is the body's reaction to stress or infection. Fever serves as a sign that something is going on.

Age of the child

Age of the child is an important factor in determining what to do about fever. Fever in a child less than 2 months of age is always a concern and should be evaluated. Many times it is very difficult to determine the source of fever at this age. At this age serious infections often present with little more than fever. If your child is under 2 months of age and has a fever (T > 100.4), you should notify the pediatrician immediately. Older children should be treated with appropriate dosing of antipyretics (fever reducing medicines), and it is not necessary to notify the doctor unless the fever persists or is not responding (see below for appropriate dosing).

Method

Method by which the temperature is obtained is also important. The only true measure of central body temperature is a rectal temperature. This is the preferred method in children under 2 years of age. Other methods; oral (by mouth), axillary (under the arm), and ear are acceptable methods for determining hot vs. not hot, but the number itself is less reliable.

How the child looks

How the child looks is the third, and maybe the most important factor in assessing a child. Fever is treated primarily for the comfort of the child. Fever, in itself, will not hurt a child. Determining whether or not to give medication is based on how the child looks. For example, if a child has a 99 degree temperature, but is not comfortable or looking well, that child should be given medication, where as, if a child has a 102 degree temperature, and is active and playful, medication is not necessary. It is also important to know that when a child has a fever, it is normal for them to breathe more quickly and for their heart to beat more rapidly.

Medication

Acetaminophen (Tylenol) and ibuprofen (Motrin, Advil) are the only two fever reducing medicines now available and recommended for children. Because of the association of Aspirin with Reye's Syndrome, it should never be given to a child with a fever. Acetaminophen and ibuprofen work by different methods and can be alternated if absolutely necessary. Both medicines come in infant as well as children's forms. The only difference between the two forms is the concentration of medicine. Dosing charts are shown below.

Other ways to reduce temperature

Luke warm baths can be helpful in addition to medication, or if medication is not working. Temperature is reduced by the evaporation of water from the skin. For this reason, the temperature of the bath should be luke warm, not cold. Cold water will only shock the child.

Brain Damage and Seizures

It is extremely rare for fever to cause brain damage (almost never). Occasionally a child can have a generalized seizure associated with a rapid rise in temperature or sometimes a high fever. This usually causes a generalized shaking of arms and legs, and lasts for a short period of time. If a child has a "febrile seizure", it does not mean they have a seizure disorder, nor are there any permanent consequences of this experience. Febrile seizures are most common in young children (age 2-6), may run in families, and are more likely to occur in children who have had them before.

Acetaminophen Dosage

Child's weight more than (pounds)	6	12	18	24	36	48	60	90	lbs.
Total Amount (mg.)	40	80	120	160	240	325	450	650	mg
Drops 80 mg/dropper	1/2	1	1-1/2	2	3	--	--	--	dropper
Syrup 160mg/5ml (1 tsp.)	--	1/2	3/4	1	1-1/2	2	2-1/2	4	tsp.
Chewable 80 mg. tablets	--	--	1-1/2	2	3	4	5-6	8	tabs
Chewable 160 mg. tablets	--	--	--	1	1-1/2	2	3	4	tabs
Adult 325 mg. tablets	--	--	--	--	--	1	1-11/2	2	tabs

• Acetaminophen Dosage 5-7 mg/pound/dose (10-15 mg/kg/dose) every 4-6 hours (Adult 650)
• Note: Acetaminophen also comes in 120, 325, and 650 mg suppositories (same dosage).
• Don't use under 3 months of age (Reason: fever during the first 12 weeks of life needs to be documented in a medical setting and if present, the infant needs a complete evaluation.)

Pediatric Telephone Protocols by Barton D. Schmitt, MD. PTP version.
Copyright 1994. Decision Press, Littleton, CO.
Revised 7/1997

Ibuprofen Dosage

Child's weight more than (pounds)	12	18	24	36	48	60	72	96	lbs.
Total Amount (mg.)	50	75	100	150	200	250	300	400	mg
Drops 50 mg/1.25 ml.	1	1 1/2	2	3	4	--	--	--	dropper
Liquid 100mg/5ml (tsp.)	1/2	3/4	1	1 1/2	2	2 1/2	3	4	tsp.
Chewable 50 mg. tablets	--	--	2	3	4	5	6	8	tabs
Adult 200 mg. tablets	--	--	--	--	1	1	1 1/2	2	tabs

• Ibuprofen Dosage 3-5 mg/pound/dose (5-10 mg/kg/dose) every 6-8 hours
• Adult Dose: 400 mg
• Don't use under 6 months of age (Reason: Safety not established and doesn't have FDA approval.)

Pediatric Telephone Protocols by Barton D. Schmitt, MD. PTP version.
Copyright 1994. Decision Press, Littleton, CO.
Revised 7/1997

JDMD 12/26/00, 2/10/02 (revised)