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How to Respond When a Fever Strikes

How to respond when your child has a fever.


It's cold season again and fever, that perennial parental boogeyman, is on the loose and threatening to cause discomfort and anxiety for kids and grownups alike.

We put up a brave front against the sniffles and sore throats, coughs and tummy aches. However, fever strikes fear in even the most seasoned caregivers. Part of this is no doubt due to feeling a loss of control as your child's temperature rises. But there's also a lot of folklore about fever – and much of it's not true.

"There's a lot of mythology and fear around fever," says Michelle Heng, M.D., a pediatrician at Overlake Medical Center. "I think that people worry about brain swelling. They know that's associated with high body temps. That's one thing that's scary. Some children have seizures. That's another thing that's scary. Parents [therefore] want to get the fever down as soon as possible."

Heng, who is also an American Academy of Pediatrics fellow, calls the belief that a high fever causes harmful brain swelling an "old wives tale" that has no legitimate medical grounding. Brain damage may occur with severe overheating due to sunstroke or being locked in a hot car, but that has no relationship to fever.

A febrile seizure is a fever-induced seizure that typically happens to infants or toddlers, which affects approximately 4 percent of the pediatric population, says Heng.

While experiencing this event, the child can lose consciousness and shake, moving limbs on both sides of the body. Often, these seizures are found in children who have temperatures higher than 102 degrees Fahrenheit; it is the rapid rise in temperature that is thought to be most significant when considering the many factors likely to contribute to which children will have a seizure.

While frightening for parents, febrile seizures are typically short and harmless. Febrile seizures don't lead to epilepsy or to learning problems. "Most of the time, they are a one-time event," Heng explains. "We caution parents [whose child has had a febrile seizure] to be more aggressive in treating the fever [next time]."

Michael Clinard agrees, wholeheartedly. His daughter, Tala, experienced a febrile seizure when she was little more than 1 year old. Clinard got a call from daycare saying that his child had a temperature. While they had Tylenol on hand, they did not have the paperwork in place to administer the medication, so he went to bring her home.

"When I picked her up, she was noncommunicative. I could tell she was sick and didn't feel good. I took her to the pediatrician," Clinard remembers. "The pediatrician thought she was fine, just needed some Tylenol. She had had this throat thing. The doctor thought the fever was because of that."

Clinard brought Tala home and left the room to get the medication. When he returned, Tala was on her side, shaking and making a rattling sound. He immediately called 911.

"I put her on her back and she went completely blue. I was losing it at that point. The [911 operator] told me to get her temp down. I ripped her shirt off, grabbed a cold towel, put it on the back of her neck. When I did that she started to cry."

Clinard had never heard of febrile seizures. "It's important that people know what this is," he says. "If you're home alone, you're the caretaker, and you don't know what it is, it's scary as hell."

If your child does seize, position him on his side so that he is less likely to choke or fall, call 911 and stay with him until 911 arrives. Tala, who turned 2 recently, has never experienced another seizure.

Clinard says he's more apt to medicate earlier for fever now, and immediately remove her clothing if his daughter ever has a prolonged fever again.

Treat the Child, Not the Number

People may not even know why they're worried about fever, says Heng, but the confusion about how to measure temperature and when and how to treat it, adds to the anxiety. When it comes to cutting through the folklore of fever, a wise mantra for parents is: Treat the child, not the number.

"Once you get beyond infancy," says Heng, "the degree of fever doesn't necessarily speak to the intensity of the infection or the cause of the infection. It's important to see what your child is doing. Are they running around? Are they wiped out? The key is looking at your child and seeing how they look. … This is more important than the degree of the fever."

Of course, there are times when the number matters. If your child is 4 to 8 weeks old or younger, it's important to report any fever to your health provider. During this time frame, the antibodies infants have from their mothers are waning, and their own are not strong enough yet. Plus, they haven't had a full battery of vaccinations and are vulnerable to certain infections from the birth process. From 8 weeks onward, treatment is the same for most fevers (technically above 101.5 Fahrenheit, by the standards of most medical providers).

Using the Right Thermometer

Another challenge associated with fever is the difficulty of getting an accurate reading. Jessica Swanson, a mother of two under the age of 5, laments: "I can't find, keep, use properly, or rely upon any single thermometer. My mom had the same glass mercury thermometer my entire life. I'm locked in the endless quest for a good one."

To be sure, the list of thermometers today and where on the body they measure temperature is long and can be daunting.

The gold standard for infants is a rectal thermometer. If your child is 3 months old or younger, you can start by taking an axillary temperature (under the armpit). If that presents high, repeat with a rectal reading, says Heng.

For children older than 3 months, temporal artery scanners, which measure ambient temperature on the forehead, are effective. Ear thermometers work similarly, but are not recommended for children younger than 6 months of age. They can also be easily thrown off by earwax or inaccurate placement.

If the fever is lower than 102, Heng recommends letting the body do its job. "You usually don't have to treat it unless it's causing discomfort to the child." While there are no studies that show that giving medication when it isn't needed lengthens the duration of the sickness, Heng says in an optimal situation, you want the body to do the work "without intervention."

Samantha LeVine, ND, a naturopath who specializes in pediatric care, agrees. "I usually prefer allowing the fever to take its course. Sometimes, a well-tolerated fever can be a ‘good' thing for a child. However, when there is no identifiable cause, or the fever is persisting, suppressing is certainly recommended." LeVine recommends adding nutrients to the diet that support the body's natural system for fighting illness. 

"Most fevers with most childhood viruses last about three days. Typically the fever is highest initially," Heng says. "A lot of people think they need to get the temp down to what's considered normal. A lot of times you're not going to bring it down to 98.6, but you'll bring down a couple of degrees. That's going to make them feel better."

If you choose to medicate, acetaminophen (Tylenol) and ibuprofen are similarly effective. Acetaminophen can be given every four hours and ibuprofen can be given every six hours. Contrary to what some parents may have heard, there's no benefit to alternating between the two, although it is safe to be giving both. Heng suggests picking one drug and sticking with it to avoid confusion.

Acetaminophen has been in the news lately because of its potential to be toxic to the liver if not given in the recommended dosage. It's important to read the instructions carefully and recognize that infant Tylenol, for example, is a stronger concentration than Tylenol for children. And be sure to communicate with other caregivers to ensure you're not doubling up. Ibuprofen cannot be given until after 6 months of age.

There are other things you can do, says Heng, such as giving your child a tepid bath and having her drink cold fluids. One mom even swears by putting wet socks on her child's feet at bedtime and covering them with plastic bags. She guarantees the fever will break by morning.

Sounds a little crazy? Maybe. But when it comes to fever, sometimes doing nothing is the hardest thing of all.


Note: This article was originally published in January 2014.

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