Fever is very common in infants and children and is a normal response of the body to a viral or bacterial infection. Fever can make a child feel bad but it is exceedingly rare for a fever itself to cause harm. Children frequently run high fevers of 103-105 with viral infections. The height of the fever is not an indicator of the seriousness of the infection because children often run high fevers with harmless viruses. What is most important is how the child looks and acts, not the exact number of the temperature. Many children will act sick when the fever is present but then will smile and even play when the fever cycles down. This cyclic behavior tells you that the child is handling the infection well. About 3% of children between 6 months and 6 years of age will have a seizure when a fever rises rapidly. While scary to witness, these seizures are usually brief and ultimately harmless. These febrile seizures can rarely be prevented by treating with fever medications.
The definition of a fever depends on the site where it is measured. Rectal temperatures are the most accurate and a rectal temperature above 100.4 degrees is considered a fever. Oral temperatures above 100 degrees, axillary temperatures above 99 degrees and ear temperatures above 100.4 degrees in rectal mode are considered fevers. Fever below 102 is considered low grade and above 102 is considered high grade.
It is not necessary to treat fever in every instance. Fever needs to be treated only if it causes the child discomfort. Remember, fever is a normal response of the body to infection. Fever should initially be treated with Tylenol. If Tylenol does not work satisfactorily, then Motrin or Advil (Ibuprofen) can be used provided the child is over 6 months of age. We strongly recommend against using both Tylenol and Motrin. Use one or the other. If further treatment is desired, a lukewarm sponging of the head, neck and upper torso may help. Do this for about 20 minutes. This helps cool the body much like sweat does since it takes heat to evaporate the moisture. Remember to use lukewarm water and not cold water and certainly not alcohol. It is also helpful to remember that how well a fever responds to medication tells us nothing about the seriousness of the infection.
Most febrile illnesses can be managed easily at home. However, any child younger than 3 months with a fever needs to be evaluated by their doctor. These young infants are at risk for potentially serious infections due to bacteria they are exposed to at birth. Children over 3 months with fever should be evaluated by their doctor if they act sick or if the fever persists for more than 3 or 4 days.