Fever is the body’s natural immune system response to infection. Perhaps its goal is to raise the temperature of the body to create an environment that’s inhospitable to unwanted visitors. Here’s what we’ll cover in this article:
A normal body temperature for most children is between 97.5°F and 99.5°F (37°C to 37.5°C). Temperature can fluctuate throughout the day and is usually lowest between 4:00 a.m. and 8:00 a.m. and highest in the early evening.
Children under 3 months
Fever is usually defined in children as a body temperature of 100.4°F or higher. A rectal temperature should be measured on children less than 3 months old, as it’s the most accurate way to measure small temperature changes. In children less than 3 months of age, the difference between a rectal temp of 100.2°F and one of 100.4°F is the difference between needing a good physical examination and perhaps no tests, and needing a lot of tests done (blood, urine, nasal swabs or even a spinal tap) and possibly being admitted to the hospital for antibiotics.
Fever of any degree should be taken very seriously for children under 3 months and for any child with a proven significantly weak immune system. In these children, the relatively weak immune system may not be able to help fight off an infection and they can get sick very quickly.
Children over 3 months
In children over 3 months, there is no specific degree of fever that should trigger an immediate visit to a health care provider. The elevated body temperature won’t cause damage to the brain or body unless it gets above 107°F, which generally doesn’t happen with children with normal brain function. Children with severe damage to specific parts of the brain can sometimes get fevers well over 106°F with infections, but most children won’t get fever higher than 106°F. Some children with temps of 104°F or even 106°F can be running around and playing, while another child with a temp of just 101°F might feel, look and act very sick. In this scenario, it’s the child with the 101°F fever who is the most worrisome!
Fever can make any child sleepy, cranky, clingy, achy and not interested in eating or drinking. They’ll also breathe faster, and their hearts will beat more quickly. The real reason to treat the fever is to help relieve these symptoms. As the temperature comes down, the child should perk up and look and act much more like themselves, even if the temperature doesn’t go all the way down to normal. If your child is still looking and acting sick when their temp comes down, that’s the time to be concerned, because it means the infection itself, and not just the fever, is causing the symptoms. Many times, pediatricians will recommend having an older infant or child seen if the temperature is over 102°F – 103°F, not because the fever is dangerous, but because the infection causing it may require testing and/or specific treatment.
If the child appears relatively well when the temperature comes down, is not having a lot of trouble breathing, isn’t having lots of vomiting or diarrhea, is drinking fluids well and not having any severe pain, there’s no need to see a doctor as an emergency, although you should certainly seek an evaluation at any time if you’re concerned.
What TO do when your child has a fever
These measures can affect your child’s natural temperature regulation, and in some cases increase their fever.
If your child’s primary care physician is not available, consider taking your child to an urgent care center or the emergency room.
Urgent care clinics have capabilities to provide Xrays and laboratory tests to help with accurate diagnosis and treatment. Not all urgent cares are the same; pediatric urgent care centers treat children from birth to 21 years of age. A pediatric urgent care clinic is staffed by pediatricians or sometimes family physicians, nurse practitioners and/or physician assistants who have experience and training in taking care of children.
It’s best to go straight to an emergency room (ER) if your child appears very sick or badly injured, is having severe trouble breathing, is having uncontrollable bleeding or severe pain, is having a seizure, is confused or is not responding to you as they usually do. In these cases, it’s often best to call 9-1-1 to have your child evaluated and treated even before you can make it to the hospital on your own.
Lou Romig MD, FAAP, FACEP, Medical Director
After Hours Pediatrics Urgent Care