Fever 101: When to Freak and When to Chill

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Winter is almost over, but cold and flu season seems like it will never end this year. And with cold and flu season comes FEVER! I have been a pediatric ER nurse for many years and fever is one of the top reasons parents bring their child to the ER. Nothing strikes fear in a mom’s heart like seeing your baby lying there, burning up with fever, and not knowing what to do.

older boy with fever

As terrifying as it can seem, fever is usually not a scary thing and there are many myths about it that need explaining:

*Fever is harmful–FALSE: Fever is a symptom of illness. It is not harmful in and of itself but it lets you know something viral or bacterial is likely going on. It is your body’s natural response to help fight these illnesses, so fever can actually be our friend! 

*I need to take my child to the ER for fever over 102–FALSE: There is no magic number when it comes to fever. Some kids may be 102 degrees and feel horrible while others may be 104 and still be running around and playing. Treat the symptoms, not the number. 

*Fever causes brain damage–FALSE: Fever does not cause brain damage. Even if the child has a simple febrile seizure, studies show no long-term effects.

*I need to give Tylenol every 4 hours –FALSE: Tylenol and/or Ibuprofen (in children over 6 months) can be given to alleviate discomfort but it is not necessary. Allowing fever to occur can help your body fight the illness. But if a child is miserable, refusing to drink, etc., fever control medicine is certainly warranted.

*My child needs antibiotics for their fever–FALSE (mostly): Fevers are typically due to a viral infection. Viral illnesses will not respond to antibiotics but can actually contribute to the creation of antibiotic-resistant bacteria. Many ear infections are actually viral and can be “watched” to see if antibiotics are necessary.  And while we are on this topic, the color of mucus does not indicate a bacterial illness or that a sinus infection is present, especially in babies, since frontal sinuses are not even fully developed until late adolescence. Many of these “sinus infections” can be treated with supportive care and do not require antibiotics.

*The fever won’t go down with Tylenol so it must be a serious illness–FALSE: Some illnesses tend to run higher fevers than others and sometimes they will not come down even with proper dosing of fever reducers. This alone does not mean that this illness is any more serious or dangerous. What is more important is the duration of the fever. Unexplained fever lasting 5 or more days should be evaluated by a health care professional and any necessary testing should be completed. 

baby with fever

WHEN TO FREAK:

If your child has a chronic medical condition or is medically fragile in any way and is running fever, call your pediatrician to see what you should do. If your child is less than 3 months old and has a rectal temperature over 100.4, this is considered fever and needs to be checked out. It is also concerning if your child recently had surgery and he or she will need to be seen by a doctor to rule out post-operative infection. Also worrisome: difficulty breathing, abdominal pain or vomiting, neck stiffness, or a rash that doesn’t “blanch” when you run your finger across it. 

WHEN TO CHILL:

There are exceptions to every rule and this is certainly not intended to take place of your pediatrician’s advice, but when your child is drinking well, has peed at least 3-4 times in the last 24 hours, and is acting normally, you can consider monitoring at home. Fever can cause rapid breathing, headaches, and refusal to drink, but once you are able to get the temperature down, your child should feel better and these side effects of fever should improve. Fever in children is usually due to viral illness and your child may just need supportive care (nasal suctioning, encouraging fluids, fever reducers when needed, and rest). Just remember to keep your child out of school for at least 24 hours after symptoms have resolved, otherwise you might have to share this post with their classmates!  

 

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Kathryn
I am a pediatric ER nurse who works weekends and stays home with four kids during the week. My life is basically one hot mess after the next and most days I am doing good just to make sure everyone is alive, fed, and bathed somewhat regularly. My husband is my best friend and the funniest person I know. We have been married 13 years and love to travel, go on date nights, and wonder what people without kids do with all their time and money! We have a ten year old, six year old twins, and a 1 year old who came to us via embryo adoption. Our lives are nuts but we wouldn't trade it for anything. Hashtag blessed!