What is a fever and What happens to my child’s body when he/she has a fever?

A fever is a body temperature that is higher than normal. Fever occurs when the body’s internal “thermostat” raises the body temperature above its usual level. This body “thermostat” is regulated in the part of the brain called the hypothalamus. The hypothalamus makes sure that our bodies maintain a certain temperature — usually around 98.6° Fahrenheit or about 37° Celsius.

A body temperature (including your child’s body temperature) may fluctuate during the day — a little lower in the morning and a little higher in the evening and can also increase as activity level increases. The temperature may fluctuate as much as 2° during the day. The hypothalamus may “reset” the body’s temperature to a higher degree in response to an infection, illness or some other cause-researchers believe increasing the heat is the body’s way of fighting the “germs” that cause infections- possibly making the body a less hospitable place for “germs” to live and reproduce. The white cells of the body produce a substance called interleukin-1when they digest a germ. Interleukin-1 induces the formation of prostaglandins- prostaglandins are the substances that act on the hypothalamus resetting the body thermostat to a higher level- resulting in a fever. Fever is a “friend”.

Fevers are generally harmless and help your child fight infection. Fever is a good sign because it signals that your child’s immune system is working and the body is trying to get rid of the infection. When your child has a fever, her heart and breathing will speed up slightly in addition to your child feeling slightly warm. She/he may appear flushed and perspiration may be present as well. There may be shivering, muscle aches, lack of appetite and general weakness. The “height” of the fever is not related to the “seriousness” of the illness. Just because your child has a fever of 104°F, this does not means that it is going to climb higher- like 106° for example. Temperatures of 104°F are common in children >12 months and are not an emergency — check out the information provided in this article or call the office for advice.

What causes fever? What is a viral/bacterial illness? How long can I expect the fever to last?

Again, it is important to remember that fever is a symptom- fever itself is not an illness. Fever may be caused by bacteria, a virus, a parasite, or heat stroke. Fever may also be caused by overdressing (especially infants because it is more difficult for them to regulate their body temperature) or by immunizations. A viral illness is the most common kind of illness that causes a fever. A virus may cause an illness such as a cold or the flu. Symptoms of a viral illness often come on quickly (over hours to a day or two). Viruses are infectious agents just like bacteria are. They reproduce fast, but only in a host cell (your child’s nose, mouth, or throat), and cannot carry on their own body functions without the help of the host (in this case the human body). Viral infections usually associated with minor illnesses are usually not serious and go away without medical treatment. Antibiotics are not used to treat a viral illness and will not help it go away any faster- the illness typically just has to “run its course”.

A “constant runny nose” (even yellow or green nasal discharge) is almost always attributed to a virus. The average number of upper respiratory viral illnesses that a young child gets each year is 6-10; even more if the child attends “play groups” or is in daycare. These viral illnesses sometimes overlap to create the “constant runny nose” phenomenon. A “supportive care” approach is encouraged as the body fights the virus on its own. Most of the common viral illnesses have a 2-5 day “incubation period”, which is the time after a child is exposed to the virus, but isn’t showing any symptoms yet. Most viruses are first brought into the child’s body through the nose and mouth from germs on the hands; so the first symptoms usually appear there- runny nose, cough, congestion, and sore throat. As the body fights the virus, the symptoms may increase over the next 3-4 days- this stage of the illness can be more severe than the first day or two. After this time, the body’s immune system typically has won the war, and the severity of symptoms will trail off within the next few days to a week. A bacterial illness is one that can cause such problems as streptococcal sore throat, pneumonia, and meningitis among others. Bacteria are treated with antibiotics. Bacteria may produce a fever that may last for longer than 72 hours. This is another reason why your child should be seen if the fever is present for longer than 72 hours.

How do I take my child’s temperature?

A parent can usually tell if their child is warmer than usual by feeling his/her forehead and how high the temperature is- this is termed “tactile temperature”. However, it may be important to find out the exact temperature in most instances: if your child is less than a year of age (especially infants <3 mos), if your child feels “really hot”, if the temperature has persisted past 48 hours, if the fever is accompanied by a rash or any other symptom, if the child looks very ill or is unusually fussy or is very drowsy, if your child has a condition that suppresses immune responses like cancer or sickle cell disease, or if your child has had a seizure.

Mercury thermometers should not be used at any time to measure fever. They have been replaced by digital thermometers and are no longer available in stores. The American Academy of Pediatrics (AAP) encourages parents to remove mercury thermometers from their homes to prevent accidental exposure to this poison. Don’t throw your mercury thermometer in the trash because of the likelihood of environmental contamination. Check with your local pharmacy or health department to see if they will dispose of it for you. Body temperature may be taken rectally (bottom), orally (mouth), axillary (underarm), and aurally (ear).

How to measure a rectal temperature
Rectal temperatures taken with a rectal digital thermometer are the gold standard (the most accurate) way of measuring body temperature-especially if your child is younger than 3 years of age and especially younger than 6 months of age.

1. Clean the end of the thermometers with rubbing alcohol or soap and water. Rinse it with cool water- do not rinse with hot water.
2. Put a small amount of lubricant, such as K-Y jelly on the end.
3. Place your child belly down across your lap or on a firm surface. Hold her by placing your palm against her lower back, just above her buttocks.
4. With the other hand, turn on the thermometer switch and insert the thermometer ½-1” into the anal opening. Hold the thermometer in place with 2 fingers, keeping your hand cupped on your child’s bottom.
5. Hold in place for about 1 minute or until you hear the “beep”. Remove the thermometer to check the reading.

How to take an oral temperature
Oral temperatures may be taken once your child is 5 or 6 years of age; you may prefer taking his temperature by mouth with an oral digital thermometer. For an accurate reading, no hot or cold drinks for at least 15 minutes before you take the oral temperature.

1. Clean the thermometer with soapy water or rubbing alcohol. Rinse with cool water.
2. Turn on the switch and place the sensor under your child’s tongue toward the back of the mouth.
3. Hold in place for about one minute or until you hear the “beep”. Check the digital reading.

How to take an axillary temperature
An axillary temperature or “under the arm” temperature is not as accurate and cannot be used if your child is less than 3 months old. Contrary to packaging instructions, please do not add or subtract a degree for an axillary temperature- when reporting your child’s temperature to the office- state the temperature and how the temperature was obtained.

1. Place the sensor end of either an oral or rectal digital thermometer in your child’s arm pit.
2. Hold the arm tightly against your child’s chest for about one minute or until you hear the “beep”. It is very important to have consistent skin contact with the tip of the thermometer for an accurate reading.
3. Check the digital reading.

How to take a tympanic temperature
Tympanic/ear thermometers are another way to measure body temperature for older babies and children- easy, quick and effective for a screening measure. The ear thermometers work by detecting infrared radiation from the ear drum. Ear temperature readings are not accurate in children <6 months-there may be discrepancies in the results, depending on technique, amount of ear wax, etc.

1. Gently put the end of the thermometer in the ear canal. Try to aim the thermometer at your child’s nose. Press the start button. A digital reading appears in seconds.
2. Always use a clean tip cover for each reading.

Other methods of measuring temperature are available and are not discussed here because they are not recommended at this time. Examples of these temperature measuring methods are: pacifier, temporal artery, forehead, etc.

How do I treat the symptom of fever?

A fever may be a serious sign of illness in a child less than 3 months of age and fever-reducing medication should not be administered — please call the office.

You may want to make sure that your child is dressed in light clothing, encourage fluids such as water, diluted fruit juices, or a commercially prepared oral electrolyte solution such as Pedialyte®, or Liquilytes®. Avoid giving extremely fatty foods or others that are difficult to digest as fever may decrease digestive activity. There is no reason why your child cannot have the milk he/she normally drinks. If the room is warm and stuffy, cool the air with a fan, but not too much to create shivering.

There are also medications that may be given to a child to help reduce temperature if he/she is uncomfortable. Any drug that reduces fever is called an “antipyretic”. An antipyretic works by blocking the formation of prostaglandins from fever. Because a child without a fever does not have interleukin-1 circulating (white blood cells are not digesting the germ cells and so this substance is not formed), prostaglandins are subsequently not formed which is why an antipyretic does not reduce temperature in a person who does not have a fever. Both acetaminophen (if child > 3 months) and ibuprofen ( if child > 6 months) are safe and effective in proper doses. Be sure to administer the correct dose to your child for each medication — use the dropper provided with each particular medication and do not switch droppers between medications. It is not recommended to “alternate” or “piggyback” both of these medications unless otherwise directed. Acetaminophen may be given every 4 hours. Ibuprofen should only be used for children older than 6 months of age and can be dosed every 6 hours. Please see the dosing charts. Do not use aspirin to treat your child’s fever. Aspirin has been linked with serious side effects in children, including Reye’s Syndrome.

What is a febrile seizure?

4-6% of children (usually 6 mos-5 years) may experience a “febrile seizure” as the body’s temperature rises. These seizures may last for 1-10 minutes and are frightening to observe but rarely cause any harm to the child. Febrile seizures are a brief loss of unconsciousness followed by involuntary jerking movements of the body associated with a fever. During the seizure, the child may abruptly stiffen his body and roll his eyes up, followed by a jerking or twitching of the limbs and body. These seizures usually occur during the first 24 hours of an illness, often before a parent knows that their child has a fever or is even ill. Usually a seizure is related to the rate of rise in temperature than to the height of the temperature. If your child is experiencing a febrile seizure, here are some tips to help you:

1. Calm down!! Your child will be fine.
2. Move the child to a carpeted surface if possible, so that he/she does not hit any sharp or hard objects during the seizure.
3. Remember: children with seizures are not at risk of swallowing their tongues. Therefore do not put anything in your child’s mouth.
4. If the seizure lasts more than 4 minutes, call 911. If your child’s seizure lasts less than 4 minutes call Town and Country after your child is comfortable and resting.
5. It is normal for your child to be very sleepy after the seizure.

Children who have had one febrile seizure may be at risk of another. The parents of a child who has experienced a febrile seizure should have aggressive fever management – Tylenol (acetaminophen) every 4 hours - OR - Motrin (ibuprofen) every 6 hours. Febrile seizures are not a form of epilepsy, a neurological condition.

When do I call Town and Country?

It has always been our philosophy that you know your child better than anyone, if you have a question-always call! If your child <3 months old and has a temperature of 100.4°- you should call the office immediately! If the fever has been present for more than 72 hours (even if your child is acting well), it is important that you request an appointment to have your child seen in the office. Other reasons why you should request an appointment include:

1. If the temperature is high (=105°)
2. If the fever has appeared after your child has had symptoms for a couple of days
3. Severe sore throat or consistent sore throat accompanying the fever
4. Breathing seems heavy or labored
5. Vomiting frequently with fever
6. Pain with urination with fever
7. Dehydration (no tears, no urine for at least 6 hours)
8. Excessive fatigue
9. Stiff neck or neck pain
10. Headache with fever
11. Rash (especially a purple rash) accompanying the fever.

How can I tell if my child’s illness is serious or not?

When you call the office, the medical personnel are usually interested in how the illness is affecting your child’s ability to do what he she does best. Is your child still interested in playing, drinking well enough to urinate, is alert and smiling at you, has a normal skin color, and looks well when the temperature comes down- if the answer is yes to one or all of these- you probably do not need to worry too much. A child who has a fever will lose his/her appetite- this is an expectation. Do not worry so much about her solid food intake-focus on increasing fluids. Offer whatever he/she normally drinks (including milk/formula).

When can my child go back to school/child care?

It is wise to check with your provider; however a good rule of thumb is that your child remains out of school until fever free for 24 hours, and is feeling well enough to participate in any activity.