It was around 10:00p.m. when I got the call from the exchange. “My daughter is 16 months old and she has a fever of 101 degrees.

 

Should I take her to an urgent care or the emergency room?” the distressed mom asked. In 35 years of practice I cannot count how many of these calls I have answered. No doubt fever is a worrisome and angst-provoking thing for the parent of a child to go through.But fever serves a useful function and is protective in many cases. It can help the body fight certain infections.
 

When I get a call about fever there are two main questions that I want to know:

1) When did the fever start and

2) What are the associated signs and symptoms?

A fever of one or two days duration without associated symptoms is not particularly concerning as long as the child is taking adequate fluids and is playful when the fever comes down. The height of the fever should not be worrisome if there are no specific symptoms that would indicate a localizing infection. It is not uncommon for a child with a viral illness to have a fever of 103-105 degrees .He may look listless and needing to go to the emergency room.But if he perks up and is playful when the fever is brought down to 99 degrees, it is less concerning. Quite often a fever associated with viral illnesses will “go up” later in the day between 4 o’clock and 8 o’clock p.m.
 

One must also remember that a small percentage of children who receive immunizations may get a fever in the first 24-48 hours after the vaccine. They may be fussy and irritable perhaps have some redness and soreness at the vaccine site but usually do not have specific symptoms. A fever lasting up to and beyond 5 days is more concerning. It is important to determine if there could be a more serious infection going on. A sustained fever beyond 5 days would make one think about the possibility of Kawasaki disease (see archived articles in the Informed Parent about this).

 

After determining the duration of the fever it is important to look at any specific signs or symptoms that would suggest a particular infection.

 

Does the child have a cough or congestion that would indicate a cold or pneumonia? Is the cough a bark-like cough that could mean the child has croup? Is there any wheezing or labored breathing? Does the child have any vomiting or diarrhea that would indicate a gastro-enteritis or “stomach bug”? Does the child have a rash? Is the child pulling at his/her ear to suggest possible ear infection? Does the child have pain with swallowing or a sore throat? These are the questions that are essential to determine if the child needs to be seen more urgently.
 
Another concern of parents whose child has a fever is, “At what temperature do I have to be concerned about my child having seizures?” Around 2-3% of children may have what are called febrile seizures. These can occur between the ages of 6 months and 5 years and DO NOT mean the child has epilepsy. They DO outgrow these. Febrile seizures usually happen early in an illness when the fever is on its way up and typically last less than 5 minutes. While they are frightening for a parent to witness they are not particularly dangerous.
 

It is not the height of the fever that causes the seizure but it is the genetic predisposition that causes a child to have a seizure when he gets a fever.

 
The best thing a parent can do for a child to prevent seizures is to be vigilant about fever and try to keep it down as best as they can. As mentioned above, fever does serve a useful function and I usually don’t have parents give anything for fever unless it gets above 100.5 degrees. The caveat to this is a newborn (an infant under 30 days of life). Any newborn with a fever above 100.4 degrees rectally MUST be admitted to the hospital for specific tests and antibiotics.
 
A child with a fever of 1-2 days duration, with no specific symptoms who is playful and active may be given measures to bring the fever down to make he more comfortable. He may be given a tepid sponge bath. I have the parents put him in a tub of air temperature water with toys to lethim play while being sponged down. This helps the body get rid of excess body heat by increasing the evaporative losses of heat. It is very effective but it is important to avoid shivering which will happen if the water is too cold. The brain gets tricked into thinking that the body is cold and will make the body shiver to generate more body heat. After the sponge bath the parent should dry the child well and dress him lightly. Parents can also give anti-pyretics such as acetaminophen and ibuprofen. In the proper dosing for the child’s weight, these are very effective.
 

In summary, fever can be a very frightening thing for parents but it can serve a useful function for the body.

 
When a child has a fever it is important to be in communication with the child’s doctor. A child usually doesn’t need anything for fever unless it gets above 100.5 degrees. The most important fact is that when a child has a high fever and looks ill, he perks up and is playful and happy when the fever is brought down to a near normal value. It is also important that he is taking fluids well…enough that he continues to have good urine output. The real bottom line is that if a parent has ANY question, they should call the child’s doctor.