When to Call the Doctor for Your Child’s Fever

¿Le inquieta que su niño tenga fiebre? Le explicamos lo que necesita saber.

Advice From Our Experts

May 15, 2020

by 

Katie Sweeney

Nervous about your child’s fever? Here’s what you need to know. 

What should you do if your child has a fever? When should you call the doctor? And how is fever related to COVID-19 and a new, rare condition in kids called multisystem inflammatory syndrome in children (MIS-C)?

Christopher Tolcher, MD, FAAP, a pediatrician with Agoura-West Valley Pediatrics—part of the CHLA Health Network—shares the facts on fever and what parents need to know.

What counts as a fever?

A normal body temperature for a child ranges from 97 to 100 degrees, with an average of around 98.6 F. When a person’s temperature reaches 100.4 or above, it’s a fever. (With an oral thermometer, anything over 99. 5 is considered a fever.)

Fever is good

Christopher Tolcher, MD

Fevers are common in children. And while a fever is never fun, in most cases it’s nothing to fear. It’s part of the body’s way of fighting an infection.

“Fever helps the immune system,” Dr. Tolcher explains. “It slows down the spread of viruses and bacteria. It helps the body make more antibodies and chemicals that fight the infection, and it helps the immune system’s cells move around better in the body.”

How high is too high?

“Fevers are almost never dangerous, with the exception of ‘hyperthermia’, or a high body temperature from the body’s being unable to cool off in a very hot environment,” he says. “A fever has to reach 107 to cause damage to tissues. That’s extremely rare.”

That said, if your child’s fever reaches 105, call your doctor. “It doesn’t mean the child is in danger,” he adds, “but the child should be checked by the doctor that day to see what’s going on.”

When to call the doctor

Call your child’s doctor right away for:

• A fever that lasts more than four to five days
• A fever (over 100. 4) in a newborn younger than 2 months old
• If you can’t reach your doctor, go to the emergency department.
• A fever of 105 or higher in a child of any age, including teens
• A fever in an infant (less than a year old) over 102 for more than two days—without a clear reason for the fever

If your child has a fever AND any of the following signs, call your doctor right away or go to the emergency department:

• Widespread, red or purple rash
• Stiff neck and bad headache
• Severe pain, including bad abdominal pain
• Shortness of breath
• Extreme weakness or altered mental state
• Dehydration (diapers are dry, child is not peeing much and urine is very dark)

Fever and seizures

Children under 5 can sometimes have a seizure during a fever. “Seizures are scary as heck to watch, but most of the time, you don’t need to go to the ER,” Dr. Tolcher says.

• If your child has a seizure that lasts less than two minutes, call your doctor.
• If a seizure lasts more than four to five minutes, call 911.

COVID-19, MIS-C and Kawasaki disease

• COVID-19. In children, COVID-19 symptoms can be similar to colds and flu and can include fever, runny nose and cough, and sometimes vomiting and diarrhea. If you think your child might have COVID-19, call your doctor.
• MIS-C. MIS-C is a new health condition seen in some children who have been infected with the novel coronavirus and recovered—but later had an immune response that caused high levels of inflammation in their body. The symptoms are very similar to Kawasaki disease. MIS-C and Kawasaki disease are not contagious, but can be life-threatening.

Call your doctor if your child has any fever for more than four or five days. Also call your doctor if your child has a high fever AND any of the following: cracked red lips, red tongue, red eyes, swollen hands and feet, rash, abdominal pain or enlarged lymph nodes.

“I want to reassure parents that MIS-C is rare,” he adds. “We need to watch for it, but don’t freak out.”

Tips for treating a fever

• Treat the child, not the number. “Focus on how the child is doing, not the number on the thermometer,” Dr. Tolcher says. “If the fever is 100.5, but the child is crying from a headache or earache, give a pain reliever. But if they have a 104 and aren’t that bad, just give them fluids and keep them comfortable.”
• Don’t over-bundle. Too many layers and heavy blankets will raise the fever higher—and make your child more miserable. The child should dress comfortably. Lightweight pajamas and light blankets are fine.
• Give plenty of fluids. “The body burns through water a lot faster when it has a fever, which is why extra fluids are important,” Dr. Tolcher explains. “You don’t want your child to get dehydrated.”

Tip: Watch how much your child is peeing. If your child’s urine is dark, or your child is not peeing as often as normal, give more fluids. Good options: water, clear soups, electrolyte solution or popsicles.

• Focus on comfort. “You don’t have to get the fever down to 98.6,” Dr. Tolcher says. “If a child has a 104 and a lot of body aches, giving one medicine will bring it down two or three degrees. That’s enough. You just want to make the child more comfortable.

“If you aggressively try to keep it down to 98.6, you slow the immune response to the infection,” he notes.

• Be careful with dosing medicine. Keep track of what medicine you give and when. You don’t want the child to get extra doses. And don’t exceed the dosing intervals on the medicine label. If the directions say wait six hours, wait at least six hours.

The best medicines for fever are acetaminophen (Tylenol) or ibuprofen (Advil). Never give aspirin. If COVID-19 is suspected or diagnosed, acetaminophen should be your first choice.

The bottom line? Keep your child comfortable, hydrated and at home. “We all need to rest when we’re sick,” Dr. Tolcher says. “That’s one of the benefits of fever. It slows you down and gets you to take a break.”

Fever in babies: 7 things you might not know

Fever is a rectal temperature of 100.4°F or higher

Your baby wakes up with flushed cheeks, his skin radiating heat. You take his temperature with a digital rectal thermometer, and it reads 99.9 degrees Fahrenheit. Is it time to grab medicine or call the doctor? Probably not. Technically, this doesn’t even qualify as a fever: A rectal temperature of less than 100.4 degrees is considered normal, even in the very youngest infants.

Babies’ temperatures – like adult temperatures – can rise slightly for all kinds of reasons, from physical exertion to a warm bath to being a little overdressed. Even time of day can have an impact, with body temperatures rising in the late afternoon and dropping in the early morning. So unless the rectal thermometer reads 100.4 degrees or higher, you can consider your little one fever-free.

Note: Heat stroke is sometimes confused with fever. This condition occurs when the body temperature rises to dangerous levels (from overdressing your baby in hot, humid weather, for example). When it’s hot out, dress your baby in lightweight, loose clothing and never leave him in a closed car, even for just a minute.

Rectal temperatures are the most accurate

You may be reluctant to use a digital rectal thermometer to take your baby’s temperature, but this is the best way to get an accurate temperature reading in a baby or child younger than 3 years old. (Never use a glass thermometer. If the glass is damaged, the toxic mercury inside could harm your baby.)

“Only a rectal thermometer gives a true core temperature,” says Tyeese Gaines, an emergency room physician in New Jersey. “Underarm readings, forehead thermometers, and even ear thermometers aren’t nearly as accurate.”

These other types of thermometers can read too low or too high, so not using a digital rectal thermometer can make you miss a fever, or cause extra stress and lead to unnecessary emergency room visits.

Bacterial or viral fever? The difference matters

A viral fever results when your baby’s body is fighting off an illness caused by a virus, whether it’s an intestinal infection, the flu, or the common cold, explains Carrie Brown, a pediatrician at Arkansas Children’s Hospital in Little Rock, Arkansas. Viral fevers tend to subside within three days. Antibiotics aren’t necessary because they have no effect on viruses.

Bacterial fevers, on the other hand, are caused by a bacterial infection, such as an ear infection (which can be bacterial or viral), a urinary tract infection, bacterial meningitis, or bacterial pneumonia. Bacterial infections are less common than viruses – and more concerning because they can lead to serious illness if left untreated. Antibiotics are usually required to treat bacterial illnesses.

Make sure your baby gets the medical attention she needs by calling her doctor immediately if:

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• Your baby is younger than 3 months and has a rectal temperature of 100. 4 degrees F or higher.
• Your baby is younger than 2 years old and her fever lasts longer than 24 hours.
• Your child is 2 years or older and her fever lasts more than three days.
• Your child’s fever repeatedly rises above 104 degrees, regardless of her age.

For babies younger than 3 months, fever is urgent

In babies younger than 3 months, a rectal temperature of 100.4 degrees or higher needs to be brought to a doctor’s attention as soon as possible, according to the American Academy of Pediatrics (AAP).

Call your baby’s doctor immediately to let her know that your baby is younger than 3 months and has a fever. If you can’t reach your baby’s doctor, go to an urgent care clinic or the emergency room right away, even if it’s the middle of the night. Don’t give your baby any medicine to reduce fever unless the doctor advises it – you don’t want to mask any symptoms before your baby is examined.

There are two reasons for the urgency. First, explains Brown, the protective layer of cells between the bloodstream and the central nervous system is very thin in young babies. This means that in bacterial infections, the bacteria can “cross over” and cause damage rapidly.

Also, as emergency room physician Gaines explains, “Young babies don’t show signs of severe infection like older babies do.” A young baby can develop a full-fledged blood infection (sepsis) and not display the typical symptoms.

If the fever is viral, there’s no need to worry about sepsis. But the problem is that it’s impossible to distinguish between a bacterial fever and a viral fever with just a physical exam. That’s why an infant with a fever may need blood, urine, X-rays, or stool tests to determine whether there’s a bacterial infection. (The exact tests ordered depend on your baby’s age and symptoms).

An infant with a fever may also need a spinal tap to test for meningitis, an uncommon but serious infection that causes inflammation of the protective membranes covering the brain and spinal cord.

Treat the symptoms, not the number

Many parents believe that the higher the fever, the sicker the child, but that’s not always the case. A baby with a temperature of 103 degrees may appear perfectly comfortable, contentedly playing on his mat, while a baby with a temperature of 101 may be fussy, tired, and need to be held constantly.

Does this mean that if your feverish baby is comfortable, he doesn’t need a fever reducer? That’s right. As pediatrician and AAP spokesperson Janice Sullivan puts it, “Treat discomfort, rather than fever.”

Keep in mind that fever actually helps the body fight infection. Fever makes the body less hospitable to germs and triggers the body’s immune defenses, such as the white blood cells that battle invading viruses and bacteria.

Pay attention to your baby’s symptoms and behavior to determine how sick he is, and ask his doctor for treatment advice based on those signs. “It’s much more important to look at symptoms,” says Gaines. “Listlessness and fatigue, for example, are better indicators of illness than temperature.”

Fever is a healthy response

Despite what you may have heard, fever will not injure your child’s brain.

“In and of itself, fever does not cause any harm,” says Gaines. Even the febrile seizures that some children have in response to a sudden spike in body temperature are almost always harmless. (In rare cases, children can inhale saliva or vomit during a seizure and develop aspiration pneumonia, or they may injure themselves falling or bumping against hard surfaces). Fever reducers can help lower a fever, but they don’t prevent febrile seizures from happening.

When you’re rocking your hot baby in your arms and the anxiety starts to creep in, try to remember that fever is actually a sign that her immune system is working properly. Of course, it’s important to call the doctor, but the vast majority of babies with fevers recover just fine.

As Gaines explains, whether it’s from a viral or bacterial infection, or a side effect of immunization, a rising temperature is a natural immune response. So rest assured that your baby’s immune system is doing exactly what it’s supposed to do.

Use medications judiciously

Medicines such as ibuprofen (for babies who are at least 6 months old) and acetaminophen temporarily reduce fever and can help to relieve discomfort. But before using these, try bringing down your baby’s temperature with a sponge bath. Use slightly warm water (85 to 90 degrees) to wipe down your baby’s skin, particularly the forehead and underarms. This home remedy can be surprisingly effective.

Another way to help your baby feel better is to keep her hydrated, so offer plenty of breast milk or formula.

It may also help to dress your baby in light clothes and keep the environment comfortably cool. For example, if the room is warm and stuffy, use a fan to keep the air moving.

If your baby still seems uncomfortable, fever-reducing medication may be a good way to go. Don’t give medicine to a baby younger than 3 months without a doctor’s approval, and follow these important safety guidelines whenever you give your baby a fever reducer:

• If your child is younger than 2 years old, check with your pediatrician or pharmacist for the right dose.
• If your baby is between 3 and 6 months, you can give her acetaminophen but not ibuprofen.
• Starting at age 6 months, most babies can have either acetaminophen or ibuprofen.
• The dosage is determined by your baby’s weight, not her age.
• Don’t give your child aspirin because it has been associated with Reye’s syndrome, a rare but serious (and sometimes fatal) condition.

And if your baby is sleeping peacefully, there’s no need to wake him to administer fever medicine, according to the AAP. Instead, let him sleep – and get some rest yourself.

Hemorrhagic fever with renal syndrome (HFRS)

Measures to prevent hemorrhagic fever with renal syndrome (HFRS)

The Office of Rospotrebnadzor in the Perm Territory reminds owners of garden plots and residents of the region who plan to visit the forest, legal entities and individual entrepreneurs to prevent hemorrhagic fever with renal syndrome (HFRS).

Hemorrhagic fever with renal syndrome is a natural focal infection. The pathogen parasitizes in the body of small mammals and together with them forms foci of the disease that exist in nature for an indefinitely long time. Natural foci of HFRS in the Perm Territory are territorially located in the forest-steppe zone and forests of the southern territories of the Territory, bordering the Republic of Bashkortostan, the Udmurt Republic, the Kirov Region, are confined to massifs of deciduous forests and occupy a significant part of the territory of the Territory (about 60% of the territory of the Territory).

Perm region is endemic for this disease. HFRS diseases occur throughout the year. The lowest incidence rate occurs in February-April, in May the number of cases increases and reaches a maximum in September-October, then a gradual decline occurs. The nature of seasonality is determined by the number and species composition of rodents, the degree and frequency of contact of the population with the source of infection. The incidence rate in different years depends both on the number of rodents and on climatic and social factors (development of forest areas).

In 2022, 128 cases of HFRS were registered, the rate was 4.9 per 100 thousand population, there is a 4.5-fold increase in incidence compared to 2021 (1.07 per 100 thousand population), the indicator in the region is at the level of the Russian Federation (RF – 4.7 per 100 thousand population).

The reservoir of the HFRS pathogen in nature is small mammals (hereinafter referred to as MM, the main carrier is the bank vole). An analysis of the results of accounting work showed that the relative number of SMs in 2022 is 13.8% (average hit percentage), which is 2.9 higher than the same period last yeartimes (2021 – 4.7%), but at the level of average long-term indicators (13.9%). With a successful wintering of MM in 2023, , the epidemiological situation is expected to worsen in terms of the incidence of HFRS in the population of the region.

Infection of a person occurs by the air-dust route when the dried feces of infected rodents enter the respiratory tract with dust. Foodborne infection is possible through products contaminated with rodent secretions. Infections most often occur during a short stay on vacation in the forest, when working in gardens, vegetable gardens and cottages, at the place of residence, in houses located near the forest, in production related to work in the forest or near it, in the countryside, during transportation hay and straw, etc.

The disease begins suddenly – with chills, fever, severe headaches, aching muscles and joints, loss of appetite and general weakness. Subsequently, vomiting, nausea, dizziness, insomnia join.

If you do not seek medical help in time, severe forms of the disease can develop, which pose a serious danger to human life.

Preventive measures:

• when working with a large amount of dust (demolition of old buildings, loading of hay, straw, grass, dismantling of stacks of boards, logs, heaps of brushwood, cleaning of premises, etc.), it is necessary to use gloves and a respirator or a cotton-gauze bandage;
• cleaning of premises should be carried out only with a wet method;
• strictly observe the rules of personal hygiene;
• products must be kept inaccessible to rodents, stored in a metal, tightly closed container. Food products damaged by rodents cannot be used for food without heat treatment;
• do not drink water from open reservoirs;
• Never touch live or dead rodents without gloves or rubber gloves.

Legal entities, individual entrepreneurs, heads of horticultural non-profit partnerships, citizens must provide:

• improvement of the organization’s territories, sites and adjacent territories;
• organizing and carrying out deratization measures against mouse-like rodents on their territory, ensuring that buildings and structures are rodent-proof;
• carrying out preventive deratization measures against mouse-like rodents on their territory, including cleared areas of forests from debris, dead wood, dead wood, dense undergrowth, in autumn and spring.

West Nile fever – which peoples are most susceptible to a severe form of the disease

Specialists of the Genotek Medical Genetic Center conducted a study in which they found out which peoples of Russia have an increased risk of a severe form of West Nile fever – they, in particular, turned out to be Russians and Ukrainians. Alexander Rakitko, Product Director of Genotek, shared the results of the study with Izvestia on March 13.

It is specified that the study sample included 100 thousand people aged 18 to 65 years.

It turned out that a mutation in the CCR5 gene (it is also responsible for resistance to HIV infection) is associated with the symptomatic course of West Nile virus. These are, in particular, pain in the eyes, inflammation of the lymph nodes, general weakness, vomiting, diarrhea and abdominal cramps. Notably, CCR5 does not significantly affect susceptibility to West Nile virus infection.

“The same mutation can affect the manifestation of different diseases and symptoms in completely different ways. For example, people who are resistant to the human immunodeficiency virus due to a genetic mutation in the CCR5 gene have susceptibility and, therefore, an increased risk of developing a severe form of such a rare tropical disease as West Nile fever. This is a rather rare disease for our latitudes, however, it is important to know about it as part of travel or business trips, so we also show such mutations in our test, ”said Rakitko.

Previously, Genotek identified the populations with the highest genetic resistance to HIV infection. In the case of the West Nile virus, the researchers found that these ethnic groups are most susceptible to the severe course of this infectious disease. Among them are Udmurts and Besermens (1.9%), Ashkenazi Jews (1.8%), Mordovians (1.5%), Russians (1.3%), Ukrainians (1.1%), Tatars (1% ).

“Rarely, a mutation in the CCR5 gene occurs in Ingush (0.027%), Buryats and Mongols (0.063%), Yakuts and Dolgans (0.068%), Bashkirs (0.07%), Azerbaijanis (0.10%) and Chechens ( 0.11%),” said Rakitko.

According to him, from a regional point of view, the leaders in the prevalence of the above genotype in Russia are: the Udmurt Republic (2.1%), the Republic of Karelia (2%), the Kostroma region (2%), the Ulyanovsk region (1.8%) and Moscow (1.7%) region.

West Nile fever is an infectious disease transmitted by the bites of Culex mosquitoes, Aedes mosquitoes and ticks. According to the expert, the disease is common in countries with a hot tropical climate (Africa, Asia, South America, India), however, with the development of tourism and the natural migration of infected birds, cases of infection have also been noted in Europe and Russia (mainly in the south of the country – Krasnodar Territory, Volgogradskaya , Astrakhan, Rostov regions and others).