Fever

Is this your child’s symptom?

• An abnormal high body temperature
• Fever is the only symptom. Your child has a true fever if:
• Rectal (Bottom), Ear or Forehead temperature: 100.4° F (38.0° C) or higher
• Oral (Mouth) temperature: 100° F (37.8° C) or higher
• Under the arm (Armpit) temperature: 99° F (37.2° C) or higher
• Caution: Ear temperatures are not accurate before 6 months of age
• Caution: Forehead temperatures must be digital. Forehead strips are not accurate.

Causes of Fever

• Overview. Almost all fevers are caused by a new infection. Viruses cause 10 times more infections than bacteria. The number of germs that cause an infection are in the hundreds. Only a few common ones will be listed.
• Viral Infections. Colds, flu and other viral infections are the most common cause. Fever may be the only symptom for the first 24 hours. The start of viral symptoms (runny nose, cough, loose stools) is often delayed. Roseola is the most extreme example. Fever may be the only symptom for 3 to 5 days. Then a rash appears.
• Bacterial Infections. A bladder infection is the most common cause of silent fever in girls.
• Sinus Infection. This is a problem caused by a cold. The main symptom is the return of fever after it has been gone for a few days. The sinus congestion also changes to sinus pain. Color of nasal discharge is not very helpful for making this diagnosis.
• Vaccine Fever. Fever with most vaccines begins within 12 hours. It lasts 2 to 3 days. This is normal and harmless. It means the vaccine is working.
• Newborn Fever (Serious). Fever that occurs during the first 3 months of life can be serious. All of these babies need to be seen as soon as possible. The fever may be due to sepsis (a bloodstream infection). Bacterial infections in this age group can get worse quickly. They need rapid treatment.
• Meningitis (Very Serious). A bacterial infection of the membrane that covers the spinal cord and brain. The main symptoms are a stiff neck, headache and confusion. Younger children are lethargic or so irritable that they can’t be consoled. If not treated early, can suffer brain damage.
• Overheated. The fever is usually low grade. Can occur during heat waves or from being overdressed. The temp becomes normal in a few hours after moving to a cooler place. Can also occur during hard exercise. Fever goes away quickly with rest and drinking extra fluids.
• Not Due to Teething. Research shows that “getting teeth” does not cause fevers.

Fever and Crying

• Fever on its own shouldn’t cause much crying.
• Frequent crying in a child with fever is caused by pain until proven otherwise.
• Hidden causes can be ear infections, kidney infections, sore throats and meningitis.

Roseola: Classic Cause of Unexplained Fever in Young Children

• Most children get Roseola between 6 months and 3 years of age.
• Cause: human herpes virus 6
• Rash: pink, small, flat spots on the chest and stomach. Rash is the same on both sides of the body.
• Then spreads to the face.
• Classic feature: 2 or 3 days of high fever without a rash or other symptoms.
• The rash starts 12 to 24 hours after the fever goes away.
• The rash lasts 1 to 3 days.
• By the time the rash appears, the child feels fine.

Normal Temperature Range

• Rectal. A reading of 98.6° F (37° C) is just the average rectal temp. A normal low can be 96.8° F (36° C) in the morning. It can change to a high of 100.3° F (37.9° C) late in the day. This is a normal range.
• By mouth. A reading of 97.6° F (36.5° C) is just the average mouth temp. A normal low can be 95.8° F (35.5° C) in the morning. It can change to a high of 99.9° F (37.7° C) late in the day. This is a normal range.

When to Call for Fever

Call 911 Now

• Not moving or too weak to stand
• Can’t wake up
• Severe trouble breathing (struggling for each breath; can barely speak or cry)
• Purple or blood-colored spots or dots on skin
• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Trouble breathing, but not severe
• Great trouble swallowing fluids or spit
• Fever in baby less than 12 weeks old. Caution: do NOT give your baby any fever medicine before being seen.
• Fever over 104° F (40° C)
• Shaking chills (shivering) lasting more than 30 minutes
• Nonstop crying or cries when touched or moved
• Won’t move an arm or leg normally
• Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.
• Pain or burning when passing urine
• Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Age 3-6 months old with fever
• Age 6-24 months old with fever that lasts more than 24 hours. There are no other symptoms (such as cough or diarrhea).
• Fever lasts more than 3 days
• Fever returns after being gone more than 24 hours
• Recent travel outside the country to high risk area
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• You have other questions or concerns

Self Care at Home

• Fever with no other symptoms and your child acts mildly ill

Seattle Children’s Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

• 
  
  
  
  
  Bellevue
  
  
  
• 
  
  
  
  
  Everett
  
  
  
• 
  
  
  
  
  Federal Way
  
  
  
• 
  
  
  
  
  Seattle
  
  
  
• 
  
  
  
  
  Virtual Urgent Care
  
  
  

Care Advice for Fever

1. What You Should Know About Fever:
   • Having a fever means your child has a new infection.
   • It’s most likely caused by a virus.
   • You may not know the cause of the fever until other symptoms develop. This may take 24 hours.
   • Most fevers are good for sick children. They help the body fight infection.
   • Use the ranges below to help put your child’s level of fever into perspective:
   • 100° – 102° F (37.8° – 39° C) Low grade fever: helpful, good range. Don’t treat.
   • 102° – 104° F (39 – 40° C) Average fever: helpful. Treat if causes discomfort.
   • Over 104° F (40° C) High fever: causes discomfort, but harmless. Always treat.
   • Over 106° F (41.1° C) Very high fever: important to bring it down. Rare to go this high.
   • Over 108° F (42.3° C) Dangerous fever: fever itself can be harmful.
2. Treatment for All Fevers – Extra Fluids
   • Fluids alone can lower the fever. Reason: being well-hydrated helps the body give off heat through the skin.
   • Offer your child extra water or other fluids by mouth. Cold fluids are better. Until 6 months old, only give extra formula or breastmilk.
   • For all children, dress in 1 layer of light weight clothing, unless shivering. Reason: also helps heat loss from the skin.
   • For shivering (or the chills), give your child a blanket. Make them comfortable.
   • Caution: if a baby under 1 year has a fever, never overdress or bundle up. Reason: babies can get over-heated more easily than older children.
3. Fever Medicine:
   • For fevers 100°-102° F (37.8° – 39°C), fever meds are not needed. Reason: fevers in this range help the body fight the infection. Fevers turn on the body’s immune system. Fevers do not cause any discomfort.
   • Fever meds are mainly needed for fevers higher than 102° F (39° C).
   • Give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Goal of treatment: keep the fever at a helpful level. Most often, the fever meds lower the fever by 2° to 3° F (1 – 1.5° C). They do not bring it down to normal. It takes 1 or 2 hours to see the effect.
   • Do not use aspirin. Reason: risk of Reye syndrome, a rare but serious brain disease.
   • Do not use both acetaminophen and ibuprofen together. Reason: not needed and a risk of giving too much.
   • Pain: fever does not cause pain. If your child also has pain, it’s from the infection. It may be a sore throat or muscle pain. Treat the pain, if it’s more than mild.
4. Sponging with Lukewarm Water:
   • Note: sponging is an option for high fevers, but not required. It is rarely needed.
   • When to Use: fever above 104° F (40° C) AND doesn’t come down with fever meds. Always give the fever medicine at least an hour to work before sponging.
   • How to Sponge: use lukewarm water (85 – 90° F) (29.4 – 32.2° C). Sponge for 20-30 minutes.
   • If your child shivers or becomes cold, stop sponging. Other option: you can also make the water warmer.
   • Caution: do not use rubbing alcohol. Reason: can cause a coma.
5. Return to School:
   • Your child can return to school after the fever is gone. Your child should feel well enough to join in normal activities.
6. What to Expect:
   • Most fevers with viral illnesses range between 101° and 104° F (38.4° and 40° C).
   • They may last for 2 or 3 days.
   • They are not harmful.
7. Call Your Doctor If:
   • Your child looks or acts very sick
   • Any serious symptoms occur such as trouble breathing
   • Fever goes above 104° F (40° C)
   • Any fever occurs if less than 12 weeks old
   • Fever without other symptoms lasts more than 24 hours (if age less than 2 years)
   • Fever lasts more than 3 days (72 hours)
   • You think your child needs to be seen
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 07/14/2023

Last Revised: 12/30/2022

Copyright 2000-2023. Schmitt Pediatric Guidelines LLC.

Fever – The Pediatric Clinic

What is a fever?

A fever means the body temperature is above normal. Your child has a fever if:

• The rectal temperature is over 100.4° F (38° C).
• The temperature taken by mouth is over 100° F (37.8° C).
• The armpit temperature is over 99.0° F (37.2° C).
• The ear temperature is over 100.4° F (38° C).
• The pacifier temperature is over 100° F (37.8° C).

Fever helps fight infections. Most fevers are not harmful. They may last 2 or 3 days.

How can I take care of my child?

• Use medicine only if the child needs it. Remember that fever helps your child fight the infection. Use medicine only if the fever is over 102° F (39° C) and your child is uncomfortable.
  • You can give acetaminophen (Tylenol) to children older than 3 months. Fever medicine lowers the fever by 2 to 3° F (1 to 1.5° C).
  • You may want to give your child ibuprofen instead. Ibuprofen (Advil) works 2 hours longer than acetaminophen. Give the right dose for your child’s weight, every 6 to 8 hours, as needed. You can give ibuprofen to children over 6 months of age.

• Do not give your child or teen aspirin.
• Sponge your child if the fever does not go down. Sponge your child if your child’s temperature stays over 104° F (40° C) 30 minutes after your child has taken acetaminophen or ibuprofen. Always give your child acetaminophen or ibuprofen first. Sit your child in only 2 inches of lukewarm water. Sponge off the child’s skin. If your child shivers, stop sponging or put in more warm water.
• Have your child drink a lot of cold fluids.
• Have your child wear as little clothing as possible. Do not bundle up your child. It may make the fever go higher.

For fevers of 100 to 102° F (37.8 to 38.9° C), cold fluids and little clothing may be all your child needs. Your child may not need acetaminophen.

Call your child’s doctor right away if:

• Your child is less than 3 months old.
• Your child’s fever is over 104° F (40° C).
• Your child has a seizure.
• Your child looks or acts very sick.

Call your child’s doctor within 24 hours if:

• Your child is 3 to 6 months old (unless the fever is due to an immunization shot).
• Your child has had a fever more than 24 hours and you don’t know what is causing it AND your child is less than 2 years old.
• Your child has had a fever for more than 3 days.
• The fever went away for over 24 hours and then came back.
• You have other concerns or questions.

Fever – Teen Version

What is a fever?

A fever means the body temperature is above normal. You have a fever if your oral temperature is over 99.5°F (37.5°C).

The body’s average temperature when it is measured orally is 97.6°F (36.5°C), but it normally changes during the day. Oral temperature normally can change from a low of 95.8°F (35.5°C) in the morning to a high of 99.4°F (37.5°C) in the late afternoon. Mildly increased temperature (100.4° to 101.3°F, or 38° to 38.5°C) can be caused by exercise, heavy clothing, a hot bath, or hot weather. Warm food or drink can also raise the oral temperature. If you suspect such an effect on your temperature, take it again in a half hour.

How do I take my temperature?

1. Do not have a cold or hot drink for 30 minutes before you take your temperature.
2. Turn on the thermometer if you’re using the digital type.
3. Place the tip of the thermometer under one side of your tongue and toward the back.
4. Wait until the thermometer signals that you can take it out.
5. Read the display on a digital thermometer.

What causes a fever?

Fever is a symptom, not a disease. It is the body’s normal response to infections. Fever helps fight infections by turning on the body’s immune system. Most fevers (100° to 104°F, or 37.8° to 40°C) are not harmful. Most are caused by viral illnesses such as colds or flu. Some are caused by bacterial illnesses such as strep throat or bladder infections.

How long will it last?

Most fevers with viral illnesses last for 2 to 3 days. In general, the height of the fever doesn’t relate to the seriousness of the illness. How sick you feel is what counts. Fever does not cause permanent harm until it reaches 108°F (42°C). Fortunately, the brain’s thermostat keeps untreated fevers below this level.

How can I take care of myself?

• Extra fluids and less clothing

Drink extra fluids. Cold drinks are helpful. Body fluids are lost during fevers because of sweating.

Dress in light clothing because most heat is lost through the skin. During the time you feel cold or are shivering (the chills), wrap yourself in a light blanket.

If the fever is less than 102°F this is the only treatment needed. Fever medicines are not necessary.

• Medicines

Remember that the fever is helping your body fight the infection. Take medicine only if your fever is over 102°F (39°C) and you are also uncomfortable. You should take either acetaminophen or ibuprofen.

Acetaminophen: Take any one of the acetaminophen products: Tylenol, Anacin-3, Panadol, or Tempra. The dosage is 2 tablets (650 mg) every 4 to 6 hours. 2 hours after they are taken, these drugs will reduce the fever 2° to 3°F (1° to 1.5° C). Medicines do not bring the temperature down to normal unless the temperature was not very high before the medicine was taken. You will need to take repeated dosages of the drugs because the fever will go up and down until the illness runs its course.

Ibuprofen: Ibuprofen is available in 200-mg tablets without a prescription as Advil, Motrin, etc. The dosage is 2 tablets (400 mg) of ibuprofen every 6 to 8 hours. When you use ibuprofen, stop taking acetaminophen.

Avoid aspirin: Doctors recommend that anyone under age 21 years) not take aspirin if they have any symptoms of a cold or viral infection, such as a fever, cough, or sore throat. Aspirin taken during a viral infection, such as chickenpox or flu, has been linked to a severe illness called Reye’s syndrome.

When should I call my healthcare provider?

Call immediately if:

• Your fever is over 104°F (40°C).
• You have fever along with a severe headache, confusion, a stiff neck, trouble breathing, or you can’t drink liquids.

Call within 24 hours if:

• Your fever went away for more than 24 hours and then returned.
• You have a fever for more than 3 days.
• You have other concerns or questions.

High temperature – causes of occurrence, in what diseases it occurs, diagnosis and methods of treatment

Encephalitis

Tick-borne encephalitis

Borreliosis

Measles

Whooping cough

Rubella

Diphtheria

Scarlet fever

Chicken pox

Poliomyelitis

Colds

1978

05 July

High temperature – the causes of occurrence, in which diseases it occurs, diagnosis and methods of treatment.

An increase in temperature serves as a protective reaction of the body and can occur under the influence of various factors. Be sure to separate such conditions as hyperthermia (overheating) and fever, which is also accompanied by an increase in body temperature, but its mechanism differs from overheating and requires other measures to influence the body.

Possible causes

Fever is triggered by external (or exogenous) pyrogens – substances foreign to the body that have entered the bloodstream. These include infectious pyrogens: toxins of viruses and metabolic products of microorganisms. The primary group also includes non-infectious pyrogens: certain lipids, proteins and protein-containing substances that enter the body from the external environment or occur in the body during inflammatory processes, allergic reactions, or the decay of tumor tissues. Primary pyrogens, interacting with the cells of the immune system, initiate the production of internal, or endogenous (secondary) pyrogens – cytokines. They, acting on the center of thermoregulation in the brain, cause an increase in body temperature.

The feverish state has its own dynamics and includes several stages.

If body temperature is taken as the criterion for the course of fever, then three stages can be distinguished:

stage 1 – the period of temperature rise;

Stage 2 – the period of preservation, or standing temperature;

Stage 3 – the period of temperature decrease to normal values ​​..

Temperature rise stage

The rate of temperature rise depends on the concentration of pyrogens in the blood and can serve as a diagnostic sign.

A rapid increase in temperature to high values ​​​​is observed with influenza, lobar pneumonia,

and also possible when a foreign protein enters the blood (for example, when transfusing blood components). In this case, there is a strong chill, there is a cooling of the skin, which is due to a spasm of the superficial blood vessels.

A slow rise in temperature is characteristic of adenovirus infection, typhoid fever, brucellosis. In these cases, severe chills may be absent, and the first sensations of the disease will be fever, dry eyes, headache, and malaise. Possible blanching of the skin, coldness of the feet and hands.

What should be done?

First of all, it is necessary to warm the patient by wrapping him in a blanket. A heating pad applied to the legs and arms gives a good effect.

Temperature standing stage

After reaching the upper value, the temperature remains at this level for some time. This period is called the stage of standing temperature, when a balance is established between heat production and heat transfer. At this stage of the disease, the patient feels fever, drowsiness. Perhaps lack of appetite, thirst. Depending on the level of temperature rise, a weak or subfebrile temperature is distinguished – 37-38 ° C; moderate, or febrile – 38-39°C; high – 39-41 ° C and excessive – above 41 ° C.

Knocking down the temperature is not always appropriate.

Fever is a protective and adaptive reaction of the body that occurs in response to the action of pyrogens.

At a temperature of 37.5-38 ° C, the body actively fights infection. However, each person reacts differently to elevated temperatures. Therefore, when deciding on a drug-induced decrease in temperature, one should focus on well-being and associated symptoms. This is especially true for children. Conditionally, the threshold temperature at which it is necessary to strengthen the monitoring of the state of health and external manifestations is a temperature of 38 ° C and above.

The period of maintaining the temperature at a high level depends on the infectious agent, the state of immunity and the treatment being carried out.

In normal cases, this time can vary from one to five days, but in severe cases of the disease, it can be extended for several weeks.

Temperature fluctuations in a febrile patient have a certain rhythm: the maximum values ​​are noted at 5-6 pm, the minimum – about 4-5 am and variability. With inflammation of the lungs, for example, the temperature can stay at a high level for a long time. For bronchitis, pulmonary tuberculosis are characterized by significant daily temperature fluctuations (1-2 ° C). The so-called debilitating fever is very dangerous, which is characterized by sharp temperature fluctuations (with a rapid rise and fall), sometimes repeated two or three times during the day. There is such a fever with sepsis, the presence of cavities in pulmonary tuberculosis and the decay of lung tissue.

What should be done?

At high temperatures, it is necessary, if possible, to free the patient from excess clothing and provide access to fresh air, eliminating drafts. A cold compress can be applied to the forehead and areas of large vessels (elbows and knees). You can wipe the body with a towel moistened with cool water.

The issue of drug temperature reduction is decided in each case individually.

It is more difficult for a person to endure not high temperature, but intoxication of the body. Therefore, the main measures should be aimed at removing toxic metabolic products from the body. This is achieved by drinking plenty of water, if necessary – cleansing enemas.

When prescribing antipyretic drugs for children, the following nuances are taken into account:

– the age of the child is less than three months, and the temperature has risen above 38 ° C;

– a previously healthy child between the ages of three months and six years has a temperature above 39°C;

– in a child with heart or lung disease, the temperature exceeds 38 ° C;

– a child of any age (up to 18 years old) with a convulsive syndrome, diseases of the central nervous system, in the presence of such external signs as pallor, cyanosis of the skin and cold extremities, general lethargy and lethargy, it is necessary to reduce the temperature if it reaches 38 ° C Otherwise, a convulsive syndrome may occur, which is extremely dangerous and can lead to suffocation.

At high temperatures, the functioning of all organ systems changes.

The heart rate increases by 8-10 beats per minute for every degree of temperature increase. Often there are arrhythmias, more often extrasystole (extraordinary contractions), spasm of blood vessels and increased blood pressure.

The secretory and motor functions of the gastrointestinal tract are reduced, which leads to food retention in the intestines, and the lack of fluid causes constipation. Given these factors, it is necessary to adjust the nutrition of a febrile patient. Preference should be given to liquid easily digestible food, reducing the portion size, but increasing the number of meals.

There is a feature that should be taken into account for patients with diabetes. It must be remembered that fever is accompanied by an increase in blood glucose levels, which requires appropriate measures.

Treatment

The main antipyretic drugs include non-steroidal anti-inflammatory drugs – paracetamol, ibuprofen, diclofenac. These drugs act quickly and are quickly eliminated from the body.

Although the practice of taking antipyretic pills is widespread, experience shows that side effects are more pronounced in this case.

It is preferable to use rectal suppositories.

With this method of drug administration, the active substance enters directly into the blood through the blood vessels of the rectum. There is no irritating effect of drugs on the gastric mucosa. It becomes possible to administer the drug regardless of food intake.

Temperature reduction stage

The decrease in temperature in infectious diseases occurs either quickly and is accompanied by profuse sweating, and sometimes a drop in blood pressure, or slowly, within one to two days.

What should be done?

You can help the patient with a sharp drop in temperature by quickly changing wet clothes to dry ones and drinking hot tea.

It is important to remember that a decrease in temperature is not an indicator of recovery.

There are still microorganisms or viruses in the body that can cause a second wave of the disease. Especially dangerous in this regard are streptococcal infections, which often give complications to the heart, kidneys and joints. Therefore, bed rest should be observed not only at high temperatures, but also immediately after its decrease. Upon recovery, it is recommended to perform clinical blood and urine tests.

Fever

The state of the body, characterized by a rise in body temperature above normal, is called fever. Normally, the temperature of the human body is maintained at a level of about 37 ° C, however, in some (often infectious) diseases, a protective and adaptive reaction occurs, which is based on an increase in body temperature with the obligatory preservation of the thermoregulation mechanism. This property is a hallmark of fever from hyperthermia (overheating). Pyrogens cause fever – substances that enter the body during infection (exogenous pyrogens) or are formed by cells of the immune system as a result, for example, of inflammation (endogenous pyrogens).

Fever always passes in three stages:

1. Rise in temperature – blood vessels constrict, skin becomes pale, there is a feeling of chills, muscle tremors, metabolism in muscles increases. At this stage, heat production is much higher than heat transfer.
2. Temperature retention – the mechanisms of heat production and heat transfer are balanced – the temperature can be fixed for hours, days or weeks. Skin vessels dilate, the skin ceases to be pale and becomes hot to the touch, chills and trembling go away. At this time, a person experiences a feeling of heat.
3. Drop in temperature – both a sharp and gradual decrease in body temperature is possible. At this stage, heat transfer significantly exceeds heat production, profuse sweating occurs and diuresis increases. This stage begins in case of exhaustion of exogenous reserves or cessation of production of endogenous pyrogens.

There are several types of fever:

• Relapsing (laxative) type is characterized by diurnal changes in temperature, which does not drop to normal;
• Intermittent (intermittent) type characterized by rapid diurnal fluctuations in temperature, which falls to normal and rises again;
• Constant fever – slight fluctuations in elevated temperature during the day;
• Relapsing fever – persistently elevated temperature for one or more days, then it returns to normal and rises again;
• Perverse Fever – a rise in temperature in the morning is characteristic;
• Incorrect fever – temperature fluctuations during the day occur without any dependence.