Measuring your child’s temperature.

Temperature will vary depending on where on the body the temperature is taken, the age of the child, and the time of day.  A fever is considered to be a temperature over 100.4 degrees.  Rectal temperatures are the most accurate.  Oral and ear (tympanic) are next most accurate and are generally one-half degree cooler.  Last is underarm (axillary) which runs about one degree cooler than rectal.  Forehead and temple measurements are more unpredictable.  Fever measurements do not always have to be exact.

 We recommend inexpensive digital thermometers.  To take a rectal temperature, lubricate the thermometer tip with petroleum jelly or K-Y jelly.  Next lay your infant on his back with the diaper off. Gently but firmly hold your child's legs up with one hand.  When he relaxes a bit, gently advance the thermometer until only the tip is in the rectum.

Oral temperatures are best in older children (over 4 years). Place the thermometer tip into the fleshy pocket beneath the tongue and have the child close his lips firmly around the thermometer.

To take an axillary (armpit) temperature, place the thermometer in the hollow of the armpit and hold the arm down against the side of the body.  In the younger child, distraction with a book, a toy, or even the TV is usually necessary.

Fever

In most cases fever is a normal response to an infectious illness.  It is important to remember that it is not a disease itself.  In fact, fever helps our body fight infection.  Low-grade fevers can often be managed without medication if the child appears well.  However, the cost of higher fevers (lost appetite, lost hydration, fast metabolism, discomfort) exceeds the benefit and so we recommend that you treat your child’s moderate or high fever. 

The height of your child’s fever does not predict how serious an illness is, nor does a high temperature cause harm to your child.  If a fever takes a long time to come back down, that’s fine too.  It is best to focus on how your child is acting, especially when the fever is reduced with medication.  You should contact our office if your child has fever and appears ill, is less than 2 months old, or has over 72 hours of fever.  Children with fevers over 104 degrees should be seen in our office that day or the following morning.  Other symptoms may also require evaluation, such as earache, sore throat, persistent headache, difficulty breathing, abdominal pain, pain on urination, swollen or inflamed joints, persistent drowsiness or irritability, diarrhea, or vomiting.

Fever Therapy

Treating fever starts with proper hydration and creating a comfortable environment for your child.  Encourage lots of fluids and keep your child lightly dressed.  Sponging in a lukewarm bath is only marginally helpful and often causes discomfort, crying, and shivering.  Never sponge your child with alcohol or cold water.  The best treatment for fever is the proper dose of acetaminophen (Tylenol and other brands) every 4 hours, or ibuprofen (Advil, Motrin, and other brands) every six hours as needed.  Start with acetaminophen since it is gentle on the stomach and works most of the time.  If it is not effective, use ibuprofen.  We do not recommend combining or alternating these medications because this can cause more side effects and may result in giving the wrong dose at the wrong interval of time. For safety, it’s a good idea to write down the times and dosages given to avoid confusion, especially if you have more than one ill child.

Fever will continue until your child’s illness resolves.  If an antibiotic is prescribed for her infection, remember that the fever may persist for a couple of days, so you may need to continue using fever-reducing medications during this time.  Call us if your child’s illness doesn't improve after 72 hours or worsens.

Last, but certainly not least, realize that while your child has fever, she is likely to be contagious.  Avoid public places, school, daycare, birthday parties, etc. until the fever is gone for 24 hours without the use of medications.  Please be responsible and keep your ill child at home so that he does not put others in the community at risk especially those who have chronic illnesses or immune problems.