My pager goes off at 3 a.m. As I fumble for the phone and dial the number, I grumble to myself, "This better be important!" But when I hear the worried voice of the mom on the line, telling me her child is burning up with a fever, my grumpiness fades. I ask several specific questions and determine that the baby isn't urgently sick. My advice: Give the child a dose of acetaminophen and call our office first thing in the morning.
Thankfully this scenario doesn't occur every night, or I would never get any sleep. But many of the late-night calls I receive are about fever, and it's hardly surprising that parents are concerned when their child turns into a rag doll in their arms. But fever itself is rarely dangerous: It's a sign that the body is fighting an infection.
What Causes Fevers?
Fever is the body's normal response to an invading germ. When the immune system detects a virus or bacteria, an increase in white blood cells sends a message to the brain to raise the body's temperature, helping it fight the infection.
Fever itself isn't an illness. Like the "check engine" light on your dashboard, a fever is a warning that something needs attention. Fevers that are caused by viruses rather than bacteria don't respond to antibiotic treatment. Some common viral causes of fever are roseola (identified by a rash on the upper body that emerges after the fever breaks), Coxsackie virus (also known as hand-foot-and-mouth disease, it causes painful sores or blisters in these areas), as well as the common cold. Bacterial causes of fever, which will respond to antibiotics, are certain ear infections (though your doctor may take a wait-and-see approach before writing a prescription at the first sign of infection), some forms of pneumonia, and sinus and bladder infections.
The Degree of the Problem
What constitutes a fever? I generally consider any temperature under 100.4 degrees to be normal. Between 100.5 and 103 is a moderate fever, and anything over 103 is a high fever. Infants generally have a higher temperature than older children, and everyone has a slightly higher reading between the late afternoon and early evening.
The rectal method is considered the most accurate, and is recommended for infants younger than 3 months of age. For these babies, it's important to know the exact temperature to determine the proper course of action. After 3 months, an underarm or pacifier thermometer is fine. They're less invasive than rectal, and it isn't as important to know the exact temperature in a baby that age. Since thermometers can vary, I prefer for parents to tell me both the temperature and the method used for measurement so I can decide how to interpret the information.
When to contact your doctor about a fever depends on your child's age.
2 months old and younger When an infant this young has a rectal temperature of 100.4 degrees or higher, call your doctor immediately, no matter the hour. The reason for such urgency is that while older babies can fight off most infections, young infants are more vulnerable -- a serious infection can spread rapidly and cause life-threatening complications. In this case, your doctor most likely will want to evaluate your child, or, if your newborn is 4 weeks or younger, send you to the hospital.
3 to 6 months Call your doctor if your child has a fever higher than 101 degrees.
Older than 6 months You may want to consult your doctor if the fever exceeds 103 degrees. But usually, a fever in older babies rarely warrants a 3 a.m. page.
The degree of fever usually doesn't indicate the severity of the illness. Many harmless viruses can cause a high fever, while more serious bacterial infections such as meningitis (an inflammation of the brain's membranes) will often cause only a moderate fever. How your baby behaves is a more significant indicator. Tell your doctor if your child has a loss of appetite, repeated vomiting or diarrhea, appears lethargic, is irritable or has a rigid neck and body. An infant who screams in pain when his neck or body is bent (during a diaper change, for example) may have meningitis.
A quick rise in body temperature or a fever higher than 102 degrees also can cause convulsions, otherwise referred to as febrile seizure. While the episode can be frightening for parents, febrile seizures are not necessarily an indication of serious infection and rarely cause any harm to the child -- still, you'll want to call your doctor as soon as possible if your child has a febrile seizure. Symptoms may include trouble breathing, eyes that are rolling back, shaking arms and legs, and loss of consciousness that can last for a few minutes. If a febrile seizure lasts more than five minutes, call 911. One reassuring sign for parents: If an infant becomes active and playful again after fever-lowering measures, then a serious illness is less likely.
An important principle to remember is to treat the baby, not the fever. Fevers don't always need to be lowered, as some degree of fever may be helpful in fighting infection. Based on your baby's age and symptoms, if an infant is acting fairly well, then you may let the fever ride. But when it is causing too much discomfort, here are ways to lower your infant's fever.
Treat It If your baby is under 3 months, you should call your pediatrician before giving her any medication. For older babies, acetaminophen (such as Tylenol Infants' Drops) or ibuprofen (such as Infants' Motrin or Advil) both work well at reducing fevers. Dosages, which are listed on the bottle, will be determined by her weight.
Drink Up Fever can contribute to mild dehydration but rarely to any degree of concern. Try to push fluids, including breast milk or formula, or whole milk if your baby is over 12 months old and weaned.
Sponge Him Down Research has brought this practice into question. If a sponge bath is given without fever-reducing medication, it may cause shivering and have the opposite effect and make the fever higher. But if it appears to comfort your child, it's OK to give him one in conjunction with fever-reducing medication. If he begins to shiver or feels too cold, however, dry him off and warm him up in a towel.
It's equally important to know what not to do as it is to know what to do. Never use rubbing alcohol to cool a baby down. Baby's skin absorbs the alcohol quickly and she can inhale the fumes, both of which could lead to alcohol poisoning and other problems. Do not give aspirin to children because of the risk of Reye's syndrome, a rare but serious illness associated with aspirin use in children that can injure the brain and liver. Finally, avoid bundling a baby with a fever. The blanket will trap heat.