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Fever Relievers

Even though I've seen my three kids through everything from the flu to the chicken pox, I almost lost it the night my toddler spiked a fever of 104°F. Why was she burning up? Should I rush her to the emergency room or wait for her doctor to return my call? Fortunately, he phoned back within 30 minutes, and all it took to reduce Rosalie's fever was acetaminophen and a lukewarm bath. Soon she recovered from what proved to be a harmless virus.

There's no doubt about it: Children's fevers are scary. Ninety-one percent of parents worry that one will harm their child, according to a recent study from researchers at the Johns Hopkins Bayview Medical Center, in Baltimore. Indeed, fevers account for nearly 30 percent of visits to the pediatrician. But although a fever in a very young baby is always cause for concern, in most children a high temperature won't cause neurological damage unless it tops 105°F -- which is very rare.

"Fever is not an illness but a sign that the immune system is fighting off an infection," says Lynn Smitherman, M.D., assistant professor of pediatrics at Wayne State University. "When viruses or bacteria attack the body, white blood cells come to the rescue by producing interleukin, a hormone that raises body temperature. In effect, this rise in body heat helps kill the germs that are making your child sick." There's also some evidence that a fever helps fight illness by lowering blood levels of iron, which may be needed by germs to survive.

When Should You Worry?

A high temperature doesn't necessarily mean that a child is sicker than if she has a low one. "How she acts is a more accurate indicator of how ill she might be," says Anne Thiele, M.D., assistant professor of pediatrics at the University of Alabama School of Medicine, in Birmingham. "If your baby is listless but isn't fussing much, and still seems interested in feeding, then in all likelihood there's nothing to worry about."

In fact, a temperature isn't even considered a fever until it's 100.2°F or higher. A normal body temperature is about 98.6°F, and it will fluctuate throughout the day, says Mark Stegelman, M.D., a pediatrician with Children's Health Care of Atlanta. "A baby's temperature can be as low as ninety-seven degrees or as high as ninety-nine and still be normal."

These variations are caused by a host of different factors, including the time of day and how active a child has been. His temperature may go up if he's wearing too many layers of clothing or if he's just had a warm bath.

Temperature readings also depend on how they're taken and the type of thermometer used. Most doctors consider a rectal thermometer to be the gold standard: Its readings are closest to core body temperature. In contrast, a digital underarm thermometer is usually one degree lower than a rectal one, and an ear reading can be too high or too low.

No matter which method you use, it's important to know your child's normal range so you have something to compare it with when he's sick, says Dr. Stegelman. Take his temperature first thing in the morning (before 6 a.m., when body temperature is typically lowest) and again in the early evening (when it usually peaks, between the hours of 5 and 7 p.m.).

Fighting A Fever

How you treat a fever depends on the child's age. The American Academy of Pediatrics recommends that you call your child's doctor right away if an infant 2 months or younger has a rectal temperature of 100.2°F or higher, even if she shows no other signs of illness. "Go to the emergency room if you have to," says Charles Shubin, M.D., director of pediatrics at Mercy FamilyCare, in Baltimore. "In the early weeks of life, babies have only a limited ability to fight illness because their immune system isn't yet fully developed." Unless there's an obvious reason for the fever, such as a cold, a doctor will want to rule out the (rare) possibility of an infection of the blood or the urinary tract.

Babies between 3 and 6 months should see a pediatrician at once if they have a rectal reading of 101°F or higher; children this age have a greater (though still very small) risk of a serious bacterial infection than older kids do. You should also call a doctor right away if a baby over 6 months is running a temperature of 103°F or higher, or if a feverish child of any age develops other symptoms -- an earache, a rash, swollen glands, trouble breathing. A doctor will want to make sure she doesn't have a more serious illness, such as pneumonia, roseola, or meningitis. If left untreated, very high fevers can lead to seizures or shock.

Febrile (fever-related) seizures can occur when a child's body temperature soars too quickly. While these can be very scary for parents to witness, they rarely are serious or cause any lasting harm. The seizure can cause a child to stiffen, roll up his eyes, or shake for up to five minutes. If your child has one, lay him on the floor or a bed away from sharp objects. Never force a spoon or any other object into the mouth during a seizure. If the convulsions last less than a minute, as happens in most cases, call your doctor as soon as they're over. He'll most likely want to see your child to rule out the rare possibility of epilepsy or another disorder. If the seizure lasts longer than a minute, call 911.

If a fever is making your child fussy and uncomfortable, the following can help him feel better fast:

? Offer him plenty to drink. Prolonged fever can lead to dehydration, so continue with breastfeeding or formula. Your doctor may also recommend giving your child a rehydrating solution, such as Pedialyte, ReVital, or Gerber LiquiLyte.

? Try a warm sponge bath. Recent research suggests that a lukewarm sponge bath will help lower your baby's temperature, only if given in conjunction with fever-reducing medication. Don't put your child in cold water -- shivering will only warm him up -- and take him out if he appears uncomfortable. Never try to cool him with rubbing alcohol; if inhaled or absorbed through the skin, it can be toxic.

? Help him feel comfortable. Don't try to make a child "sweat out" a fever by bundling him up; that will only make his fever last longer. Instead, dress him in lightweight, breathable clothing.

? Consider using medication. It's safe to use acetaminophen (Infant Tylenol) or ibuprofen (Infant Motrin, Infant Advil) with your doctor's okay. (Never give aspirin to a child -- it's been linked to Reye's syndrome, a rare but serious disease that affects the brain and the liver.) Your pediatrician can provide the proper dosing.

While ibuprofen's effects can last for six to eight hours and may lower a fever faster, it's not approved for use in infants under 6 months of age. Acetaminophen only lasts for four hours, but it's gentler on the stomach and can be given to newborns. Don't give acetaminophen and ibuprofen in alternating doses without talking to your pediatrician first. "There's no evidence that the combination is more effective than using just one drug," says Dr. Stegelman. "Mixing medications can be confusing and could put children at risk of an overdose."

Above all, relax! As scary as a fever can be, most kids bounce back from it in a day or two. With a healthy dose of TLC, your child should be well again in no time.

Lisa Collier Cool is an award-winning health and parenting writer based in New York, and a mother of three.

Temperature Takers

First things first: If you still have a mercury thermometer in your medicine cabinet, get rid of it. The American Academy of Pediatrics advises parents to stop using these thermometers because injesting mercury has been linked to blood and nervous system damage in pregnant women and children. Call your local health or sanitation department for advice on disposal. When choosing a thermometer, factor in your baby's age and comfort level. And always tell the doctor which thermometer you used, the body part you took the temperature from, and the exact reading you got. Here are the options:

Rectal: For babies under 3 months, when even a slight fever can be serious, you'll want a rectal thermometer, which provides the most accurate readings. To use one, lay your baby on his stomach, dip the bulb in petroleum jelly, and gently insert it not more than one inch into the rectum. New, fast digital models, like The First Years' Ultra High Speed Thermometer ($11) and the Safety 1st 10-Second Fold-up Thermometer ($10), give readings in 10 seconds, speeding up an unpleasant task.

Underarm: Armpit readings are a safe option for older babies, though they'll usually register a degree low and can take two to four minutes. To use one, place the thermometer tip in the center of your child's armpit and have him press his arm firmly against his side. Two to try: The First Years' Underarm Thermometer ($9) and Omron's 3-way Instant Digital Thermometer ($40), which can be used to take underarm, rectal, or (for older kids) oral readings.

Ear: This convenient method isn't ideal for babies under 1 year, as it can give a false high or low reading. To use one, tug your child's ear back before gently placing the probe in the ear canal, with the tip pointed toward the eardrum. Then take several readings to determine if your baby has a fever. The Summer Infant deluxe digital ear thermometer ($40) takes readings in one second and has memory recall for tracking. Or try Omron's Instant Ear Thermometer ($40), which takes 12 scans in one second.

Pacifier: Binky thermometers can be a lifesaver, though on average they're half a degree low. To use one, place it in the baby's mouth for a reading. Lumiscope's Babytherm ($20) beeps when the reading is complete, and Tender Tykes' Pacifier Thermometer ($10) gives a readout in only 90 seconds.

Forehead: These are fairly accurate at detecting high fevers, but are less likely to detect a mild fever. Place it firmly against your baby's forehead for about 15 seconds. Read while it's still pressed against the head. Baby Tech's Forehead Fever Thermometer ($3) takes 15 seconds for a reading.

-Althea Keough

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