HOME CARE ADVICE FOR FEVER 1. Reassure the Caller: Presence of a fever means your child has an infection, usually
caused by a virus. Most fevers are good for children and help the body fight infection. Use the following definitions to help put the child's level of fever into perspective: 100°F-102°F = low-grade fevers and beneficial 102°F-104°F = moderate-grade fevers and beneficial More than 104°F = high fevers and cause discomfort, but harmless More than 105°F = higher risk of bacterial infections More than 107°F = the fever itself can be harmful
2. Treatment for All Fevers: Extra Fluids and Less Clothing
Give cold fluids orally in unlimited amounts. (Reason: Good hydration replaces sweat and improves heat loss via skin.) Dress in 1 layer of lightweight clothing and sleep with 1 light blanket. (Avoid bundling.) (Caution: Overheated infants can't undress themselves.) For fevers 100°F-102°F, this is the only treatment needed (acetaminophen is unnecessary).
3. Fever Medicine: Give acetaminophen or ibuprofen for fevers >102°F if your child is
uncomfortable. The goal of fever therapy is to bring the temperature down to a comfortable level. Remind parents that fever medicine usually lowers the fever by 2°F-3°F. See the dosage charts. Avoid aspirin (Reason: risk of Reye syndrome). Don't alternate ibuprofen and acetaminophen (Reason: risk of parent error and overdosage). Instead, give reassurance for fever phobia or switch entirely to ibuprofen.
4. Sponging: Sponge for fever >104°F that doesn't come down with acetaminophen Or
ibuprofen AND causes discomfort. How to sponge: Use lukewarm water (85°F-90°F). (Do not use rubbing alcohol.) Always give fever medicine first. Sponge for 20-30 minutes. If your child shivers or becomes cold, stop sponging or increase the water temperature. (Note: Sponging is optional for high fevers, not required.)
5. Expected Course of Fever: Most fevers associated with viral illnesses fluctuate
between 101°F and 104°F and last for 2 or 3 days.
6. Call back if
Looks very sick 1 hour after acetaminophen or ibuprofen.
Fever goes above 105°F. Fever without a cause persists >24 hours (if <2 years old). Any fever occurs if <12 weeks old. Fever lasts >3 days (72 hours). Your child becomes worse.
Pediatric Telephone Protocols: Office Version. Copyright 1994-2004. Barton D. Schmitt, MD.
Dosage: 5-7 mg/lb/dose (10-15 mg/kg/dose) every 4-6 hours. Adult dose: 650 mg). Note: Acetaminophen also comes in 80-, 120-, 325-, and 650-mg suppositories. (The rectal dose is the same as the dosage given by mouth.) Scolnik D,et al. Comparison of oral versus normal and high-dose rectal acetaminophen in the treatment of febrile children. Pediatrics. 2002; 110:553-556. Don't use <3 months of age. (Reason: Fever during the first 12 weeks of life needs to be documented in a medical setting and if present, the infant needs a complete evaluation.)
IBUPROFEN DOSAGE (FOR
Dosage: 3-5 mg/lb/dose (5-10 mg/kg/dose) every 6-8 hours as needed Adult dose: 400 mg Don't use <6 months of age (Reason: safety not established and doesn't have Food and Drug Administration approval) Pediatric Telephone Protocols: Office Version. Copyright 1994-2004. Barton D.
The Myths Behind Fever Phobia: How to Counteract Them With Reassurance
MYTH: All fevers are bad for children. FACT: Fevers turn on the body's immune system. Fevers are one of the body's protective mechanisms. Most fevers are good for children and help the body fight infection. MYTH: Fevers cause brain damage, or fevers >104°F are dangerous. FACT: Fevers with infections don't cause brain damage. Only body temperatures >108°F can cause brain damage. Fevers only go this high with high environmental temperatures (eg, confined to a closed car). MYTH: Anyone can have a febrile seizure. FACT: Only 4% of children can have a febrile seizure. MYTH: Febrile seizures are harmful. FACT: Febrile seizures are scary to watch, but they usually stop within 5 minutes. They cause no permanent harm. MYTH: All fevers need to be treated with fever medicine. FACT: Fevers only need to be treated if they cause discomfort. Usually fevers don't Cause any discomfort until they are >102°F or 103°F. MYTH: Without treatment, fevers will keep going higher. FACT: Wrong. Fevers from infection top out at 105°F or 106°F or lower, due to the thermostat of the brain. MYTH: With treatment, fevers should come down to normal. FACT: With treatment, fevers usually come down 2°F or 3°F. MYTH: If the fever doesn't come down (if you can't "break the fever"), the cause is serious. FACT: Fevers that don't respond to fever medicine can be caused by viruses or bacteria. It doesn't relate to the seriousness of the infection. MYTH: If the fever is high, the cause is serious. FACT: If your child looks very sick, the cause is serious. MYTH: The exact number of the temperature is very important. FACT: How your child looks is what's important. MYTH: Temperatures between 98.7°F and 100°F are low-grade fevers. FACT: Oral temperatures between 98.7°F and 100°F are normal temperature variations— often peaking in the late afternoon and evening. (For rectal, normal elevations are 99.5°F-100.3°F.) Pediatric Telephone Protocols: Office Version. Copyright 1994-2004. Barton D. Schmitt, MD.
Bachur RG, Harper MB. Predictive model for serious bacterial infections among infants younger than 3 months of age. Pediatrics. 2001 ;108:311-316 Baraff LJ. Management of infants and children 3 to 36 months of age with fever without a source. Pediatr Ann. 1993:22:497-498, 501-504 Bonadio WA. The history and physical assessments of the febrile infant. Pediatr Clin North Am. 1998:45:65-77 Finkelstein JA, Christiansen CL, Platt R. Fever in pediatric primary care: occurrence, management, and outcomes. Pediatrics. 2000:105:260-266 Graneto JW, Soglin DF. Maternal screening of childhood fever by palpation. Pediatr Emerg Care. 1996; 12:183-184 Greenes DS, Fleisher GR. Accuracy of a noninvasive temporal artery thermometer for use in infants. Arch Pediatr Adolesc Med. 2001 ;155:376-381 Herzog LW, Coyne LJ. What is fever? Normal temperature in infants less than 3 months old. Clin Pediatr (Phila). 1993:32:142-146 Lee GM, Fleisher GR, Harper MB. Management of febrile children in the age of the conjugate pneumococcal vaccine: a cost-effectiveness analysis. Pediatrics. 2001:108:835-844 Mayoral CE, Marino RV, Rosenfeld W, Greensher J. Alternating antipyretics: is this an alternative? Pediatrics. 2000:105:1009-1012 Newman TB, Bernzweig JA, Takayama Jl, Finch SA, Wasserman RC, Pantell RH. Urine testing and urinary tract infections in febrile infants seen in office settings. Arch Pediatr Adolesc Med. 2002; 156:44-54 NizetV, Vinci RJ, Lovejoy FH Jr. Fever in children. Pediatr Rev. 1994:15:127-135 Press S, Quinn BJ.The pacifier thermometer. Arch Pediatr Adolesc Med. 1997:151:551-554 Rideout ME, First LR. Fever: measuring and managing a sizzling symptom. Contemp Pediatr. 2001:18:42-50 Scolnik D, Kozer E, Jacobson S, Diamond S, Young NL. Comparison of oral versus normal and high-dose rectal acetaminophen in the treatment of febrile children. Pediatrics. 2002:110:553-556 Sectish TC. Management of the febrile infant. Pediatr Ann. 1996:25:608-613 Shann F, Mackenzie A. Comparison of rectal, axillary, and forehead temperatures. Arch Pediatr Adolesc Med. 1996:150:74-78 Pediatric Telephone Protocols: Office Version. Copyright 1994-2004. Barton D. Schmitt, MD.
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