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20140405 fever 1

With the nerdy science behind fevers covered in my first post and your “must haves” when thermometer shopping covered in my last post (click here or here to read these if you missed them the first time), we can move on to discuss more of the things that all parents wonder when the thermometer climbs to 100.4 and beyond.  Since fevers love to begin during the middle of the night, how do you know if it is an emergency situation versus one that can wait until the office opens in the morning?  As you will see below, this is one case where age is everything!

If they are less than 1 month of age and have a rectal temperature of 100.4 or greater, it is a medical EMERGENCY! Do not pass go! Do not collect $200!  They must receive immediate medical attention no matter the time - day or night.  In infants between 1 and 2 months of age, you should still immediately call your pediatrician for advice as many of these infants need rapid evaluation as well.

Educational aside:  So why are the first two months so critical when it comes to fever?  Temperatures of 100.4 or higher in this age group may be the first and only sign of serious infections such as urinary tract infections, blood infections or meningitis (which is an infection around the brain and spinal cord), that if left untreated for even 1 day, could have serious long term implications.  What else is “magical” about 2 months?  That is when infants generally receive their first set of immunizations and their immune system has “grown up” a bit and can better handle foreign invaders.

“A child who has fever but is otherwise acting like their usual rambunctious, talkative, and fun-loving self is a very reassuring sign.”

For older infants (> 2 month of age) and children, your course of action when your child has a fever often depends on a number of other factors.  Is your child still playful?  Are they drinking well? What other symptoms are they having?  Besides age, how your child is behaving should be the biggest driving force when deciding what to do when their temperature spikes.  A child who has fever but is otherwise acting like their usual rambunctious, talkative, and fun-loving self is a very reassuring sign.  On the other hand, if you find it difficult to arouse your child, they are refusing to move around, or have other drastic changes in their personality when they have a fever, immediate evaluation is needed.

A school-aged child with a sudden onset of fever, sore throat and a headache probably needs a visit to the pediatrician to evaluate for strep throat.  If your child has had a runny nose and then begins with fever and complaining of ear pain, they probably need a check to make sure their ears are not infected.  For those children with a fever for 3 days or less who are otherwise happy, playful, and drinking well, close observation at home is likely a good plan.  Any child with fever for more than 3 days or if your child is not drinking well, again, has a drastic change in behavior, or if they have other complaints of focal pain (i.e. pain in one specific location), an appointment with the pediatrician is in order.

“It is more important to look at the child as a whole rather than just the number on the thermometer.”

I am often asked by parents if high fevers mean that the child is sicker or has a more serious infection.  The simple answer is ‘no’.  I have seen many children with temperatures to 103 who are running around my office and climbing all over the place while kids with fever to 101.5 might be just sitting on mom’s lap and look absolutely miserable.  Viral infections are actually notorious for causing higher fevers.  I can tell you that I saw numerous kids in the past few months who were diagnosed with the flu and often had temperatures of 103 or higher.  It is more important to look at the child as a whole rather than just the number on the thermometer.

So now you should have your gameplan set and ready for the next time your little one spikes that fever in the middle of the night.  In my final fever post, I will discuss just how and when to treat fevers so STAY TUNED!