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Fever

Fever is good and bad. It’s good because it warns you that something is going on in the body, and, since most viruses don’t fare well in heat, it helps purge the illness. It’s bad, obviously, because your kid is sick and uncomfortable. But as serious as a febrile illness may be, a fever in and of itself is not dangerous for the body and won’t damage the brain, even in the rare event that it causes convulsions [See: Febrile Convulsion].

A normal temperature is between 97° and 99°F, a low-grade fever is around 100.5°F, a moderate fever is around 101.5°F, and a high fever is over 103°F. The margin of error is about half a degree, depending on how you take the temperature and the type of thermometer you use. There is also a wide variation in the amount of fever a child generates. The same illness will make some kids boiling hot, while it leaves other kids cold, so to speak.

In Newborns
For the first few days outside the womb, Lucy’s temperature can fluctuate for no apparent reason. Her “thermostat” is not yet fully operational, because you performed temperature regulation for her in utero. Covering her with too many blankets can slightly raise her body temperature above 100.5°F (the official cutoff for a fever). In newborns, fever is rare and an indicator of serious illness. In fact, a drop in temperature below 97°F may signal an infection. Other signs, such as poor feeding or extreme sleepiness, indicate the severity of an illness better than a fever does. In any event, don’t bother taking Lucy’s temperature routinely when she’s a newborn, only if she feels unusually warm or cold to your touch. You should promptly talk to your doctor about any fever or drop in temperature.

Before Three Months
Before three months of age, fever is still very rare. If Lucy feels warm to the touch and has a recorded temperature of more than 100.5°F, she definitely has a fever. At that age, fever could be the sign of a serious ailment and therefore must always be addressed, especially if she’s sleepy or lacks appetite. Don’t waste your time lowering her temperature with medication; take her to the doctor to determine the source of her fever.

After Three Months
When Jimmy has a fever, the most important question is not “How high is it?” but “Why is it there?” A child could have an uncomfortable but harmless flu with a temperature of 105°F or, alternatively, a much more threatening illness with a temperature of 101°F. Don’t let yourself be falsely worried or reassured by the number on the thermometer.

WHEN TO WORRY

If Jimmy is very sleepy or sluggish and remains that way when the fever drops after anti-fever medication.

If he has other symptoms, like respiratory difficulty or repetitive vomiting.

If his fever persists over several days, or subsides and returns.

If he drinks little fluid, which could lead to dehydration.

WHEN NOT TO WORRY

If Jimmy is lucid and aware, even in discomfort.

Even if you can’t bring the fever down, you shouldn’t necessarily worry; some flus and viruses produce fevers that medications can barely touch. This is not a reliable sign of an illness’s severity.

If the fever disappears after a few days.

WHAT TO DO

Lower Jimmy’s temperature with either acetaminophen or ibuprofen or even both, more to alleviate discomfort than to get a better reading on the thermometer. If his discomfort is pronounced, don’t be stingy; use the highest recommended dose for his age, and repeat as often as needed [See: Pain and Fever Medications].

If you have any doubt as to the origin of the fever or the need for treatment, address the issue with your doctor.

WHAT NOT TO DO

Don’t take Jimmy’s temperature over and over again. You know he has a fever. It   will go up and down until the illness resolves.

Don’t use cool baths or an alcohol rub. These strategies date from prehistory, and they just create chills and discomfort. Medications are much more effective.

Real questions from real parents
How high is too high?
I know a high fever is nerve-wracking. Nevertheless, it doesn’t necessarily spell doom. Readings can even reach over 105°F with fairly short-lived viral illnesses. Of course, you’ll want to discuss any fever over 103°F with your doctor to determine what course to take.

Why is his little heart racing?
Because it’s supposed to race. When the body is warm, a reflex mechanism speeds up the heart to help expel heat. The more the blood circulates, the more heat is reduced.

Why is he breathing so fast?
For the same reason. Heat is dissipated in the breath.
What if he has a seizure?
High fevers can cause febrile convulsions in predisposed children. These look scary, but they’re not dangerous. No matter what you may hear, you can’t prevent them by giving fever medication constantly.

When should I lower the temperature?
Only if Jimmy is uncomfortable. Otherwise, let the fever follow its course while you monitor the symptoms. This way, you’ll be able to gauge the progression of the illness rather than obscure the symptoms by suppressing them. Fever serves a purpose: The elevated temperature makes Jimmy’s body a much less friendly environment for a virus. Also, the fever has a hidden advantage: It knocks him out so that he’ll rest instead of run around under the influence of Tylenol.

Is it true that I have to keep my child inside for twenty-four hours after a fever?
I’m not sure who made up this rule. Most diseases are contagious before the onset of fever rather than afterward. You’ll be surprised by how quickly kids bounce back after an illness. The next day, if Jimmy is up to it, let him play or go to school.