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Fever Again? by Robyn Lilly, CPNP-PC

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fever My child has fever again.....


Does that sound like a phrase you've said to your healthcare provider? Well, you are not alone. Fever is one of the most common symptoms managed by pediatricians and parents alike. Fever always seems to strike in the middle of the night or when the pediatrician's office is closed, right? And fever can be a scary thing to parents because it just simply can make most children feel bad and not act their normal selves which can be very worrisome to most parents. So what is one to do about fever: when do you give the Tylenol or Motrin, what dose of medication is appropriate for my child, what temperature is too high for a child, when should I call my healthcare provider—those are all questions that run through a parent's mind when trying to manage fever.


First, fever is not an illness itself but a sign that the body is doing its job to fight infection and the level of fever does not correspond to severity of illness. It is important to remember these important facts when your child has fever. There is also some data that indicates fever can have a beneficial effect in viral illnesses leading to a quicker recovery. In a recent article by the American Academy of Pediatrics (Pediatrics, March 2011), the topics of fever and anti-fever medicine use were addressed. According to this article, "parents are frequently concerned with the need to maintain a 'normal' temperature in their ill child"(p.580), and this is usually done with anti-fever medicines like Tylenol or Motrin. So what is the degree of temperature at which you should call your healthcare provider? There is not a hard and fast temperature at which you should call. Overall, one needs to consider the severity of child's symptoms and response to anti-fever medications. If your child is very sleepy and tired, irritable or confused, has difficulty breathing, experiencing a decrease in oral intake, still appears ill even after fever is relieved, has other specific complaints (headache, stomach pain, pain with urination), or has fever for greater than 48 to 72 hours, you should call your healthcare provider. Another very important note, any infant under the age of 4 months with a rectal temperature greater than 100.4 degrees Fahrenheit should be seen by a healthcare provider immediately.


So when should one start anti-fever medications? The most important thing to remember is acetaminophen (Tylenol) and ibuprofen (Motrin) (anti-fever medications) are given to help your child feel better. Yes, the medications will also bring the fever down but the goal is to make your child more comfortable when he or she has fever. The goal isn't to reach 98.6 degrees or a normal temperature instead it is to make your child comfortable. You can access medication dosing charts here: It is important to assure that the correct dose based on your child's weight is given to your child. In general, it is important to keep track of when and how much anti-fever medication has been given to your child in order to know when it is safe to give another dose of fever reducing medications. The recommended interval between acetaminophen doses is every 4 to 6 hours and for ibuprofen is every 6 to 8 hours. Ibuprofen should not be given to infants under 6 months of age. Aspirin should be avoided in all children due to high risk of Reye's syndrome.


In conclusion, fever can be a worrisome symptom in children and it often happens when the doctor's office is closed. Hopefully next time fever strikes, you will feel a little more relieved to manage it. There is never a wrong time to call or see your healthcare provider when your child has fever.