Fever

1. First and foremost, remember that a fever itself is not dangerous.  It is simply a sign that your child has an infection.  Do not be afraid of the height of a fever.  We commonly see children with 104-105 fevers.
2. ALWAYS accurately record temperatures with a thermometer.  For kids younger than one year the best place to check is in the rectum.  For kids older than one, refer to the thermometer article attached to this handout.  When measuring a temperature, we recommend not adding or subtracting a degree, but reporting it as shown by the thermometer.  Other information that can be helpful include: serially measured temperatures, when they were taken, where they were measured, and when the last time a fever reducing medication was given.  A simple chart documenting these items can be very helpful.  Fever is defined as any temperature >100.4 degrees F.

 Taking a Rectal Temperature

• Lubricate the tip of the thermometer with a lubricating jelly.
• Place your baby face down across your lap, supporting his head, or lie him down on a firm flat surface such as a changing table.
• Press the palm of one hand firmly against your baby’s lower back to hold him still.
• Using your other hand, insert the lubricated thermometer through the anal opening, about 1/2 to 1 inch (about 1.25 to 2.5 centimeters) into the rectum. Stop at less than 1/2 inch (about 1.25 centimeters) if you feel any resistance.
• Steady the thermometer between your second and third fingers as you cup your hand against your baby’s bottom. Soothe your baby and speak to him quietly as you hold the thermometer in place.
• Wait until you hear the appropriate number of beeps or other signal that the temperature is ready to be read. Read and record the number on the screen, noting the time of day that the reading was taken.

1. If febrile, a lukewarm sponge bath for 15-30 minutes may be soothing (26-28 degrees Celsius or 78.8-82.4 degrees Fahrenheit is optimal).  Repeat this every 2 hours, as needed.
2. NEVER use aspirin in children as it is associated with a dangerous condition known as Reye’s Syndrome.
3. For children younger than 6 months, only use Tylenol (also known as acetaminophen) as Ibuprofen is not as safe in children younger than 6 months.
4. For children older than 6 months, Ibuprofen (name brands include Motrin/Advil, but any brand of ibuprofen is fine) generally works better to keep the fever down.  If you are using a single medication, you can give Ibuprofen every 6 hours as needed or you can also use Tylenol every 6 hours.  If you desire greater fever control, you can choose to use both medications staggering Tylenol and Ibuprofen. However, you should then give each medication every 8 hours rather than every 6 hours.  For example:  Give Ibuprofen at 12:00, then Tylenol at 4:00, then Ibuprofen at 8:00, then Tylenol at 12:00, and so forth.  Although you can stagger the medications as detailed, it is safest to use a single medication whenever possible.
5. Remember that it takes about 30-45 minutes for the medications to start working.  Sometimes, even if you give your child medication, a fever may not immediately drop (even after 30-45 minutes).  With time however, most fevers will break (often sooner than later).

1. See Chart on the back of this sheet for detailed dosing information. Remember that weight is a better parameter than age in calculating dosage.

If the fever is not improving or your child is becoming sicker or the fever lasts >2 days, please call us or make an appointment a.s.a.p.

Acetaminophen/Ibuprofen Dosage Charts

Generic versions of acetaminophen and ibuprofen work well.  Brand names of acetaminophen include Tylenol.  Brand names of ibuprofen include Motrin and Advil.  Weight is a better measure than age in determining medication dosage.  Infants’ Acetaminophen Concentrated Drops (80mg/0.8mL) is no longer being offered, so please refer to the chart below for new dosages.

*DO NOT TAKE ACETAMINOPHEN MORE THAN 5 TIMES IN 24 HOURS.

**DO NOT TAKE IBUPROFEN MORE THAN 4 TIMES IN 24 HOURS.

***Concentrated infant drops (80mg/0.8mL) are no longer offered

• NEVER use aspirin in children as it is associated with a dangerous condition known as Reye’s Syndrome.
• For children younger than 6 months, only use Tylenol (also known as acetaminophen) as Ibuprofen is not as safe in children younger than 6 months.
• Remember that it takes about 30-45 minutes for the medications to start working. Sometimes, even if you give your child medication, a fever may not immediately drop (even after 30-45 minutes). With time, however, most fevers will break (often sooner than later).
• If the fever is not improving, your child is becoming sicker, or the fever lasts more than 3 days, please call your pediatrician or make an appointment A.S.A.P.
• Do not combine or give acetaminophen (Tylenol) with Ibuprofen (Motrin) at the same time.
• Do not use combination medications (such as Motrin Cold or Tylenol Cold) as you may duplicate Motrin/Tylenol doses.
• Please note that infant’s concentration and children’s concentration are different.
• See backside for suppository information (in case of vomiting).

Consumer Reports April 2007

Oral thermometers are tops for temps

Flu season is on the way, as is a “burning” question for coughers and sneezers: Which type of fever thermometer is best? We asked 24 adults and 21 children ages 5 to 14 to test eight oral, ear, and forehead thermometers and found:

• The oral ones proved best overall.
• Price and performance don’t correlate. The best cost less than $15. A $30 children’s ear thermometer was only fair.
• Simple as thermometers are, some have bells and whistles–beeps that tell you when they’re in the right spot or when they’re finished, or soft or curved tips–that can add to convenience.

We based our Ratings primarily on precision, or how widely the thermometers’ results varied from those of our control, the accuracy of which we verified.