Your child has a fever –now what? A high temperature can be alarming, but when should you call your pediatrician and when is a fever a real emergency?
From causes to treatment, Dr. David Levine talks about the facts – and the myths - regarding fevers in children.
Selected Podcast
Fevers in Children: How High is Too High?
Featured Speaker:
Dr. Levine is a member of the American Academy of Pediatrics. He has been featured in the New Jersey Family "New Jersey's Favorite Kids' Docs" listings.
David Levine, M.D. FAAP
In addition to his position at Summit Medical Group, David B. Levine, MD, FAAP, is an adolescent clinic preceptor for the Atlantic Health System Internal Medicine Residency Program. He specializes in pediatric and adolescent medicine. His expertise includes obesity and nutrition. Dr. Levine believes that each child is unique. "Pediatrics is not a one-size-fits-all practice," he says. "I believe that it's important to understand and approach each of my patients' needs individually. I enjoy helping parents understand the importance of spending time with their children and being good role models for healthy habits and behaviors."Dr. Levine is a member of the American Academy of Pediatrics. He has been featured in the New Jersey Family "New Jersey's Favorite Kids' Docs" listings.
Transcription:
Fevers in Children: How High is Too High?
Melanie Cole: A high temperature in children can be alarming, but when do you call your doctor and when do you let it take its course. My guest is Dr. David Levine. He is a board-certified pediatrician at Summit Medical Group. Welcome to the show, Dr. Levine. Tell us about fevers. What are they?
Dr. David Levine: Fevers are, in many ways, a normal part of living on earth. We’re an organism, we’re a body, and we come in contact with other organisms, some of which are beneficial to us and some of which are not so beneficial to us. A fever is just our way of describing a temperature in the body that’s above what we would expect it to be. Most children run, let’s say between 96 and 99 is pretty normal temperatures. These temperatures vary throughout the day. Sometimes at the day, especially during the middle of the day, they could be on the lower side and as we get into the evenings, they can come up a little bit. A lot of people find that their children have temperatures closer to 99, even 99-point-something in the evenings, and those are just due to variations in our hormone that affects the temperature but sometimes the temperature can go higher.
Melanie: What causes the fever?
Dr. Levine: There's a lot of hormones and regulators in our body that are set off in response to certain things. For instance, if you get strep throat, a lot of children will get fevers from that. If you get the flu, you’ll get a fever from that. That’s because it's a foreign invader in your body that is causing the release of these chemicals which causes the temperature to rise, and we believe that the temperature rises in order to make the environment in the body less comfortable for the invader, trying to help to kill them off.
Melanie: How do you take temperature? What do you think is the best? Obviously, those mercurial thermometers are going by the wayside. For a baby, do you like us to do the tush? Do you like it under the arm? What do you like?
Dr. Levine: Yes. Rectal temperatures are by far are the best and most accurate measure. I have a newborn at home and I have taken his temperature. I understand the worry that parents have about doing rectal is because a lot of parents are afraid that they’re going to go too far. Most of the rectal thermometers that I have found are tapered in a way that you really cannot hurt the child by gently inserting a rectal temperature with a little bit of ethylene on the end, just deep enough that you don’t see the tip anymore and it starts to read the temperature.
Melanie: How alarmed should we be? Let’s start with babies, with infants. What is a temperature that would send us to see you?
Dr. Levine: Okay. When you're under three months of age, you're in a different category than when you're over three months of age. A rectal temperature above 100.4 in an under-three-month-old child is reason to either call your doctor, or in some cases, depending on what the doctor has told the patient, go directly to an emergency room because fevers under the age of three months can be more dangerous because the infant’s mechanisms of fighting infection are weaker than they are when they get older. That’s kind of a special case. Over three months of age, I’d say most of this depends on the parent. A fever of 100.5, a fever of 101, 101.5, these can mean anything and nothing at all. What I generally tell parents is, “If you're worried about the fever, give us a call and we’ll take a look at the child.” There are a couple of things I add. One, calling us with fever on the very first day is probably not going to get you anywhere unless the child looks very sickly, because a lot of times we can't tell what something is the first hour that a fever arises. After a day or two, we could start to see, does the runny nose start, does the cough start, do they have developed an ear infection, things like that. The height of the temperature, in general, is less concerning than what the child looks like. This is what I always tell my patient. I have seen kids with 104 temperatures, running around my office like normal kids and I've seen kids with 101 who look like they’re on Death’s door. The height of the fever does not mean that the child is sicker because a lot of the high fevers can be caused by viruses which are generally benign and will run their course with just some comfort medicine over three or four days. I tell parents: If your child has a 101 and you can't arouse them, there's something about them that makes you very, very worried, you're giving them some Tylenol or some Motrin ibuprofen and they’re not getting better, then these are kids that we want to see. A child with 102 temperature, you give them some Tylenol, 30 minutes later they’re bouncing around, feeling good. They have no specific symptoms. They have normal variations that the temperature comes back up, they look sick; the temperature comes down, they feel better. You can watch that child for a day or two or maybe even three depending on what the symptoms are and what kind of a parent you are. If you are very alarmist, then you might be calling sooner but if you’ve been down this road before and the child seems to be responding, we try to empower the parent to feel like they can help their kids without having to run them to the doctor every single time, not that we don’t want to see them, but we want the parents to feel like they can do more than just always need to call the doctor at the first signs of a fever.
Melanie: When do we want the fever to come down, Dr. Levine? Do we let it take its course? It’s there to fight infection, to be inhospitable to the infection. When do we let it take its course and when do we give Motrin, Tylenol?
Dr. Levine: In general, if a child is acting sickly, they’re crying, uncomfortable, they don’t feel like they want to eat or drink because of how sick they feel, these are kids that deserve a medication. When the fever comes down, they’ll perk up, they’ll drink, they’ll eat a little bit which is always helpful to keep your hydration up when you're not feeling good. These are always helpful. A child obviously with 103 or 104 who’s burning up or kind of a little delusional, which can happen at any age with a high fever, you're going to want to take that down because it's going to help them get comfortable. It's going to help them get some rest. This is going to give their body a chance to fight off whatever is causing the infection. There are other parents that I know who the child has 101 but they’re not really uncomfortable and they have asked like, “Is it okay that I don’t give them Tylenol?” I say, “Yeah.” The temperature will come down eventually. I can't tell them how quickly but there's no reason that some parents who want to hold off need to run and jump in at the very first signs of it, because what’s important to look at is the trend of the fever. A fever that is going upwards over several days as opposed to plateauing, a fever that is coming and going at certain intervals, like every couple of days, there is a fever and then it goes away only to recur again a couple of days later, this is also very important because what I failed to say in the very beginning is fevers are not always caused by infections and sometimes they can be caused by other types of illnesses.
Melanie: When do we keep our children home from school, Dr. Levine?
Dr. Levine: In general, it's recommended that you keep the child home from school until they have been fever-free for 24 hours.
Melanie: What about something like a febrile seizure with a fever? They’re so alarming, so scary. Do we call 911?
Dr. Levine: I would say that most parents, if their child was having a seizure from a fever, would call 911, and that would be appropriate. Febrile seizure, they’re probably going to change the name of that because although they look like seizures, they don’t act like a typical seizure would in somebody who does not have a fever. We don’t know exactly why they occur. There is definitely a familial predisposition towards them and they are pretty specifically occurring between usually six months of age and five years of age. The most important part about febrile seizures, in general, is that they do not predispose you to non-febrile seizures. In other words, a child who has, let’s say, two or three seizures when they’re between six months and five years of age, they all were associated with 102, 103, 104 temperatures and the child was otherwise fine, those children, in general, do not go on to develop epilepsy. These children generally do just fine. Usually, you do not find the source of the fever but most parents when they see it, it is appropriate to, at the minimum, call their doctor. But most parents when they see the seizure starting will call 911, which is appropriate because someone needs to get there and at least calm the parent and see to make sure the child is going to be okay.
Melanie: In the last just a minute, please, Dr. Levine, wrap it up for us your best advice on parents dealing with fevers in their children.
Dr. Levine: Okay. The best way to wrap it up would be to not be fever-phobic. Fevers are not going to damage your child. They’re not going to melt their brains. A 104 temperature is not going to cause them to have brain damage. Fevers are, in general, a symptom of an illness of some kind. Those illnesses can be very benign or they can be very deadly. It is the parent’s job as a parent to observe their child and see, “Is this something that is worrying me and is this something that is not worrying me?” It is also the job of the pediatrician to inform the parent as to what are the signs of something that’s worrisome and what are the signs of something where I can watch this for a day or two and then give you guys a call and have the child be seen if necessary. We always will see any child with a fever, and at Summit Medical Group we will usually see those children the same day, but it can be very helpful to the parent to know that there are things that they can do for the child at home before they come in for the visit or even afterwards that can make the child comfortable and allow the parent to observe them, see how the child is behaving and how they’re doing, and then using that information to then speak with the physician when things are not going the way that they were expected to.
Melanie: Thank you so much, Dr. David Levine, board-certified pediatrician at Summit Medical Group. You're listening to SMG Radio. For more information, you can go to summitmedicalgroup.com. This is Melanie Cole. Thanks for listening and have a great day.
Fevers in Children: How High is Too High?
Melanie Cole: A high temperature in children can be alarming, but when do you call your doctor and when do you let it take its course. My guest is Dr. David Levine. He is a board-certified pediatrician at Summit Medical Group. Welcome to the show, Dr. Levine. Tell us about fevers. What are they?
Dr. David Levine: Fevers are, in many ways, a normal part of living on earth. We’re an organism, we’re a body, and we come in contact with other organisms, some of which are beneficial to us and some of which are not so beneficial to us. A fever is just our way of describing a temperature in the body that’s above what we would expect it to be. Most children run, let’s say between 96 and 99 is pretty normal temperatures. These temperatures vary throughout the day. Sometimes at the day, especially during the middle of the day, they could be on the lower side and as we get into the evenings, they can come up a little bit. A lot of people find that their children have temperatures closer to 99, even 99-point-something in the evenings, and those are just due to variations in our hormone that affects the temperature but sometimes the temperature can go higher.
Melanie: What causes the fever?
Dr. Levine: There's a lot of hormones and regulators in our body that are set off in response to certain things. For instance, if you get strep throat, a lot of children will get fevers from that. If you get the flu, you’ll get a fever from that. That’s because it's a foreign invader in your body that is causing the release of these chemicals which causes the temperature to rise, and we believe that the temperature rises in order to make the environment in the body less comfortable for the invader, trying to help to kill them off.
Melanie: How do you take temperature? What do you think is the best? Obviously, those mercurial thermometers are going by the wayside. For a baby, do you like us to do the tush? Do you like it under the arm? What do you like?
Dr. Levine: Yes. Rectal temperatures are by far are the best and most accurate measure. I have a newborn at home and I have taken his temperature. I understand the worry that parents have about doing rectal is because a lot of parents are afraid that they’re going to go too far. Most of the rectal thermometers that I have found are tapered in a way that you really cannot hurt the child by gently inserting a rectal temperature with a little bit of ethylene on the end, just deep enough that you don’t see the tip anymore and it starts to read the temperature.
Melanie: How alarmed should we be? Let’s start with babies, with infants. What is a temperature that would send us to see you?
Dr. Levine: Okay. When you're under three months of age, you're in a different category than when you're over three months of age. A rectal temperature above 100.4 in an under-three-month-old child is reason to either call your doctor, or in some cases, depending on what the doctor has told the patient, go directly to an emergency room because fevers under the age of three months can be more dangerous because the infant’s mechanisms of fighting infection are weaker than they are when they get older. That’s kind of a special case. Over three months of age, I’d say most of this depends on the parent. A fever of 100.5, a fever of 101, 101.5, these can mean anything and nothing at all. What I generally tell parents is, “If you're worried about the fever, give us a call and we’ll take a look at the child.” There are a couple of things I add. One, calling us with fever on the very first day is probably not going to get you anywhere unless the child looks very sickly, because a lot of times we can't tell what something is the first hour that a fever arises. After a day or two, we could start to see, does the runny nose start, does the cough start, do they have developed an ear infection, things like that. The height of the temperature, in general, is less concerning than what the child looks like. This is what I always tell my patient. I have seen kids with 104 temperatures, running around my office like normal kids and I've seen kids with 101 who look like they’re on Death’s door. The height of the fever does not mean that the child is sicker because a lot of the high fevers can be caused by viruses which are generally benign and will run their course with just some comfort medicine over three or four days. I tell parents: If your child has a 101 and you can't arouse them, there's something about them that makes you very, very worried, you're giving them some Tylenol or some Motrin ibuprofen and they’re not getting better, then these are kids that we want to see. A child with 102 temperature, you give them some Tylenol, 30 minutes later they’re bouncing around, feeling good. They have no specific symptoms. They have normal variations that the temperature comes back up, they look sick; the temperature comes down, they feel better. You can watch that child for a day or two or maybe even three depending on what the symptoms are and what kind of a parent you are. If you are very alarmist, then you might be calling sooner but if you’ve been down this road before and the child seems to be responding, we try to empower the parent to feel like they can help their kids without having to run them to the doctor every single time, not that we don’t want to see them, but we want the parents to feel like they can do more than just always need to call the doctor at the first signs of a fever.
Melanie: When do we want the fever to come down, Dr. Levine? Do we let it take its course? It’s there to fight infection, to be inhospitable to the infection. When do we let it take its course and when do we give Motrin, Tylenol?
Dr. Levine: In general, if a child is acting sickly, they’re crying, uncomfortable, they don’t feel like they want to eat or drink because of how sick they feel, these are kids that deserve a medication. When the fever comes down, they’ll perk up, they’ll drink, they’ll eat a little bit which is always helpful to keep your hydration up when you're not feeling good. These are always helpful. A child obviously with 103 or 104 who’s burning up or kind of a little delusional, which can happen at any age with a high fever, you're going to want to take that down because it's going to help them get comfortable. It's going to help them get some rest. This is going to give their body a chance to fight off whatever is causing the infection. There are other parents that I know who the child has 101 but they’re not really uncomfortable and they have asked like, “Is it okay that I don’t give them Tylenol?” I say, “Yeah.” The temperature will come down eventually. I can't tell them how quickly but there's no reason that some parents who want to hold off need to run and jump in at the very first signs of it, because what’s important to look at is the trend of the fever. A fever that is going upwards over several days as opposed to plateauing, a fever that is coming and going at certain intervals, like every couple of days, there is a fever and then it goes away only to recur again a couple of days later, this is also very important because what I failed to say in the very beginning is fevers are not always caused by infections and sometimes they can be caused by other types of illnesses.
Melanie: When do we keep our children home from school, Dr. Levine?
Dr. Levine: In general, it's recommended that you keep the child home from school until they have been fever-free for 24 hours.
Melanie: What about something like a febrile seizure with a fever? They’re so alarming, so scary. Do we call 911?
Dr. Levine: I would say that most parents, if their child was having a seizure from a fever, would call 911, and that would be appropriate. Febrile seizure, they’re probably going to change the name of that because although they look like seizures, they don’t act like a typical seizure would in somebody who does not have a fever. We don’t know exactly why they occur. There is definitely a familial predisposition towards them and they are pretty specifically occurring between usually six months of age and five years of age. The most important part about febrile seizures, in general, is that they do not predispose you to non-febrile seizures. In other words, a child who has, let’s say, two or three seizures when they’re between six months and five years of age, they all were associated with 102, 103, 104 temperatures and the child was otherwise fine, those children, in general, do not go on to develop epilepsy. These children generally do just fine. Usually, you do not find the source of the fever but most parents when they see it, it is appropriate to, at the minimum, call their doctor. But most parents when they see the seizure starting will call 911, which is appropriate because someone needs to get there and at least calm the parent and see to make sure the child is going to be okay.
Melanie: In the last just a minute, please, Dr. Levine, wrap it up for us your best advice on parents dealing with fevers in their children.
Dr. Levine: Okay. The best way to wrap it up would be to not be fever-phobic. Fevers are not going to damage your child. They’re not going to melt their brains. A 104 temperature is not going to cause them to have brain damage. Fevers are, in general, a symptom of an illness of some kind. Those illnesses can be very benign or they can be very deadly. It is the parent’s job as a parent to observe their child and see, “Is this something that is worrying me and is this something that is not worrying me?” It is also the job of the pediatrician to inform the parent as to what are the signs of something that’s worrisome and what are the signs of something where I can watch this for a day or two and then give you guys a call and have the child be seen if necessary. We always will see any child with a fever, and at Summit Medical Group we will usually see those children the same day, but it can be very helpful to the parent to know that there are things that they can do for the child at home before they come in for the visit or even afterwards that can make the child comfortable and allow the parent to observe them, see how the child is behaving and how they’re doing, and then using that information to then speak with the physician when things are not going the way that they were expected to.
Melanie: Thank you so much, Dr. David Levine, board-certified pediatrician at Summit Medical Group. You're listening to SMG Radio. For more information, you can go to summitmedicalgroup.com. This is Melanie Cole. Thanks for listening and have a great day.