Scott Webb (Host): We all get fevers from time to time, and this is especially true for our kids. And though some fevers will resolve on their own, other fevers may be an indication that our kiddo needs to be seen by a doctor. And joining me today to tell us more about fevers and when we should be concerned is Dr. Patty Sabey. She's a pediatrician with Stanford Medicine Children's Health.

This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Dr. Sabey, it's great to have you back again. Today, we're talking fevers. Last time, it was head lice. Today, it's fevers. And it's always great to have you here. Always great to benefit from your expertise. So, let's start there. What is a fever like? What happens? What causes a fever?

Dr. Patty Sabey: Fever, it may sound very scary to parents, but it's how our bodies respond when there's an infection, or sometimes there are other causes of fever. But most commonly in otherwise healthy children, it's the body's way of responding to like a viral infection or a mild bacterial infection, the body naturally increases its natural temperature to help kill the germs, so to speak, that are causing an illness.

So, fever, by definition, for all ages is 100.4 degrees Fahrenheit or higher, or 38 degrees Celsius or higher. And it's a result of the immune system being activated to fight the infection most commonly. And there are basically different chemicals in the body's immune system that trigger a chain reaction or cascade events when it encounters a virus or bacteria. Then, later, that leads to a fever. So, yeah, it's usually a sign that the immune system is functioning normally. And usually, just a fever by itself is not enough information for us to be concerned right away. It just depends on the age and other factors.

Host: And we're going to get to some of that, the age and the other factors. And the next question I had for you was about how to take a child's temperature. And I'm guessing you're going to say, well, it depends on the size of the little human we're caring for, you know, just how small they are and if they're bigger. But I'll leave it to you. What's the best way, Doctor?

Dr. Patty Sabey: Yeah. Yeah. So, there are many types of thermometers out there. Generally, like you said, you know, you're absolutely right, for a young infant, the most accurate temperature is actually a rectal temperature. So, I often talk to parents and educate parents on how to obtain a rectal temperature. And that is not usually the first thing we would do. So, generally, if you have a forehead scanner or ear thermometer, or sometimes there are thermometers that you can put under the armpit, you can start with those.

And if the temperature is approaching the abnormal range, then for an infant under three months, usually, we recommend getting a rectal temperature. And for older children, they are able to cooperate. They can try the armpit temperature, ear temperature. Those temperatures tend to be more reliable than the forehead temperature. And also, keep in mind that when a child has a fever, sometimes, you know, they may also have a stuffy nose and they are not able to keep their mouth closed when they're breathing. So when the mouth is open because they're congested, then the temperature in the mouth, which sometimes parents will do, that temperature may not be reliable, because it's not what we call the core temperature. We want the temperature that's as close to the internal body temperature as possible.

I also want to mention, nowadays, most thermometers are digital thermometers. So, you see the digital numbers as opposed to the old-fashioned glass thermometers that have mercury inside. I still remember when I was a child, there was a mercury thermometer in my house and my sibling and I would play with it. And one day, it broke and Mercury spilled out and it was fun to watch, but it's actually not safe. And also, the temperature is harder to read, so it may not be as accurate. So, we recommend a digital thermometer.

Host: How do we manage fevers for little babies? I remember, you know, having little babies and really struggling with the first one. So, your expertise is really beneficial here. What do we do for the little ones?

Dr. Patty Sabey: For infants under three months, although we do want to help the baby feel more comfortable, sometimes we can use medicine to bring the fever down, it's best to consult with your pediatrician, as soon as possible because in a young infant under three months. A real fever, you know, 100.4 or higher confirmed rectally could be a sign of a serious infection, such as a blood infection, meningitis, or, you know, other serious infections. So, it's important to get guidance from your pediatrician as soon as possible.

For older infants and older children and adolescents, if the temperature is reaching 101 degrees fahrenheit. Or if the child is very uncomfortable, then we typically will use Tylenol, which is acetaminophen or ibuprofen. These are two common fever-reducing medications over-the-counter. And younger infants, after consulting with your doctor, acetaminophen is also safe to give to young infants. Generally, we use acetaminophen under six months. And then, six months and older, you could also use ibuprofen in addition or, you know, instead of acetaminophen.

Host: Right. Yeah. We used to do the alternating thing. You know, we would this one. And then, four hours or six hours later do the other one. And of course, that was all based on the recommendation of the pediatrician. And as you say, when in doubt, reach out to your docs, reach out to your doctors, nurses, pediatricians, because they have the answers, certainly more than maybe the internet does, right?

Dr. Patty Sabey: Yeah. Yeah. So, the reason we do the alternating medications is that sometimes, the fever is very resistant to the medication to help the child feel more comfortable and, therefore, you know, drinking more fluids and helping their body recover faster. We will come up with a medication plan to use both medications, but we don't want to accidentally overdose or give too much of the medication. So, we will alternate to prevent the chance of overdosing on these medications.

Scott Webb: So, when do we worry about a child's fever? You gave us a sense, especially the range from, you know, infants up to older kids and the ballpark of the actual temperatures. But when is it time to worry? When do we really need to reach out or, worst case, maybe even go to the ED?

Dr. Patty Sabey: So, fever alone without any symptoms, that makes us worry more because if we see fever and we see some nasal congestion, maybe a mild cough, then a lot of times that's a virus, which, you know, the body naturally will defend and fight off a virus fairly easily. A fever without any obvious symptoms could be a hidden bacterial infection. So, we get worried if we have fever without anything in a young infant. So, like I mentioned, under three months, especially for infants under four weeks. So, they require immediate medical attention. If you have a child who is under two years of age, so three months to 24 months, they have a fever for more than 24 hours, it is a good idea to get medical help as well, or if a child is older than two years old and fever has been lasting for three days or longer.

Also additionally, for young children, six months to up to five years or so, sometimes fever, reaching 101 or higher, there's a risk of febrile seizure. So if your child develops any seizure, you know, that is important to get emergent medical health. Any signs of dehydration, such as, you know, dry mouth, absence of tears, crying, and decreased urine output, you know, fewer wet diapers, or inability to keep fluids in, so vomiting or just not able to keep anything down, difficulty breathing, or persistent cough, and higher temperature sometimes can be more worrisome too, so 102 to 103 or above that does not improve with fever-reducing medication.

And also, sometimes, some fevers are not from infection. So if there has been excessive heat exposure, fever could be a sign of heat stroke or a heat exhaustion. So if there has been a history of prolonged or excessive heat exposure, that's important to get medical attention. And then, another concerning symptom would be fussiness, inconsolable fussiness in a young infant because they are, you know, not able to verbalize how they're feeling. And the inconsolable fussiness could be a sign of a serious infection or a problem.

Host: So if I'm reading you right, doctor, it's just not easy to be a parent, is it? Some things may be an emergency, sometimes they're not. Not easy being a parent, but we do our best and always great to be able to lean on you. So, thank you so much.

Dr. Patty Sabey: Yeah. Thank you so much.

Host: And for more information, go to stanfordchildrens.org. And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.