Fevers in Babies
Dr. Shobha Bhaskar explains what degree is considered a fever in babies, the signs of a fever, why your baby might have a fever, and when you should call your pediatrician.
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Learn more about Shobha Bhaskar, MD
Shobha Bhaskar, MD
Shobha Bhaskar, MD is a pediatric hospitalist with St. Louis Children's Hospital and Washington University School of Medicine, who also sees patients at Children's Hospital facilities at Missouri Baptist Medical Center and Progress West Healthcare.Learn more about Shobha Bhaskar, MD
Transcription:
Shobha Bhaskar, MD (Guest): Hi, I’m Dr. Shobha Baskar. I’m a Washington University Pediatric Hospitalist at St. Louis Children’s Hospital and I’m also a Mom Doc.
Melanie Cole (Host): Heh this is MomDocs, the podcast from St. Louis Children’s Hospital and today, we’re talking about fever in babies. Dr. Baskar, I’m so glad to have you joining us. So, what is considered fever and why does our body so this?
Dr. Baskar: Thanks Melanie. Thanks for having me. So, fever is basically the body’s natural response to an infection. Normally, when one develops an infection be it a viral or a bacterial infection, it’s the body’s signal to kick in the immune system and also to say that the white blood cells which are the infection fighting cells are coming to work. So, a normal body temperature is about 98.6 and it can vary anywhere from 97.5 to 99.5. So, whenever there is an infection, we have the temperature rising above normal and that causes a fever.
Host: So, then when does a fever indicate a more serious condition? How high does it have to be for parents to get really concerned? Because for little guys, sometimes I remember my pediatrician saying oh you know it can get pretty high before we concern ourselves. What’s that all about?
Dr. Baskar: So, basically not all fevers indicate that there is something serious going on. So, like I said, it could be something more simple like a common cold or a simple viral infection. But at the same time, it can also mean that there is something serious like a bacterial infection going on. So, we really need to look at the age of the baby and how high the fever is and what other symptoms the baby has in addition to the fever to tell us whether there is something more serious going on.
So, if it is a smaller baby like a zero to three month old baby; then what we do with just a fever would be much different from a slightly older baby like a three month old and above. So, it really depends on the age of the baby. How the baby looks and what other symptoms are going on.
Host: Can you give us some numbers Dr. Baskar for parents so that they – when you speak about babies under three months and speak about babies over three month what is that fever number that we should look for before we go whoa and call our pediatrician?
Dr. Baskar: Absolutely. So, and rectal temperature or a core body temperature of 100.4 degrees Fahrenheit which is 38 degrees Celsius is considered a fever. Especially in a baby who is zero to three months of age, that would mean a fever which needs to be seen by the doctor right away. Because less than three month old babies need a full workup whenever they have a fever of 100.4 or mores especially so in a baby who is less than 28 days of age or less than one month of age.
The older babies on the other hand, like a three months and above our tolerance for the temperature number is a little different. So, if they have a fever from 100.4 to 102, then we are going to look at it in the context of what other symptoms the baby has. So, if the baby is looking great, acting fine, eating and drinking well, doesn’t look irritable or lethargic; then we can make sure the baby is getting some fever meds, make sure he or she is comfortable, and we can watch the baby for 24 hours. Again, if the fever is over 102 degrees Fahrenheit in a baby who is three to six months of age, then you need to bring them to the doctor right away. So, if it is less than 102, we just watch them. If they are acting great you can watch them at home and offer them Tylenol and watch them at home.
Host: So, I’d like to circle back because you did just mention Tylenol and you mentioned over-the-counter medications. Are they good to bring down fever Tylenol or Motrin? Do you have a favorite? And do we even want to bring the fever down?
Dr. Baskar: So, fevers generally don’t need to be treated unless or until the baby is acting uncomfortable or there is history of febrile seizures. So, if the baby is acting great and it’s just a fever of less than 102, and is acting comfortable, eating and drinking well; then it’s okay to watch them. But that being said, parents want to make sure the baby looks comfortable and is not acting fussy and irritable from the fever itself. So, it is safe to do Tylenol which acetaminophen or ibuprofen which is Motrin or Advil. Those are the brand names for ibuprofen. Those are the medicines which are safe. Again, less than six months of age, we do not recommend ibuprofen because it has some side effects on the gastrointestinal system and also it can cause some kidney problems. So, we do not recommend ibuprofen in babies less than six months of age. Tylenol is completely safe. So, above six months you can use either Tylenol or ibuprofen.
Host: And you mentioned a febrile seizure. Tell the listeners Dr. Baskar, what that is and why it’s so scary but not necessarily really very serious.
Dr. Baskar: Sure. So, febrile seizures are seizures which are provoked by fever. It’s not caused by the underlying illness itself. We have to be careful in differentiating between seizures that are caused in the setting of a fever from more serious infection like meningitis or encephalitis. Those are caused by the illness itself. But febrile seizures they are generally harmless and in babies, or children between six months and five years of age, fever itself can sometimes trigger seizures and those are called febrile convulsions or febrile seizures. It’s mostly common in babies between 12 and 18 months of age and usually has a family history of febrile seizures and often occurs in the first few hours of the fever. As the fever is going up the baby sometimes has a seizure. And it’s important to make sure that we recognize what a simple febrile seizure is which is less than once in 24 hours and if it is a generalized tonic clonic seizure and it’s not just affecting one part of the body, then that’s a simple febrile seizure.
And also, believe it or not, if it is less than 15 minutes of duration, then it’s considered – and that’s a really long duration of time, if it’s less than 15 minutes of duration then it’s called a simple febrile seizure. And these are harmless. They don’t cause any long term intellectual problems, brain damage or learning disabilities or anything like that. It’s just really very scary for the parents and the onlookers.
Host: It certainly is. Parents I can attest to that. My daughter had one and it was really scary but thank you for that explanation that is – helps parents to understand that. So, before we wrap up, what else can we do to help our children with a fever? What other home care basics should we know about fevers in our children? Do we use cold packs? Do we want to make sure that they are not too warm? Give us some self-care that we can help our children if they have a fever.
Dr. Baskar: So, like I said, fevers in themselves are actually a good thing that the body is trying to kick in immune response to the underlying illness. So, unless a baby is not uncomfortable, we really don’t have to get too aggressive treating it unless the temperature is over 104 then definitely try to bring the fever down because it definitely causes discomfort in the baby. But anything over 102 fell free to use some over-the-counter Tylenol or ibuprofen depending on the age. A few other things that you can definitely make sure that you are taking care of is make sure the baby’s room and your home is comfortably cool, dress the baby lightly because over-bundling and overwrapping the baby can also increase the temperature and also not help with bringing the fever down. Because we often see that the baby has a fever and is starting to shiver, and parents are in an attempt to help the baby they are trying to wrap the baby and keep him or her warm. And that often causes a problem in increasing the fever further. And most important thing is hydration.
Because fever tends to make the body sweat and the babies breathe faster, all these cause a lot of insensible water losses and the babies can easily get dehydrated, so focus on hydration whether it’s a breast milk or formula. Make sure the baby is fed well and has good urine output, the lips are moist. Watch for clinical signs of dehydration. You can offer sips of Pedialyte or water or fruit juice depending on the age of the baby again. So, keeping the room temperature optimal, offering hydration, Tylenol or ibuprofen depending on the age of the baby, those are some things that you really want to watch for and take care of.
So, like I said, fevers are not necessarily a dangerous thing or a bad thing. It is a sign of the body’s immune response to an underlying illness, but I would say trust your gut instinct and if you feel that your baby needs to bee seen by the pediatrician, reach out to your pediatrician or contact us at St. Louis Children’s Hospital or one of the MomDocs. We are always glad to talk to you and see what needs to be done to either calm you down of see the baby in the emergency room and take care of it.
Host: Thank you so much Dr. Baskar for such great information. As you said, fevers can be scary but not always a bad thing. So, thank you for encouraging us and letting us know really what they are. So, thank you for giving parents a good lesson in fevers and telling us really all about them. And that wraps up another episode of MomDocs with St. Louis Children’s Hospital. More information on fevers and how to treat them in kids of all ages can be found on the MomDocs website at www.childrensmd.org. Please remember to subscribe, rate and review this podcast and all the other St. Louis Children’s MomDocs podcasts. I’m Melanie Cole.
Shobha Bhaskar, MD (Guest): Hi, I’m Dr. Shobha Baskar. I’m a Washington University Pediatric Hospitalist at St. Louis Children’s Hospital and I’m also a Mom Doc.
Melanie Cole (Host): Heh this is MomDocs, the podcast from St. Louis Children’s Hospital and today, we’re talking about fever in babies. Dr. Baskar, I’m so glad to have you joining us. So, what is considered fever and why does our body so this?
Dr. Baskar: Thanks Melanie. Thanks for having me. So, fever is basically the body’s natural response to an infection. Normally, when one develops an infection be it a viral or a bacterial infection, it’s the body’s signal to kick in the immune system and also to say that the white blood cells which are the infection fighting cells are coming to work. So, a normal body temperature is about 98.6 and it can vary anywhere from 97.5 to 99.5. So, whenever there is an infection, we have the temperature rising above normal and that causes a fever.
Host: So, then when does a fever indicate a more serious condition? How high does it have to be for parents to get really concerned? Because for little guys, sometimes I remember my pediatrician saying oh you know it can get pretty high before we concern ourselves. What’s that all about?
Dr. Baskar: So, basically not all fevers indicate that there is something serious going on. So, like I said, it could be something more simple like a common cold or a simple viral infection. But at the same time, it can also mean that there is something serious like a bacterial infection going on. So, we really need to look at the age of the baby and how high the fever is and what other symptoms the baby has in addition to the fever to tell us whether there is something more serious going on.
So, if it is a smaller baby like a zero to three month old baby; then what we do with just a fever would be much different from a slightly older baby like a three month old and above. So, it really depends on the age of the baby. How the baby looks and what other symptoms are going on.
Host: Can you give us some numbers Dr. Baskar for parents so that they – when you speak about babies under three months and speak about babies over three month what is that fever number that we should look for before we go whoa and call our pediatrician?
Dr. Baskar: Absolutely. So, and rectal temperature or a core body temperature of 100.4 degrees Fahrenheit which is 38 degrees Celsius is considered a fever. Especially in a baby who is zero to three months of age, that would mean a fever which needs to be seen by the doctor right away. Because less than three month old babies need a full workup whenever they have a fever of 100.4 or mores especially so in a baby who is less than 28 days of age or less than one month of age.
The older babies on the other hand, like a three months and above our tolerance for the temperature number is a little different. So, if they have a fever from 100.4 to 102, then we are going to look at it in the context of what other symptoms the baby has. So, if the baby is looking great, acting fine, eating and drinking well, doesn’t look irritable or lethargic; then we can make sure the baby is getting some fever meds, make sure he or she is comfortable, and we can watch the baby for 24 hours. Again, if the fever is over 102 degrees Fahrenheit in a baby who is three to six months of age, then you need to bring them to the doctor right away. So, if it is less than 102, we just watch them. If they are acting great you can watch them at home and offer them Tylenol and watch them at home.
Host: So, I’d like to circle back because you did just mention Tylenol and you mentioned over-the-counter medications. Are they good to bring down fever Tylenol or Motrin? Do you have a favorite? And do we even want to bring the fever down?
Dr. Baskar: So, fevers generally don’t need to be treated unless or until the baby is acting uncomfortable or there is history of febrile seizures. So, if the baby is acting great and it’s just a fever of less than 102, and is acting comfortable, eating and drinking well; then it’s okay to watch them. But that being said, parents want to make sure the baby looks comfortable and is not acting fussy and irritable from the fever itself. So, it is safe to do Tylenol which acetaminophen or ibuprofen which is Motrin or Advil. Those are the brand names for ibuprofen. Those are the medicines which are safe. Again, less than six months of age, we do not recommend ibuprofen because it has some side effects on the gastrointestinal system and also it can cause some kidney problems. So, we do not recommend ibuprofen in babies less than six months of age. Tylenol is completely safe. So, above six months you can use either Tylenol or ibuprofen.
Host: And you mentioned a febrile seizure. Tell the listeners Dr. Baskar, what that is and why it’s so scary but not necessarily really very serious.
Dr. Baskar: Sure. So, febrile seizures are seizures which are provoked by fever. It’s not caused by the underlying illness itself. We have to be careful in differentiating between seizures that are caused in the setting of a fever from more serious infection like meningitis or encephalitis. Those are caused by the illness itself. But febrile seizures they are generally harmless and in babies, or children between six months and five years of age, fever itself can sometimes trigger seizures and those are called febrile convulsions or febrile seizures. It’s mostly common in babies between 12 and 18 months of age and usually has a family history of febrile seizures and often occurs in the first few hours of the fever. As the fever is going up the baby sometimes has a seizure. And it’s important to make sure that we recognize what a simple febrile seizure is which is less than once in 24 hours and if it is a generalized tonic clonic seizure and it’s not just affecting one part of the body, then that’s a simple febrile seizure.
And also, believe it or not, if it is less than 15 minutes of duration, then it’s considered – and that’s a really long duration of time, if it’s less than 15 minutes of duration then it’s called a simple febrile seizure. And these are harmless. They don’t cause any long term intellectual problems, brain damage or learning disabilities or anything like that. It’s just really very scary for the parents and the onlookers.
Host: It certainly is. Parents I can attest to that. My daughter had one and it was really scary but thank you for that explanation that is – helps parents to understand that. So, before we wrap up, what else can we do to help our children with a fever? What other home care basics should we know about fevers in our children? Do we use cold packs? Do we want to make sure that they are not too warm? Give us some self-care that we can help our children if they have a fever.
Dr. Baskar: So, like I said, fevers in themselves are actually a good thing that the body is trying to kick in immune response to the underlying illness. So, unless a baby is not uncomfortable, we really don’t have to get too aggressive treating it unless the temperature is over 104 then definitely try to bring the fever down because it definitely causes discomfort in the baby. But anything over 102 fell free to use some over-the-counter Tylenol or ibuprofen depending on the age. A few other things that you can definitely make sure that you are taking care of is make sure the baby’s room and your home is comfortably cool, dress the baby lightly because over-bundling and overwrapping the baby can also increase the temperature and also not help with bringing the fever down. Because we often see that the baby has a fever and is starting to shiver, and parents are in an attempt to help the baby they are trying to wrap the baby and keep him or her warm. And that often causes a problem in increasing the fever further. And most important thing is hydration.
Because fever tends to make the body sweat and the babies breathe faster, all these cause a lot of insensible water losses and the babies can easily get dehydrated, so focus on hydration whether it’s a breast milk or formula. Make sure the baby is fed well and has good urine output, the lips are moist. Watch for clinical signs of dehydration. You can offer sips of Pedialyte or water or fruit juice depending on the age of the baby again. So, keeping the room temperature optimal, offering hydration, Tylenol or ibuprofen depending on the age of the baby, those are some things that you really want to watch for and take care of.
So, like I said, fevers are not necessarily a dangerous thing or a bad thing. It is a sign of the body’s immune response to an underlying illness, but I would say trust your gut instinct and if you feel that your baby needs to bee seen by the pediatrician, reach out to your pediatrician or contact us at St. Louis Children’s Hospital or one of the MomDocs. We are always glad to talk to you and see what needs to be done to either calm you down of see the baby in the emergency room and take care of it.
Host: Thank you so much Dr. Baskar for such great information. As you said, fevers can be scary but not always a bad thing. So, thank you for encouraging us and letting us know really what they are. So, thank you for giving parents a good lesson in fevers and telling us really all about them. And that wraps up another episode of MomDocs with St. Louis Children’s Hospital. More information on fevers and how to treat them in kids of all ages can be found on the MomDocs website at www.childrensmd.org. Please remember to subscribe, rate and review this podcast and all the other St. Louis Children’s MomDocs podcasts. I’m Melanie Cole.