Q & A with Pediatrician Kelli Ostermann, MD
Fever is a common reason parents seek medical care for their children. So, let’s talk a little bit about fever…
NOTE: If your child has immune system problems like cancer, sickle cell disease, etc., please follow the guidance given by their medical providers. This information is intended for children without these concerns.
What is fever?
Fever means body temperature is elevated above normal.
- Medical providers can have different definitions of fever, but I hope you will see that the exact number on the thermometer is usually not what is most important.
- The generally accepted definition of fever is a temperature of 100.4° F (38.0° C) or higher.
- The definition of a low-grade fever is 100.4 – 102° F.
What causes fever?
Fever is usually caused by an infection. Other rare causes of fever include heat stroke (such as children left in a hot car on a hot day) and reaction to medication during general anesthesia.
Why do infections cause fever?
Fever is our immune system’s way of fighting off the infection.
- The viruses and bacteria that cause infections do not live well at the higher body temperatures. Our immune system has enzymes that get activated at the higher temperatures and are more effective at fighting the infection.
- For many infections, including COVID-19, there is good evidence that NOT treating the fever – letting the fever happen without the use of fever-lowering medications – helps the body get better faster.
When is fever dangerous? What if the fever goes too high?
Our body’s thermostat will not let the fever caused by an infection go “too high” to be dangerous.
- The brain’s thermostat usually keeps fever from infection at 104° or lower, but fever can go as high as 105-106°.
- Fevers can be dangerous if over 108°, but that only happens with heat stroke or with certain medication reactions as mentioned earlier.
How is fever treated?
Most fevers are beneficial and do not need to be treated.
- A fever will not continue to rise without treatment.
- Infections will be shorter if fever is allowed to continue untreated.
- Fever-lowering medications can be used if the fever is high enough to cause your child to be uncomfortable – usually over 102°.
- Acetaminophen (Tylenol) and ibuprofen are the recommended fever-lowering medications. NEVER use aspirin to treat fever in children because it can cause Reye syndrome.
- Pick one medication to use. I usually recommend acetaminophen as my first choice because it has less side effects.
- Fever-reducing medications will usually bring high fevers down by 2 – 3° after about 1 – 2 hours. These medications do not bring body temperature to normal.
- All children with fever need extra fluids. If your child is shivering, it is ok to dress them warmly for comfort. The shivering will stop when the temperature reaches the brain’s established temperature. If your child is sweating, dress them in light clothing for comfort. Cool baths are not necessary.
I’ve heard that fever can cause seizures. Should I be concerned?
Seizures triggered by fever, called febrile seizures, occur in about 2 – 4% of children under 5 years of age.
- Treating the fever does not prevent the seizure.
- While scary to watch, febrile seizures are not harmful.
When should I have my child evaluated for fever?
It is always okay to have your child evaluated if you have concerns.
- All children under 2 months old need to be evaluated immediately if they have fever of 100.4° or higher.
- When your 2-to-6-month-old child has fever for over 24 hours without having other symptoms common to a viral illness like a cough, runny nose, diarrhea, etc.
- When your child, of any age, looks or acts very sick.
- When your child has any serious symptoms such as trouble breathing, stiff neck, severe headache, etc.
- When your child has fever over 104°.
- When your child’s fever lasts longer than 3 days (72 hours).
Whenever you are concerned about fever or anything else related to your child’s health and well-being, we’re here to help. To schedule an appointment in Pediatrics or Family Medicine, call Winona Health at 507.454.3650. If we don’t have an opening in the timeframe that works for you, our caregivers in Urgent Care can help. And, if it’s after hours and you feel it’s important for your child to be seen right away, our Emergency Department is always open.