Baby
FEVERS: WHEN TO CALL THE DOCTOR
By Pervez Faruqi, M.D.
Fever is one of the most common symptoms reported to pediatricians. A
temperature of more than 100.4 degrees Fahrenheit is considered fever.
Usually it means that the body's defense mechanism is interacting with
an infectious or a non-infectious process. Viral or bacterial
infections, vaccines, tissue injury, drugs and altered metabolic states
are some of the examples of such processes. It is important to realize
that fever itself is not a disease; rather, it is a sign of an
underlying condition and should be evaluated by a physician so that
proper treatment for the condition can be instituted.
Fever
management is a part of the routine anticipatory guidance on all health
care visits. Parents should be comfortable with fever management
techniques. A rectal thermometer is required to record temperature
accurately, especially in a child less than 2 years. Ear scans are
considered more reliable in children over 2 years of age. Auxiliary
measurement may falsely give a low reading. In an older and cooperative
child, temperature may be recorded orally, but the reading may be
falsely low because of rapid breathing.
Fevers of more than 101 degrees Fahrenheit should be actively
controlled. Acetaminophen (Tylenol) is the most commonly used drug for
this purpose. The recommended dosage for Acetaminophen is 10 to 15 mg
per kg of the body weight every four hours. The medicine is available
as infant drops or children's liquid. "Infant drops" is the
concentrated preparation and delivers more medicine in a small dose.
Ibuprofen (Motrin) is equally effective in controlling fever. It can
be administered in doses of 5 to 10 mg per kg of body weight every six
to eight hours. Recently use of Ibuprofen has gained popularity to
control temperatures higher than 102 degrees Fahrenheit. There is no
scientific data establishing better control of higher temperatures by
Ibuprofen. Although aspirin is also effective in controlling fevers,
its use in children is not recommended because of its association with
Reyes Syndrome.
One of the common mistakes parents make in management of febrile
children is to bundle them up in layers of clothes and blankets. This
conserves body heat. On the contrary, heat should be allowed to
dissipate from the skin surface. Therefore a child with fever should be
dressed lightly. For temperatures more than 103 degrees Fahrenheit,
sponging with tepid water is recommended. Use of cold water or alcohol
results in narrowing of the vessels bringing blood to the skin. This
would result in the body retaining the heat rather than loosing it to
the environment.
Fever in infants less than two months of age
can be an early warning sign of a serious infection. Temperature of
100.4 degrees Fahrenheit or higher should be reported to the
pediatrician immediately. In older children, unless the fever is
clearly due to an upper respiratory infection or a cold and is less
than three to five days of duration, it should always be reported to
the pediatrician.
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About The Author
Pervez Faruqi, M.D. is Assistant Professor of Pediatrics at SUNY HSC
(State University of New York-Health Science Center) and Attending
Pediatrician at Infants and Children's Hospital of Brooklyn, Maimonides
Medical Center.
