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.