Fever

Remember fevers are not the illness but a way for the body to help fight an illness. Fevers, though helpful for the body when fighting an infection, can be extremely uncomfortable for a child, and when a kiddo is uncomfortable, it is tough to get them to stay hydrated or eat to keep their energy up to fight off an infection. This is why I always say, “Treat the child, not the fever.” If I have a child with a fever who is happily playing and taking in good hydration, then they may not need Tylenol/acetaminophen to lower their fever. But if I have a kiddo with the same elevated temperature who is a log on the couch unwilling to drink anything, I am going to give that kiddo Tylenol/acetaminophen (if they are 2 months of age or older) or Advil/Motrin/ibuprofen (if they are over 6 months of age) to help lower the body temperature to get the kiddo’s fighting spirit back to help battle that infection.

But how high is too high for a fever?

First off, any temperature 100.4 °F (38 °C) or above or 97 °F (36 °C) or below in a kiddo 2 months or under (taken rectally) is considered a medical urgency/emergency and should be evaluated in the emergency room for a standard set of tests that is used to rule out sepsis in this age group. 

Now if we are over 2 months, for me, any temperature above 100.4 °F or 38 °C is a fever. I wish that the actual temperature value would let us know which bug is causing this infection, but it’s not that easy. There is no fever number that tells us if something is viral or bacterial. Sometimes there are kiddos who spike 106 °F (41 °C) fevers with the common flu, while others spike 101 °F (38.3 °C) on their way to life-threatening bacterial sepsis. Again, “Treat the child, not the fever.”  All a fever tells me is that this kiddo is most likely fighting some sort of infection, bacterial or viral, I dunno. It is important to note that there is no temperature the body can make on its own that is harmful to the body. So fevers of 103, 105, or even 107 °F (42 °C) don’t really phase a pediatrician unless you tell us that the kiddo was stuck in a hot car or ran an Ironman in the desert. In these situations, even a fever of 100.4 °F (38 °C) is concerning as external heat-derived fevers are actually dangerous in any form. 

Having said that, fevers that spike up quickly can cause febrile seizures in younger kids, and if a kiddo has a fever of 104 °F (40 °C) or above, they are gonna look super poopy and most likely will not want to do much of anything including drink Pedialyte. They will feel and act much better with some Tylenol/acetaminophen or Advil/Motrin/ibuprofen on board. For me, if I have a kiddo with a fever above 102 °F (39 °C), I need to make sure they are staying hydrated because at those temperatures, the body needs a lot more good electrolyte fluids to keep everything going and fight off the infection. 

How long is too long for a fever?

Pediatricians are often OK with 3-4 days of a fever; i.e., at least one fever above 100.4 °F (38 °C) every 24 hours for 3-4 days.  If it gets longer than that, especially if there are no other symptoms or obvious sources like a runny nose or cough, then we have more concern for a possible bacterial infection rather than a more common viral infection such as a cold or stomach virus. So if it is Day 4 and we are spiking fevers or if we had a period of over 24 hours with no fever and now we have a new spike in temperature, it is time to say hi to your friendly pediatrician.