Written by Reuben Holland, MD; Sheera Thomas, RN; & Johnna Hommell, LPN
It’s cold and flu season, again. Sigh.
As parents, we’ll always worry when our kids are sick, especially if they have fever—and it can be really scary, when your sick child is an infant. But when should we worry? When should we call the pediatrician or head to an urgent care center?
A fever is not an illness. It’s a symptom of an underlying condition or infection. When a person has a temperature of 100.4 or higher, it’s a sign that the body is working properly to overcome an infection — either a virus (cold or flu) or bacterial infection (strep throat or some ear infections). In children, viruses are the most common culprit.
At the onset of a fever, an increase in temperature can be slow or sudden. The child may have chills, along with an increased heart rate and breathing rate. As the fever progresses, the temperature can fluctuate continuously or intermittently.
During this stage, the sick child has an increased heart and breathing rate and feels warm to the touch. He/she may be flushed, feel thirsty, lose their appetite, have a headache and/or feel weak and tired.
The final stage, when the fever subsides, can be gradual or sudden. As the body temperature returns to normal, the child likely will sweat and could become dehydrated due to loss of fluid from sweating.
When to Worry
Although a fever is a good indication that your child’s immune system is trying to heal itself and defend the body against infection, there are times that a fever indicates it’s time to visit a doctor.
Infant fevers: The American Academy of Pediatrics (AAP) recommends calling your pediatrician, if your infant is 3 months old or younger and has a fever of 100.4 or higher.
Persistent fevers: Many viral illnesses like the flu can cause a fever of 102 degrees or higher for 12 to 24 hours. For children ages 3 months to 3 years old, the AAP advises a physician visit if their fever reaches 102 degrees for more than three days and the child appears ill, fussy or refuses fluids. For any child, a fever that lasts more than three days merits a visit to the pediatrician or an urgent care center.
Fevers + other symptoms: When a child has a fever and other signs of bacterial infection, call the doctor. A fever with any of the following symptoms should be treated by the child’s pediatrician or at an urgent care center: stiff neck; severe headache; severe sore throat; ear pain; unexplained rash; shortness of breath and a cough (pneumonia symptoms); a cough, gray-yellow phlegm and wheezing (bronchitis symptoms); or persistent vomiting or diarrhea.
Challenged immune system: If your child has immune system problems, such as sickle cell disease or cancer, or is taking steroids, err on the side of caution, and talk to his/her doctor when the child has a fever.
Fever after high heat exposure: Talk to a physician, if your child starts a fever after being in a very hot environment, such as inside a non-air-conditioned car in the summer.
How to Treat a Child’s Fever
It’s important to monitor a child’s fever and to try various comfort measures to ease his/her pain and discomfort. Here are some tips for caring for a feverish child:
- Take a feverish child’s temperature every two hours, and keep a log of both the time and temperature. If symptoms change, take the temp before the end of two hours. (For example, if the child starts throwing up or the temperature is going up each time you take it.) This will help you monitor the fever, and the log can be useful when/if you visit a physician.
- Offer them liquids, especially water, often. Increase the amount of liquid they’re drinking to replace any fluids lost through sweating as the body tries to cool itself.
- Keep your child’s room and your home comfortably cool, and dress him/her lightly.
- Offer popsicles, watered-down fruit juices, Pedialyte or other low-sugar, electrolyte drink. (Sugar can be dehydrating, so skip Ice Pops and straight fruit juice.)
- For fevers that are uncomfortable, sponge the child’s body with lukewarm, not cold, water. Offer age-appropriate acetaminophen or ibuprofen to bring the fever down. Do not give aspirin or products that contain aspirin to anyone younger than age 20.
- Watch for signs of dehydration: excessive thirst, dry skin, dry mouth, chills, feeling tired or weak, and dark-colored urine. Dehydration can happen if the fever causes your child to sweat a lot or they have other symptoms like vomiting or diarrhea.
Timesaver Tip: When you need your feverish child to feel better fast, Sarasota Memorial Urgent Care Centers are open daily 8 am to 8 pm. Check in online or download the SMH Urgent Care app to save time and skip the ‘hurry up and wait.’
Reuben Holland, MD, is a Sarasota Memorial Emergency Medicine specialist and was named SMH's 2018 Physician of the Year. He also provides valued guidance on multiple SMH leadership committees, serves on the faculty of the Florida State University (FSU) College of Medicine and is on the core faculty for FSU’s new emergency medicine residency program at SMH.
SMH Mother-Baby Discharge Facilitator Sheera Thomas, RN, has been an OB nurse for more than 20 years. She is an internationally board-certified lactation consultant, a certified childbirth educator, and—perhaps her most demanding role—a mother of four.
Johnna Hommell, LPN, supervises daily operations at Sarasota Memorial’s six urgent care centers and carries a bachelor’s degree in Health Care Administration. She has been with Sarasota Memorial for nearly three decades.