Dr. Sri Explains It All: When to Worry About a Fever

By Dr. Sri Narayanan

Fevers can be scary. Your child has all the energy knocked out of him, he’s panting and sweaty and clammy and fussy all at the same time. As dangerous as they may seem, fevers are simply the body’s way to rev up the immune system and kill the viruses or bacteria that are causing an infection – with the side effect of making you feel lousy. Thankfully, most children with fevers have viruses that just need to run their course, and they can be managed at home without needing to see a doctor for further testing.

Most doctors define fever as a temperature over 100.4 degrees Fahrenheit (38 degrees Celsius), measured rectally in infants and under the armpit or tongue in older children. We see a lot of kids in the Emergency Department for fever, and our advice is usually the same:

• Give them plenty of fluids
• Let them rest
• Try some acetaminophen or ibuprofen if they cannot get comfortable

Here are a couple of situations where you may want to seek medical attention:

• Fever in an infant under 2 months of age. Little babies with a cold start off the same way as little babies with severe infections, so we recommend that any infant under 2 months with a fever gets an evaluation in the Emergency Department.
• Fever for more than five days. Some viruses like influenza and EBV (the virus that causes mono) can cause fever for a week, but an illness that lasts this long is unusual enough that you should see your pediatrician.
• Fever and vomiting / abdominal pain. If the pain is bad enough that the usual over-the-counter medicine is not helping, or if your child cannot even keep down sips of fluids, they are at high risk for dehydration and should be seen by a physician.
• Fever and difficulty breathing. As I wrote about in last month’s blog post, bronchiolitis season is here, and we saw several kids with the flu. Rapid breathing or pulling in at the neck/ribs is a reason to get checked out sooner rather than later.

Contrary to what you may hear, fevers do not cause brain damage, no matter how high the temperature gets. In a small percentage of kids under age six, fevers can cause seizures, but these almost always stop on their own and have no long-term effects. If your child is seen in our Emergency Department for a febrile seizure, we have an informative video all about seizure facts and first aid.

Fevers are a natural part of healing and are the sign of a strong immune system. They can certainly be uncomfortable, but they are rarely dangerous. Follow the tips above to help your child recover as quickly as possible, and to know when it’s important to seek medical attention.