As a pediatrician, the most common complaint I get from parents is “Doc, my baby has a fever.” While fever is the most common reason parents take their sick children to the doctor, the fact is many parents know very little about fever – what causes it or what to do when it happens. With the COVID-19 pandemic surging on, it’s more important than ever that parents have a sound understanding of what a fever is and what to do when their little one “feels hot”.
A fever is most often a healthy immune system’s response to an infection or other illness. When the immune system encounters a germ, it sets into motion a series of chemical reactions that causes the body’s thermostat to reset to a higher temperature – presumably to make the body too uncomfortable an environment for the germ to thrive.
A fever is more than just “feeling hot”. It’s an actual number that should be measured with a thermometer and not the back of your hand. A temperature of 100.4°F (38° C) or higher is the magic number, and accurate temperature measurements are helpful in guiding your pediatrician’s management and monitoring your child’s response to treatment.
It’s important to remember that the fever itself is not an illness, but a symptom of an illness that is going to persist until that illness goes away. Most fevers are caused by infections with viruses, bacteria, or other microorganisms, but there are other causes of fever as well. Overdressing infants can sometimes cause elevated body temperature and children sometimes develop a fever after immunizations since the immune system has been tricked into thinking there is an infection to fight. While teething is often made out to be the culprit for fevers in babies, it’s probably not the case if the temperature is higher than 100.4°F.
The first thing to do when you suspect your child has a fever is to take an accurate temperature reading. Rectal temperatures are the most accurate and are appropriate for children from birth to about four years of age. To take a rectal temperature, have your child lie stomach down on your lap. Another way is on the back with the legs pulled up to the chest. Put a lubricant like petroleum jelly on the end of the thermometer and the anus. Slide the thermometer gently into the anus just until you can no longer see the silver tip. Be gentle! There should not be any resistance. If there is, stop. Hold your child still. Leave a digital thermometer in until it beeps (about 10 seconds). (Rectal temperatures should not be taken in young children with leukemia or other cancers and should be avoided in other children with weak immune systems such as organ transplant, HIV or sickle cell disease.)
Forehead temperatures are the next most accurate and can be done with an infra-red thermometer placed over your child’s temple.
Your child has a fever if the rectal or forehead temperature is above 100.4°F.
Of course, at the first sign of fever, most parents want to bundle their children up and rush them to the nearest doctor’s office, but this usually isn’t necessary. If your child is older than three months, feeding well, and active, it is OK to observe them at home for a few days. They can be managed with anti-fever medicine every few hours, lots of fluids and lots of rest.
If you want your child to go in to the doctor’s office, please be sure to call ahead. While most offices have implemented COVID-19 safety protocols, we still need time to prepare for your sick child’s arrival in order to ensure the continued safety of staff, other patients, and of course, your child. Don’t be alarmed if your doctor recommends a telehealth visit or a few days of observation at home. Your child will be seen in office if it’s absolutely necessary.
Call your pediatrician right away if your child:
• Is three months or younger with a rectal or forehead temperature of 104°F or higher.
• Has a fever of 104°F or higher, at any age.
• Looks very ill, is unusually drowsy, or is very fussy and inconsolable.
• Has other symptoms like stiff neck, severe headache, severe sore throat, severe ear pain, unexplained rash, or repeated vomiting or diarrhea.
• Has immune problems like sickle cell disease, HIV, or cancer, or is taking steroids.
• Has had a seizure.
Remember, your pediatrician is a valuable resource for helping you raise happy and healthy kids. If you have concerns about your child’s temperature, do not hesitate to reach out for guidance.
• Dr. Tamarra Moss is a pediatrician committed to helping you raise happy and healthy kids. You can find her at Dr. Carlos Thomas & Pediatric Associates in Nassau, Lucayan Medical Center in Grand Bahama, or on Instagram @mykidsdoc242.