Avoid parental panic when fevers climb

Jessica Young

Flushed and barely able to keep her head up, 3-year-old Ashley Lewis began to worry her parents. She had been sick, but they thought it was just a mild, run-of-the-mill cold. So when Ashley’s symptoms dramatically worsened, stepmom Carolyn Lewis reached for the thermometer.

“She got up to 106 degrees, and we panicked. That’s a parent’s worst nightmare,” said Lewis, a Bolingbrook resident. “Her little body was limp, and you could see the strain of illness in her face. So we rushed her to the emergency room.”

The doctor was able to bring down Ashley’s fever with strong medicine and by pumping her with fluids, but she had to stay in the hospital for a week. The scary experience remains firmly planted in Lewis’s mind, and as her own young son has battled common colds, she’s jumped the gun a few times.

“Matthew got high temperatures when he was teething, and I’d always frantically call my friend, who’s a doctor, to make sure he had typical signs of sickness,” Lewis said. “I never considered ice baths because I was worried that that could cause the body to go into shock, so I usually just do the Tylenol thing and keep an eye on him to see if he’s acting normal.”

According to experts, she has handled the situation perfectly. But in the heat of the moment, it’s easy for fretful parents to be rash when a palm to a child’s forehead reveals warm skin. So before threatening bodily harm to the answering service receptionist if she doesn’t immediately patch you through to the vacationing pediatrician’s ski lodge, let some sound advice sink in.

The basics

“Fevers are the body’s reaction to some sort of stress,” said Dr. Jenny Tan of St. Charles Pediatrics, part of DuPage Medical Group. “As long as the temperature doesn’t get very high — if it’s a low-grade one between 99 and 101 — there’s no reason you have to necessarily treat it. It’s OK to just watch it. They’re generally due to something viral, and it tends to work through the system in five to seven days.”

Rising temperatures are a physiological strategy to wage warfare on infections, so they’re ordinarily a healthy bodily response meant to stave off further infirmity, Tan said. The brain’s “thermostat” (i.e. hypothalamus) cranks up the heat, allowing the body to fight germs by making the conditions unlivable, according to KidsHealth.org, a doctor-approved health Web site for parents.

Tan encourages parents to let a fever run its course instead of sounding the alarm the second their child’s temp inches above the normal range of 96.9 and 98.9 degrees. She said parents should call the physician only if the high digits persist after five days or are continuing to climb after three.

“Oftentimes, we get so hung up on numbers, and you don’t want to be too neurotic in that respect,” Tan added. “But you do want to be observant and see if that temp is coupled with any more alarming symptoms. It’s much more worrisome if the child also is incredibly lethargic, is acting bizarrely or suffers from hallucinations — in which case you need to seek help immediately.”

Dr. Alka Srivastava, pediatrics chair at MacNeal Hospital in Berwyn, agreed that a more global assessment is needed.

“If it’s a fever and they have a headache or stiff neck, or if it’s a fever and they’re nonverbal and highly irritable, or if it’s a fever and they’re not drinking and very flushed, or if it’s a fever and shortness of breath and diarrhea...” she said. “Your child might have the standard runny nose, coughing or vomiting with that fever, but it’s those other warning signs that can indicate something more is going on than a simple cold.”

The treatment

If it’s just a straightforward temperature, then the first line of defense is an acetaminophen like Tylenol or ibuprofen like Motrin or Advil, Srivastava said. As long as the child is exhibiting normal behavior and habits with the fever, this should decrease the higher numbers in the course of 45 minutes to an hour.

“You have to realize fever reducers are only designed to take the temperature down one or two degrees,” Tan said. “And they’re just for alleviation of the symptoms — they aren’t going to fix the underlying issue. There’s no substitute for rest and fluids.”

The most important thing is to have accurate dosages for the child’s weight and age. The rules of thumb are 10 to 15 milligrams per kilo of weight for acetaminophen and 8 to 10 milligrams per kilo for Ibuprofen, Srivastava said.

Tan recommends alternating between Tylenol, which can be taken every six hours, and Ibuprofen, which can be taken every six to eight hours, because the combination can have a “synergistic” effect. Shivering occurs as a fever is developing (because the outside air seems colder than the heat emanating from the skin) while sweating is usually a sign that it’s breaking, Srivastava said.

If the fever escalates and spikes to 103.5 or 104 degrees, parents should give the child cold fluid like ice water in a cup. It’s also a good idea to take a warm washcloth and sponge down the arms and neck, Tan said.

“You can even do a warm bath,” she added. “Just not a cold bath because shivering can actually increase body temperature. But the water evaporating on the skin can help bring it down. This is a good option if you’re dealing with a fever overnight when you have fewer options available to you.”

The equipment

The most accurate method of taking temperatures is rectally, Srivastava said. Those thermometers should come with sheaths that can be lubricated with petroleum jelly to make it less uncomfortable for small children.

“You want to have them lying on their tummy or side with the knees pulled up to the chest,” she added. “It should be inserted 3/4 of an inch to 1 inch. The vast majority of the models have sound alerts, but you should keep it in 1 to 2 minutes.”

Srivastava prefers the old mercury thermometers because digital options can give inaccurate readings as the batteries weaken. But Tan still favors digital fastreads. If the thermometer is used to take an underarm axillary temperature, she tells parents to add a degree. Older children should take it orally, under the tongue.

The exceptions

It pays to be overcautious with infants. Within the first three months of a baby’s life, their underdeveloped immune system puts them at risk during even slight fevers. So once the temperature hits 100.5 degrees, a pediatrician should be consulted, Srivastava said.

Parents should contact the doctor before using any fever reducers, which can mask other symptoms and complicate the diagnosis stage, Tan instructed.

“They’re almost like amphibians in that they can’t regulate body temperature, so they adapt depending on the environment,” she said. “So overbundling them can aggravate things. If you’re comfortable, they’re comfortable, so don’t pile on the blankets and clothing. And wait to take their temperature until they’re only wearing one layer.”

But ultimately, for the overwhelming majority of young patients, it’s about easing the discomfort for a little one who feels icky.

“Even though parents are very nervous the first few times around with fevers, they’ll get the hang of it,” Tan said. “Moms are great at gauging their children’s well-being. They should trust in their judgment more.” 

By the numbers:

- Studies show children — especially in their toddler years — will get six to seven colds a year. Other research puts the number upwards of 13, according to Dr. Jenny Tan of St. Charles Pediatrics.

- Children should stay home from school if their fever is over 100. They should be fever-free for 24 hours before returning to class.

- Wait 20 to 30 minutes after eating or drinking to take an oral temperature.

The fever is probably not serious if your child:

- Is still interested in playing

- Is eating and drinking well

- Is alert and smiling

- Has normal skin color

- Looks well when the temperature comes down

Seek emergency care if your child has a fever with any of the following symptoms:

- Inconsolable crying for several hours

- Extreme irritability

- Lethargy and difficulty waking

- Rash or purple spots that look like bruises

- Blue lips, tongue and nails

- Infant’s soft spot is bulging outward

- Stiff neck

- Severe headache

- Difficulty breathing aside from stuffy nose

- Limpness and refusal to move

- Leaning forward and drooling

- Seizure

Thermometer use:

- Electronic ear thermometers: not optimal for infants younger than 3 months because of ear canal size

- Pacifier thermometers: unreliable for young babies because of required insertion for several minutes without movement

- Forehead thermometers: alternative to ear thermometers for those younger than 1 year but not as accurate as oral or rectal digital thermometers

- Plastic strip thermometers: not good for exact temperature readings

- Younger than 3 months: digital used rectally

- Between 3 months and 4 years: digital used rectally or electronic ear used inside ear canal

- 4 years and older: digital used orally is optimal; underarm next best for kids unable to keep still because of coughing or stuffy nose that requires breathing through mouth

Sources: Interviews, KidsHealth.org

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