Kids get fevers all the time, but a fever can be a frightening experience for a parent. Controversy surrounding the management and treatment of fevers only confuse parents, leaving them not completely sure of what to do.

Understanding why fevers occur is the first step in fever management in kids. Taking an accurate temperature, knowing what it means, and having the knowledge about how to treat it can prevent the uncertainty and anxiety many parents feel when their child has a fever.

How a Fever Works

A minor fever is the body’s response to illness. It is the body’s attempt to fight infection. White blood cells increase in response to a fever. The job of white blood cells is to kill infected cells.

Obviously there can be a lot more involved in the explanation of fever. For our purposes here however, this explanation will suffice.

Some medical professionals believe that suppressing a fever will stop the body’s ability to fight infection. Current research demonstrates the fact that outcomes are improved when a fever is allowed to run its course. As frightening as this may be for a parent, it only makes sense that allowing a fever to continue without suppressing it allows white cells to do their job, which means the white cells can finish fighting the infection and prevent further illness. Suppressing or stopping the fever will decrease the number of white cells, allowing the infection to continue or get worse.

Normal Temperature

Health care professionals have different opinions about what defines a normal temperature. Many factors influence what your child’s temperature will be. Temperatures vary according to the time of day, what your child is wearing, environment, activity, method of taking the temperature and many other factors.

Generally speaking, an oral (by mouth) temperature ranges from 97 degrees to 99.5 degrees. A rectal (anal, in the bottom) temperature will usually be 1 degree higher than an oral temperature. If your child has an oral temperature of 99 degrees, his rectal temperature will most likely be 100 degrees.

Choosing a Thermometer

There are a wide variety of thermometers on the market. Each varies in price, ease of use, ease of readability, accuracy and how quickly they take a temperature. Listed below are the pros and cons of the most commonly used thermometers.

Mercury Thermometers

• Glass can break
• Mercury is toxic
• Takes longer than most other types of thermometers
• Can be hard to read
• Are the least expensive ~$3-$5

Digital Thermometers

• Are quick
• Very accurate
• Cost about $10
• Easy to read

Tympanic (ear) Thermometers

• Not always accurate due to ear wax, ear infection, child’s age or improper placement
• Can be expensive ~$60
• Very quick
• Easy to read

Forehead Strips

• Not reliable in measurement but can identify a fever
• Inexpensive
• Good for quick check away from home

Regardless of the type of thermometer you decide to use, reading the instructions and taking the temperature according to the manufacturers advice will provide you with the most accurate reading. It’s not always important to know the exact degree a temperature is. It becomes important when a fever rises to extreme levels.

How to Take a Temperature

There are a few methods you can use to take your child’s temperature. Generally speaking, the method of choice should be age appropriate. Whichever method you use, be sure you take the temperature correctly to get an accurate reading.

• Newborn to 3 months. Axillary (under the arm or in the armpit) temperatures are appropriate for this age. If your child’s temperature is over 99 degrees after taking it under the arm, take it rectally.
• 3 months to 4 years. It is usually recommended to take the temperature by ear or rectum in this age group. Young children have a hard time holding a thermometer in their mouth at this age.
• 5 years and older. Usually by this age children can comfortably hold a thermometer in their mouth. Once they are able to do this, oral temperatures are preferable.

Taking an Axillary Temperature

Axillary temperatures are not as accurate as oral or rectal temperatures. There are times, however, when it is acceptable and necessary to take an axillary temperature.

1. If using a digital thermometer, turn it on. If using a glass thermometer shake it down until the mercury is below 96 degrees.
2. Place the thermometer snuggly in the center of the armpit. Be sure the skin is free and clear of clothing.
3. Gently place the child’s arm across the chest and hold in position until the thermometer beeps.

Taking an Oral Temperature

Oral temperatures are the preferred method for children who are able to hold a thermometer in their mouth. Never take a temperature right after a bath. Wait at least fifteen minutes after the child has had liquids to drink before taking an oral temperature.

1. Sit your child comfortably in your lap. Never leave a child alone while taking his temperature.
2. Place the thermometer under the child’s tongue and have him close his lips around it.
3. Sometimes it is difficult for a child to control his bite when taking an oral temperature. If the child continually bites down on the thermometer, a rectal temperature may be more appropriate.
4. Wait for the thermometer to beep and note the temperature.

Taking a Tympanic (Ear) Temperature

1. Hold the child comfortably in your lap.
2. Gently pull the ear back and then down.
3. Place the tympanic thermometer in the ear opening and push the “on” button.
4. Be sure to follow the manufacturer’s instructions.

Taking a Rectal (in the bottom) Temperature

1. A rectal temperature can be taken in a few different positions. Lying the child on his back, holding the child against you (if you have a second person to help), or putting them in a knee to chest position with face down all work well. Infants do well lying across the mothers lap. Many times, depending on the age of the child, a second person will be needed to help take the temperature because kids hate to have their little bottoms messed with, especially when they don’t feel well.
2. Lubricate the thermometer with KY Jelly or any water soluble lubricant. Put about an inch of jelly (from the tip to about an inch up) on the thermometer.
3. Insert the thermometer in the rectum (anus) about a half to one inch.
4. Never let go of a thermometer that is in your child’s rectum.
5. Hold your child firmly.
6. Remove the thermometer gently when it beeps.

How to Treat a Fever

Even in this day of modern technology and research there remains much controversy and debate about the best way to treat fevers. Listed below are Do’s and Don’ts when considering the best method of treating a fever. Keep in mind that the purpose of treating a fever is to decrease the child’s discomfort, not the fever.

• Do dress your child in lightweight clothing. This helps with evaporation and helps heat escape more easily as the child sweats with increased body temperature.
• Do offer plenty of liquids at frequent intervals. If your child has nausea, liquids given by the teaspoon can still make a difference. Give them frequently and give them what they want.
• Do encourage your child to rest.
• Do give a lukewarm (NOT cold) bath only if it makes your child feel more comfortable. There is no evidence that supports sponging, however it may help your child feel better. If they show displeasure or cry during the sponging, forgo it.
• Do cover your child with a blanket if they are chilling or cold. Be sure to remove the blanket once the chilling has stopped.
• Do consider medication to make your child more comfortable if he is fussy. Always follow the label directions. Ibuprofen or acetaminophens are the medicines most usually recommended by health professionals. Keep in mind that the giving of medicine to reduce a fever can decrease your own anxiety, but should only be given to make your child more comfortable. There is some evidence that fever medications can actually prolong an illness and mask symptoms.
• Do give lots of TLC. It’s okay to spoil your child when they don’t feel well.
• Do Not give your child aspirin. Aspirin has been known to cause Reye’s syndrome in children.
• Do Not wipe the child down with alcohol.
• Do Not push foods. If your child wants to eat, by all means let them, but fluids are the necessary nutrient when your child has a fever.
• Do Not try to “sweat the fever out.” This practice is a myth and can only complicate things and make your child more uncomfortable.

When to Call the Doctor

Generally, you can wait two or three days with older children with mild illnesses. Although parents worry about fevers, most children tolerate them fairly well. If your child is responding normally and drinking fluids, there is probably nothing to worry about. Remember, fever actually helps the body fight infections. There are, however, some signs and symptoms that warrant a call to your doctor. Call your doctor if any of the following occur:

• A temperature of over 100.5 rectally in an infant less than 3 months old
• Complaints of severe pain
• Signs of dehydration (sunken soft spot on the head, dry mouth and lips, decreased urination)
• Difficulty breathing
• A temperature over 102 for more than 24 hours in a child 3 months to 2 years
• A temperature over 102 degrees for more than 3 days in a child over the age of 2 years
• Changes in behavior
• Constant vomiting or diarrhea
• Earache or pulling at the ears
• Complaints or signs of a severe sore throat
• Complaints of abdominal pain
• Listlessness, whimpering, or unresponsiveness
• Complaints or signs of a stiff neck
• Complaints of a severe headache
• High-pitched crying in an infant
• Child cries and cries -- you can not comfort them
• Red rash or blue/purple dots
• The child is not getting better or does not look good
• Seizure

Febrile Seizures

Although a febrile seizure can be one of the most frightening things a parent will see happen to their child, most febrile seizures are benign. A small percentage of children with fevers have seizures. If your child has a seizure do the following:

• Stay calm! This can be hard to do if watching a seizure for the first time, but your demeanor will affect how your child responds after the seizure has ended.
• Although seemingly impossible, try to time the seizure. Be sure to look at your watch. The length of a seizure can seem much longer than it really is.
• Turn the child on his side to prevent gagging and aspiration of secretions.
• Do not insert anything into his mouth during the seizure (such as your fingers, a bite stick, etc.).
• Remove objects that he may hit while having the seizure.
• Don’t restrain your child. Let the seizure progress until it finishes.
• After the seizure, comfort and reassure your child.
• Call your doctor

Knowing how to manage your child’s fever can be comforting to your child and reassuring to you as you wait for the fever process to end. You will be providing the best possible care to your child by having an accurate knowledge of fevers, why they happen, how to treat them and when to call the doctor.