Fever

(Excerpts from “Pediatrics” and “AAP News”) Fever in a child is one of the most common symptoms managed by pediatricians and is a frequent cause of parental concern. Fever accounts for one-third of all presenting conditions in children. Fever, however, is not the primary illness, but is a physiological mechanism that has beneficial effects in fighting infection. Fever slows the growth and reproduction of viruses and bacteria, and enhances the body’s immune response. Most fevers are of short duration, are benign and may actually be protective. Fever, in and of itself, is not known to endanger a generally healthy child; in contrast, fever actually may be of benefit. Some studies have shown that fever actually helps the body recover more quickly from viral infections. The degree of fever does not always correlate with the severity of illness. In addition, there is no evidence that fever worsens the course of an illness or that it causes long-term neurological complications.

• A normal temperature range is 97-100.4 degrees. Many parents give fever medications (Acetaminophen or Ibuprofen) even when there is minimal or no fever because they are concerned that the child must maintain a “normal” temperature. Approximately 50% of parents consider a temperature of less than 100.4 to be a fever and 25% of parents would give medication for a temperature less than 100.

• The primary goal of treating a child with a fever should be to improve the child’s comfort rather than focusing on the normalization of the body temperature. The desire to improve the overall comfort of the febrile child should be balanced against the desire to simply lower the body temperature. Parents should focus on monitoring activity, observing for signs of serious illness and maintaining appropriate fluid intake to maintain hydration. Many physicians continue to encourage the use of antipyretics, believing that most benefits result from improved comfort and the accompanying improvements in activity and feeding, less irritability, and a more reliable sense of the child’s overall clinical condition. Treating with fever medication does not prevent febrile seizures.

• Sleeping children should not be awakened to take a temperature or to give fever medications.

• Acetaminophen and ibuprofen, when used in appropriate doses, generally are regarded as safe and effective agents in most clinical situations.However, as with all drugs, they should be used judiciously to minimize the risk of adverse drug effects and toxicity. Studies provide some evidence that combination therapy may be more effective at lowering temperature. However, questions remain regarding the safety of this practice as well as the effectiveness at improving discomfort, the primary treatment endpoint. The possibility that parents will not receive or not understand dosing instructions, combined with the wide array of formulations that contain these drugs, increases the potential for inaccurate or overdosing.

• A fever can’t always be detected by feeling your infant’s forehead. It’s usually necessary to take his temperature as well. Although there are numerous thermometers on the market that measure temperature in different areas, parents should use rectal thermometers with their babies for the most accurate reading. The ‘gold standard’ measurement is still the rectal temperature.

• Fever by itself is not something to panic about. How does the child look and how are they’re acting—are they behaving normally?  Once you’ve identified a fever, you can begin treating it if needed based on your child’s age and other symptoms.  While you may instinctively want to bring your child to the doctor’s office, it may not be necessary, especially if the child seems fine once the fever is reduced.

For more information, go to “Fever Without Fear” at  http://www.healthychildren.org/English/health-issues/conditions/fever/pages/Fever-Without-Fear.aspx

Ibuprofen (for Fever and Pain) Dosage Table

Indications: Treatment of fever and pain.

Table Notes:

• AGE LIMIT: Don’t use under 6 months of age unless directed by child’s doctor. (Reason: safety not established and doesn’t have FDA approval). Avoid multi-ingredient products in children under 6 years of age (FDA recommendations 1/2008).

• DOSAGE: Determine by finding child’s weight in the top row of the dosage table.

• MEASURING the DOSAGE: Syringes and droppers are more accurate than teaspoons. If possible, use the syringe or dropper that comes with the medication. If you use a teaspoon, it should be a measuring spoon. Regular spoons are not reliable. Also, remember that 1 level teaspoon equals 5 ml and that ½ teaspoon equals 2.5 ml.

• IBUPROFEN DROPS: Ibuprofen infant drops come with a measuring syringe

• BRAND NAMES: Motrin, Advil, generic ibuprofen

• ADULT DOSAGE: 400 mg

• FREQUENCY: Repeat every 6-8 hours as needed

Acetaminophen (Tylenol) Dosage Table

Indications: Treatment of fever and pain.

Table Notes:

•  CAUTION: In May, 2011, a move to one standard concentration (160 mg/5 ml) of liquid acetaminophen medicine for infants and children was announced. Up until that time, there were mainly 2 concentrations: 80 mg/0.8 ml (Infant Concentrated Drops) and 160 mg/5 ml (Children’s Liquid Suspension or Syrup). Old concentrations (80mg/0.8 ml) of infant acetaminophen may still be available in some homes. Therefore, if it is an older product, please have the caller confirm the correct concentration of infant acetaminophen.
• AGE LIMIT: Don’t use under 12 weeks of age (Reason: fever during the first 12 weeks of life needs to be documented in a medical setting and if present, your infant needs a complete evaluation.) EXCEPTION: Fever from immunization if child is 8 weeks of age or older. Avoid multi-ingredient products in children under 6 years of age. (Reason: FDA recommendations 1/2008).

• DOSAGE: Determine by finding child’s weight in the top row of the dosage table

• MEASURING the DOSAGE: Syringes and droppers are more accurate than teaspoons. If possible, use the syringe or dropper that comes with the medicine. If not, medicine syringes are available at pharmacies. If you use a teaspoon, it should be a measuring spoon. Regular spoons are not reliable. Also, remember that 1 level teaspoon equals 5 ml and that ½ teaspoon equals 2.5 ml.

• FREQUENCY: Repeat every 4-6 hours as needed. Don’t give more than 5 times a day.

• ADULT DOSAGE: 650 mg MAXIMUM: 3,000 mg in a 24-hour period.

• BRAND NAMES: Tylenol, Feverall (suppositories), generic acetaminophen

• MELTAWAYS: Dissolvable tabs that come in 80 mg and 160 mg (jr. strength)

• SUPPOSITORIES: Acetaminophen also comes in 80, 120, 325 and 650 mg suppositories (the rectal dose is the same as the dosage given by mouth).

• EXTENDED-RELEASE: Avoid 650 mg oral products in children (Reason: they are every 8 hour extended-release)

Disclaimer: This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

How to Take a Rectal Temperature

Taking a rectal temperature is the most accurate way to measure a young child’s true body temperature. The American Academy of Pediatrics encourages parents to remove mercury thermometers from their homes to prevent accidental exposure and poisoning. Here are the steps for taking a rectal temperature:

• Use a rectal thermometer (preferably digital) that has a round bulb at the end.

• Clean the tip of the thermometer with rubbing alcohol or soap and water.

• Lubricate the tip with a water-soluble lubricant.

• Place your baby on his stomach across a firm surface or your lap. Or, if your child is more comfortable on her back, gently lift her legs and proceed to step 6.

• Stabilize your child by placing one hand on his lower back just above the buttocks. If your child is wiggling, ask someone to help you restrain him.

• Slowly insert the lubricated thermometer into the anal opening about one-half inch, stopping if you feel any resistance. Never force the thermometer.

• Gently hold the thermometer in place between your index and forefinger while keeping your hand against your baby’s bottom.

• Wait until your thermometer beeps or signals that it’s done. A reading of 100.4 degrees Fahrenheit or more is generally considered to be a fever.