Robert Ferry Jr., MD, is a U.S. board-certified Pediatric Endocrinologist. After taking his baccalaureate degree from Yale College, receiving his doctoral degree and residency training in pediatrics at University of Texas Health Science Center at San Antonio (UTHSCSA), he completed fellowship training in pediatric endocrinology at The Children's Hospital of Philadelphia.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
The three goals of home care for a child with fever are to control the temperature, prevent dehydration, and monitor for serious or life-threatening illness.
The first goal is to make the child comfortable by
monitoring and reducing the fever below 102 F (38.9 C). This is achieved using
a thermometer and medications and dressing the child appropriately. A warm
water bath can also be helpful but should be used for no more than 10 minutes
each hour.
To check your child's temperature, you will need a
thermometer. Different types of thermometers are available, including glass,
mercury, digital, and tympanic (used in the ear).
Most doctors do not recommend tympanic
thermometers, because their use outside the clinic is unreliable.
Glass thermometers work well but may break, and
they take several minutes to get a reading.
Digital thermometers are inexpensive and obtain a reading in seconds.
It is best to check an infant's or toddler's temperature rectally.
Hold the child chest down across your knees.
Spread the buttocks with one hand and insert the
thermometer lubricated with a water-soluble jelly no more than 1 inch into
the rectum with the other hand.
Oral temperatures may be obtained in older children
who are not mouth breathing or have not recently consumed a hot or cold
beverage.
Acetaminophen (Children's Tylenol, Tempra) and ibuprofen (Children's Advil, Children's Motrin) are used to reduce fever.
Follow the dosage and frequency instructions
printed on the label.
Remember to continue to give the medication over
at least 24 hours or the fever will usually return.
Do not use aspirin to treat fever in children, especially for a fever with chickenpox or other viral infection.
Aspirin has been linked to liver failure in some children. Ibuprofen use has also been questioned to treat chickenpox.
Children should not be overdressed indoors, even in the winter.
Overdressing keeps the body from cooling by evaporation, radiation,
conduction, or convection.
The most practical solution is to dress the child in a single layer of clothing, then cover the child with a sheet or light blanket.
A sponge bath in warm water will help reduce a fever.
Such a bath is usually not needed but may more quickly reduce the fever.
Put the child in a few inches of warm water, and
use a sponge or washcloth to wet the skin of the body and arms and legs.
The water itself does not cool the child. The
evaporation of the water off the skin does, so do not cover the child with
wet towels (which would prevent evaporation).
Contrary to the popular folk remedy, never apply alcohol in a bath or on the skin to reduce fever. Alcohol is usually dangerous to children.
The second goal is to keep the child from becoming dehydrated. Humans lose extra water from the skin and lungs during a fever.
Encourage the child to drink clear fluids without caffeine (not water). Water does not contain the necessary electrolytes and glucose. Other
clear fluids are chicken soup, Pedialyte, and other rehydrating drinks
available at your grocery or drugstore.
Tea should not be given because it, like any
caffeine-containing product, causes you to lose water through urination and
may contribute to dehydration.
Your child should urinate light-colored urine at least every four hours if well hydrated.
The third goal is to monitor the child for signs of serious or life-threatening illness.
A good strategy is to reduce the child's temperature
to under 102 F (39.0 C).
Also, make sure the child is drinking enough clear fluids (not water, but preferably Pedialyte, clear broth, ginger ale, or Sprite).
If both these conditions are met and your child still appears ill, a more serious problem may exist.
This article addresses the often-challenging task of diagnosing and treating febrile illnesses in infants younger than 60 days and discusses appropriate testing, treatment, and disposition of these patients.
