Fever in Children

Facts on Fever in Children

Picture of a child with fever and high temperature
Picture of a child with fever and high temperature

Fever remains the most common concern prompting parents to present their child to the emergency department. Fever has traditionally been defined as a rectal temperature over 100.4 F or 38 C. Temperatures measured at other body sites are usually lower. The threshold for defining a fever does vary significantly among different individuals since body temperatures can vary by as much as 1 F. Low-grade fevers are usually considered less than 102.2 F (39 C).

When Should You Be Worry About a Fever?

Fever itself is not life-threatening unless it is extremely and persistently high, such as greater than 107 F (41.6 C) when measured rectally. Risk factors for worrisome fevers include age under 2 years (infants and toddlers) or recurrent fevers lasting more than one week. Fever may indicate the presence of a serious illness, but usually, a fever is caused by a common infection, most of which are not serious. The part of the brain called the hypothalamus controls body temperature. The hypothalamus increases the body's temperature as a way to fight the infection. However, many conditions other than infections may cause a fever.

What Causes Fever in Children?

Causes of fever in Children include


Which illness is known as a viral upper respiratory tract infection? See Answer

What Are the Symptoms of Fever in Children?

Signs and symptoms of a fever may be obvious or subtle. The younger the child, the more subtle the symptoms.

  • Infants may
    • be irritable,
    • be fussy,
    • be lethargic,
    • be quiet,
    • feel warm or hot,
    • not feed normally,
    • cry,
    • breathe rapidly,
    • exhibit changes in sleeping or eating habits,
    • have seizures.
  • Verbal children may complain of
    • feeling hotter or colder than others in the room who feel comfortable,
    • body aches,
    • a headache,
    • sleeping more or having difficulty sleeping,
    • poor appetite.

When to See a Doctor for Fever in a Child

Call a child's doctor if any of the following are present with fever.

  • The child is younger than 6 months of age (regardless of prematurity).
  • One is unable to control the fever.
  • One suspects a child may become dehydrated from vomiting, diarrhea, or not drinking (for example, the child has sunken eyes, dry diapers, tented skin, cannot be roused, etc.).
  • The child has been to a doctor but is now getting worse or new symptoms or signs have developed.

Although you may have done your best to care for your child, sometimes it is smart to take your child to the emergency department. The child's doctor may meet you there, or the child may be evaluated and treated by the emergency doctor.

Take a child to an emergency clinic when any of the following happen:

  • One has serious concerns and is unable to contact the child's doctor.
  • One suspects the child is dehydrated.
  • A seizure occurs.
  • The child has a purple or red rash.
  • A change in consciousness occurs.
  • The child's breathing is shallow, rapid, or difficult.
  • The child is younger than 2 months of age.
  • The child has a headache that will not go away.
  • The child continues to vomit.
  • The child has complex medical problems or takes prescription medications on a chronic basis (for example, medications prescribed for more than two weeks' duration).

Diagnosis of Fever in Children

After arriving in the clinic or emergency department, a nurse will determine how quickly the child needs to be seen by a doctor. The nurse is usually very experienced and will bring the child immediately into the emergency room if a life-threatening condition appears to be present. Otherwise, the nurse will place the child in line to be seen ahead of people less ill but after those people appearing most ill.

The doctor will evaluate a child by obtaining a history from you and, if possible, the child. The doctor will then perform a physical examination and may order tests.

  • A chest radiograph (X-ray) can be useful for diagnosing some conditions in the chest, lungs, or heart (including some, but not all, pneumonias). The doctor usually will order two views to be taken, one sideways and one from front to back. The doctor may request this test if a child displays cough, chest pain, or shortness of breath.
  • A complete blood count, electrolytes, and cultures are taken from a blood sample.
    • It is much more difficult to find and enter the small veins in children. It may take more than one attempt to draw a child's blood.
    • A complete blood count (CBC) is useful for diagnosing bacterial blood infections in very young children. The CBC may suggest whether an infection is bacterial or viral and can be useful in determining whether the child's immune system is working properly.
    • Electrolytes levels in the blood are useful for evaluating dehydration and whether certain electrolytes need replacement or other therapies. For example, a high blood sugar may suggest treatment with insulin.
    • Samples of blood can assess if bacteria are present in the bloodstream. Blood culture results may take 24 hours and usually are complete in 72 hours. You will be notified if the blood culture test is abnormal.
  • Urine may be obtained for a urinalysis and urine culture. A child may be asked to urinate into a sterile cup, or a bag may be placed over a child's genital area to catch urine, or a catheter (which is a small tube) may be inserted into the urinary opening (the urethra) to enter the bladder and collect urine.
    • Urinalysis is useful to look for infections of the urinary tract and may be helpful for evaluating dehydration.
    • Urine culture helps to assess if bacteria are present in the urine. Results from a urine culture may take 24-72 hours. You will be called if urine culture results are abnormal.
  • A lumbar puncture (also called a spinal tap) is a procedure that uses a small needle to remove a sample of the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord. This test may be done if meningitis is suspected.
    • A doctor will have you sign a consent form for this procedure. The doctor will review the potential complications of the procedure.
    • Lumbar puncture is a very safe procedure with extremely rare complications in children.
    • A child either lies on his or her side or sits up, and a needle is inserted between the backbones into the space that contains fluid that flows around the spinal cord and also the brain.
    • The fluid is sent to the laboratory, where specialists use a microscope to check for bacteria in the CSF.
    • A machine analyzes the fluid for the presence of red and white blood cells, glucose, and protein.
    • Results for the spinal fluid culture may take 24-72 hours. You will be notified if CSF culture results are abnormal.
    • The lumbar puncture is most often performed to check for meningitis, which is an infection of the brain or its surrounding tissues.
      • Signs and symptoms of meningitis may include headache, stiff neck, sensitivity to light, nausea and vomiting, or altered mental status.
      • If a doctor suspects this condition, it is very important that this test be performed.
      • Without treatment, meningitis can cause permanent disability or death in just a few hours.

What Are the Home Remedies for Fever in Children?

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 reducing the fever below 102 F (38.9 C) with medications and appropriately dressing the child. A warm water bath can also be helpful but should be used for no more than 10 minutes each hour.
    • To check a child's temperature, one 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.
    • Monitoring and documenting the fever pattern is achieved using a thermometer and a handmade chart.
    • 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 cools the child. 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 but without caffeine (and not water). Water does not contain the necessary electrolytes and glucose. Other clear fluids are chicken soup, Pedialyte, and other rehydrating drinks available at the grocery or drugstore.
    • Tea should not be given because it, like any caffeine-containing product, causes one to lose water through urination and may contribute to dehydration.
    • A child should urinate light-colored urine at least every four hours if well hydrated.
    • If diarrhea or vomiting prevents one from assessing hydration, seek medical attention.
  • 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 below 102 F (39 C).
    • Also, make sure the child is drinking enough clear fluids (not water), preferably Pedialyte, clear broth, ginger ale, or Sprite.
    • If both these conditions are met and the child still appears ill, a more serious problem may exist.
    • If a child refuses to drink or has a concerning change in appearance or behavior, seek medical attention.

What Is the Treatment for Fever in Children?

A doctor may or may not be able to tell the exact cause of a child's fever.

  • Viral infections of the respiratory system are the most common cause of a fever. Antibiotics do not cure or help with viral infections and increase the chance of drug reactions and potentially other problems.
    • If a doctor diagnoses a bacterial infection, the child will be started on antibiotics.
      • Urinary tract infections, ear infections, throat infections, sinus infections, skin infections, gastrointestinal infections, and pneumonia may be treated with antibiotics at home.
      • The child may receive oral antibiotics, a shot, or both.
    • Children suspected to have bacterial meningitis are always admitted to the hospital.
  • Additionally, a doctor may recommend giving acetaminophen (Tylenol) or ibuprofen (Advil) for fever.
  • Dehydration may be treated by giving oral fluids or intravenous (IV) fluids.
    • If a child is vomiting, a drug to control nausea may be given by injection or by rectal suppository.
    • After a period of time, oral fluids will be attempted.
  • If the child's condition improves after reducing the fever, treating dehydration, and once serious bacterial infections have been ruled out, a doctor will likely discharge the child from the emergency department for further care and monitoring at home.

What Is the Follow-up for Fever in Children?

Usually, the emergency department doctor will ask that, within the next 24-48 hours, one contact or see a child's regular doctor or return to the emergency department.

  • A child's condition can be further observed at home or in the clinical area.
  • Any treatment prescribed by the doctor in the emergency department should be monitored for effectiveness.
  • One should receive information about any tests and cultures performed for your child and follow-up instructions if necessary.


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How Do I Prevent Fever in Children?

Prevention of many illnesses that cause fever revolves around personal and household hygiene. Use these strategies to prevent the spread of viruses and bacteria:

  • Wash hands with soap and water.
  • Cover the mouth and nose when sneezing and coughing.
  • Handle food with clean hands.
  • Properly immunize a child (see the pediatric immunization schedule).
  • Eat a healthy diet including fruits and vegetables.
  • Get the proper amount of sleep.

What Is the Prognosis for Fever in Children?

The prognosis for a child with a fever is excellent.

  • Most illnesses that cause fever last three to seven days.
  • Sometimes, treatment of bacterial infections fails at home, and a child will need to be hospitalized.
  • Meningitis and bacterial blood infections have a much more serious prognosis than the far more common viral infections.

Health Solutions From Our Sponsors

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