Don`t Sweat It/ Fever Facts Every Parent Needs To Know

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Fever Fact
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Written by Danielle Stringer, CPNP| www.KidNurse.org
Meet the
My name is Danielle McBurnett Stringer, but I’ve been Dani
ever since I was little. I am the KidNurse.
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The name KidNurse has a double meaning for me; I am both
a nurse practitioner who takes care of kids, and arguably, I was
a kid when I first became a nurse. After graduating and
becoming a RN at the age of 17, I went back for my master’s degree
and became a pediatric nurse practitioner at the ripe ole’ age of 18.
I have been working as a pediatric nurse practitioner ever since then. Over the past
several years, I have had the privilege of caring for thousands of children and their
families. Currently, I work at a practice in Chandler, Arizona. It’s busy, and it’s
wonderful. I learn new things from my patients every day. Sharing life with young
families is absolutely the best part; laughing together, crying, watching their little ones
grow, and cheering them on for bright, healthy futures. I am so blessed by them.
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For more resources on children’s health, visit wwww.kidnurse.org.
Disclaimer: This guide is meant for educational purposes only. It does not seek to substitute personal medical
advice. If you are ever concerned about your child's medical status, contact their pediatric health provider.
ALL RIGHTS RESERVED: KID NURSE 2014
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Introduction
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If I had to pick one issue that worried parents, it would be fever. Why? Because every single
day I have spent caring for children, I answer concerned parents question’s about fevers. Out
of thousands of patients, fever remains one of the leading causes of worry and anxiety in the
parents I help. In 2002, one national study found that more than 5 million emergency room
visits were made that year alone because of children with fever (Ishimine, 2006). These visits, just
like so many that I have done, are triggered by misconceptions that are harder to "break" than
the fevers themselves! Why should you read this book? Because your child will experience
fevers time and time again, and right now, you may be managing it incorrectly. In this book you
will learn:
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How and why fevers happen
What the definition of a fever really is
The best way to take your child's temperature
When you actually need to contact a pediatric health
provider
How and when to appropriately give comfort care
and medication
This is not your grandma’s guide to fixing a fever. She was well intentioned when she made
you soak in ice cold water while you were screaming, but simply wrong. When your mom put
you on a Tylenol schedule and forced it down (hopefully your throat and not your…
nevermind), I’m sure it was done out of pure motives, but again, it was unnecessary. Let’s leave
behind what you have formally been told and experienced about fevers, learn the fever facts
that every parent needs to know, and give your feverish child the safest, best care.
Danielle Stringer, CPNP| www.KidNurse.org
The Anatomy of a Fever
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To understand the anatomy of a fever, we must first accept that the body is an incredibly
intelligent, wonderfully made piece of art.
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Now pause, read that again, and say it out loud.
It’s just crucial to understand that the body is amazing. Fevers develop in a part of the brain
called the hypothalamus. The body does not manufacture a fever to make your parenting life a
nightmare – although it is notorious for ruining vacations and date nights, creating child
meltdowns, and incredibly sleep deprived parents. It has been said that self-preservation is the
first law of nature. The hypothalamus develops a fever out of self-preservation for the body. The
body sends messages to the hypothalamus and thus a fever is born.
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Myth: All fevers are bad for children.
Fact: Fevers turn on the body's immune system and helps the body fight
infection. Fevers are one of the body's protective mechanisms. Normal fevers
between 100 and 104℉ (37.8-40℃) are actually good for sick children (AAP,
2014).
Danielle Stringer, CPNP| www.KidNurse.org
What is a Fever?
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When talking about fevers, parents usually use descriptive
words like; warm to the touch, low-grade, high-grade, burning
up? How do you know what’s what? Here is some simple
definitions that every parent should know:
Normal: The average body temperature ranges from
97.5-99.5℉ (36.4-37.5℃). The keyword here is RANGE. Body
temperature is a spectrum. You have probably heard that your
child should be 98.6℉ (37℃) exactly. This is not true. 98.6℉ is
only a common average. Many children fall above or below that
on any given day.
Warm to the touch: All of a sudden, you pick up Susie from her nap and she feels like
she is very hot and soaking in sweat. Instead of panicking, take your child's temperature. I
can't tell you how many times parents bring me their child because he or she is "warm to
the touch." There are so many factors that can make a child warm, and they
aren't always actually from fever. Living in the extreme heat of Arizona, you
can't put your child in a car seat without them becoming "warm to the touch.”
Do yourself and your pediatric health provider a favor, if your child feels warm,
take his or her temperature.
Low-Grade, Smlow-Grade: What does low-grade temperature even mean?
The term "low-grade" temperature means something different to every patient I
talk to. My advice: stop using it. Either your kid has a fever or they don't.
Simple as that. Let's stop trying to rate it and look at the bigger picture.
Fever: Fever is any temperature of 100.4℉ (38℃) or higher. Bam. Remember
that.
Hyperpyrexia: This is the type of fever that actually deserves your concern.
Hyperpyrexia is any temperature above 106℉ (41.1℃). It is usually caused by
brain damage or extreme infection (Remember our anatomy lesson? If the hypothalamus in
the brain is injured, the body can have difficulty regulating temperature.). In my career of
seeing thousands of sick children, I have never seen a child with this high of a temperature.
If your child develops a temperature of 106℉ or greater, go immediately to a emergency
department. But, let's remember, fever this high is very rare.
Danielle Stringer, CPNP| www.KidNurse.org
What Causes a Fever?
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Fever is not a disease! Fever is a just a SYMPTOM. Here’s an example: if you have allergies, a
runny nose is not the cause of problems, it’s just a symptom. The actual cause of the problem
is your body reacting to allergens and the runny nose is simply the result. It’s the same story
for fever. A fever is the result of something else! Here are some common causes:
Infection: Fever is most commonly caused by infection. Almost always, when your child gets
a fever, it is the byproduct of viruses or bacteria. Fevers can even benefit your child by
boosting the immune system! Research shows that a fever
can help decrease the growth and reproduction of bacteria
and viruses in your child (Baker, 2013). Let’s simplify this
concept even further with an analogy. If you were
surviving in the wilderness and needed drinking water,
what would you do? Now for all of you who would rather
die than try surviving in the wilderness, I understand and
agree, but back to the point. You would pray that a Boy
Scout descends from heaven, right? And what would that
Boy Scout do? He would find a stream; collect the water, and then what? That’s right – he
would boil it, thereby purifying the water from pathogens and making it drinkable. The
brain does the exact same thing when your child gets sick. The hypothalamus creates a fever
to help the immune system combat illness. It’s really not to ruin your life as a parent after
all! Voilà!
Overdressing: Occasionally, your child can develop a fever due to overdressing. If your
child has been swaddled, or is wearing heavy clothing, and you think he or she may have a
fever, dress them in lighter clothing before becoming concerned. Children’s temperature is
just like yours, so, if you are cold, dress them in more, if you are hot, they probably are too!
Immunizations: Immunizations can also cause fever in children. In fact, it is one of the
most common side effects of immunizations. This is not a reason to worry! Really, it is a sign
that your child’s immune system is working well.
Q: Does teething cause fevers in children?
A: Teething can cause a rise in body temperature. However, if your child develops
a temperature above 100.4℉ (38℃), it is much more likely that your child has an
infection. Danielle Stringer, CPNP| www.KidNurse.org
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Taking
Your Child’s Temperature
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When it comes to taking your child's temperature, keep this in mind.
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Myth: The exact number of the temperature is very important.
Fact: How your child looks is what's important, not the exact temperature (AAP,
2014).
Have you ever been confused about how to take your child's
temperature? They feel warm and fussy, so you go to your
pharmacy and find that they have 15 different thermometers
available! A search on Amazon for thermometers yields over
3,000 results. What's a mom to do? How do you know what will
be most accurate for your child?
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Here are 3 solid methods for taking your child's temperature.
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The Gold Standard - Rectal Thermometers: You know what I'm going to say, because your
mother or grandmother probably did this to you. Yes, digital rectal thermometers are still
the gold standard for measuring temperature, especially if your child is 12 months or
younger. In fact, no matter what your child's age is, rectal thermometers are extremely
accurate! So let's stop being hesitant about doing it! If your child is 12 months or younger,
skip the fancy, expensive thermometers and go straight to what will accurately work!
Accuracy is important. Rectal temperatures cause minimal discomfort and best results.
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Here is how:
Lubricate digital rectal thermometer
(Vaseline works well).
Place your child in one of the positions
pictured on the right.
Insert rectal thermometer 1/2-1 inch,
approximately the length of the top part of
your pinky finger. Stop if you feel resistance.
Remove thermometer after you hear the
appropriate amount of beeps and write down the reading.
5. Clean thermometer with warm soapy water or cleaning alcohol.
Danielle Stringer, CPNP| www.KidNurse.org
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Tympanic Thermometers: If compliance with rectal
thermometers is an issue for you, tympanic (in the ear)
thermometers could be a good solution for you. Due to the
small size of the ear canal, tympanic thermometers should not
be used in infants younger than 6 months. Remember though,
rectal thermometers are still more accurate, so I prefer using
them in children at least up to 12 months. I think tympanic
thermometers are ideal for children 12 months to 4 years of age.
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Oral Thermometer: Taking temperatures orally can be accurate, but only in older children.
Toddlers are not coordinated enough to keep a thermometer in the back of their mouth,
under their tongue until the reading is given. Typically, digital oral thermometers can be
used for child 4 or 5 years and older.
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Thermometers to avoid:
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Auxiliary thermometers (under the arm)
Forehead (or temporal) thermometers
Pacifier thermometers
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Glass mercury thermometers
All of these methods are not as accurate and not worth your time or money. Older glass
thermometers can contain mercury, which is a health hazard your child and you and should be
disposed of properly.
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Lastly, have you ever heard of changing the temperature reading based off of the method you
used? For example, lowering rectal readings by 1℉ but raising auxiliary readings by 2℉? Let’s
leave the addition and subtraction to the first graders. If you use one of the three methods I
recommended, you don't need to add or subtract to the temperature reading. Simply tell your
pediatric health provider what the temperature was and how you took it.
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Danielle Stringer, CPNP| www.KidNurse.org
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!When To Take
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Action
The simple fact is, many of my parents act too quickly and immediately worry when it comes to
their child having a fever. They take action too fast because they don't know this fact:
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Myth: Fevers above 104℉ (40℃) are dangerous and can cause brain damage.
Fact: Fevers with infections don't cause brain damage. Only body temperatures
above 108℉ (42℃) can cause brain damage. The body temperature climbs this high
only with extreme environmental temperatures (for example, if a child is confined to
a closed car in hot weather) (AAP, 2014).
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So, when do you need to be concerned about your child's fever? As my patient's ask all the
time, what's the magic number when something should be done?
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I hate to break it to you, but unless your child is under 3 months old, there really isn't any
magic number. Children over the age of 3 months regularly get high temperatures that are
perfectly normal. Time for another fever fact!
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Myth: If the fever is high, the cause is serious.
Fact: If the fever is high,the cause may or may not be serious. If your child looks
very sick, the cause is more likely to be serious (AAP, 2014).
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With that in mind, what does a very sick child look like? Here are some general guidelines of
when your feverish child should be evaluated by your pediatric provider immediately.
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Difficulty breathing (rapid breathing, fatigue from breathing, extra chest
movement, blue lips/nails, leaning forward and drooling)
Inconsolable crying
Excessive fatigue, difficulty waking, or limpness
Seizure
If your child is 3 months or younger and develops fever (rectal temperature of 100.4℉/
38℃ or higher), take them to their pediatric health provider immediately. For this age
group, that's the magic number. It's very simple. Infants under 3 months have delicate
immune systems, and it is very important to have them evaluated should any fever occur.
Danielle Stringer, CPNP| www.KidNurse.org
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In the past, for children older than 3 months, treatment for fever was simply based on
whether a child had a temperature or not. Now, we evaluate for both the presence of fever
and the overall health of your child. Here are some simple questions to help you evaluate
your child's overall heath:
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Is your child showing signs of
dehydration? (limited urination, no
tears while crying, no saliva in
mouth, child refusing to drink fluid)
Does your child complain of specific
pain? (Painful urination, earache, sore
throat, etc.)
Does your child have a rash?
Does your child have a chronic
health condition? (Asthma, diabetes,
heart disease, etc.)
If the answer to any of those questions is yes, it is time to see your pediatric health provider.
However, what if you answered no to all of those questions and your feverish child is still
relatively a happy camper? I'm so glad you asked!
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Don't sweat it!
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For children under 2 years, go to your pediatric health
provider after 2 days of fever.
For child over 2 years of age, go to your pediatric health
provider after 3 days of fever.
Danielle Stringer, CPNP| www.KidNurse.org
Comfort Care
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Now that we know what to watch for while your child has a fever, what do you do during the
mean time?
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Let's start with what we don't do. This is going to seem
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revolutionary, but stay with me. We don't break fevers!
I hesitate to even use the word "treatment" when talking
about fevers because both of those words insinuate that we
are going to make it go away. Wrong! Remember, normal
fevers can boost the immune system and can actually be
good for sick kids!
Myth: All fevers need to be treated with fever medicine.
Fact: Fevers only need to be treated if they cause discomfort. Usually fevers don't
cause any discomfort until they go above 102 or 103℉ (39-39.5℃) (AAP, 2014).
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So before you reach for that bottle of medication, remember our keyword here: COMFORT.
What's the take-away?
Don't give happy feverish children medicine. They
are happy. What’s the problem? They don't need it.
Don't give resting feverish children medicine. They
are resting. Thank goodness. Sick children need
extra rest and sleep. Skip medicating, let them read
a book on the couch and go finish the laundry
you've been putting off.
Whatever you do, please, please, please do NOT
wake up sleeping feverish children to give medicine.
One study found that as many as 85% of parents would wake up their sleeping child to give
medications (Crocetti, 2001)! They are sleeping. Carry on, little sleepers! I'm sure you need
the sleep as much as they do, so put away the medicine, make sure they are breathing okay
and go back to bed!
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Danielle Stringer, CPNP| www.KidNurse.org
By following through with these recommendations you will avoid giving medication that your
child doesn't need and let the fever do its job and naturally fight infection! It's time to change
our mindset and start thinking of fever as the good guy, not your worst enemy.
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However, if your child is obviously uncomfortable, here's the facts that you absolutely need
to know before medicating your child with a fever.
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Myth: With treatment, fevers should comedown to normal.
Fact: With treatment, fevers usually come down 2-3℉ (1-1.5℃) (AAP, 2014).
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Myth: If the fever doesn't come down (if you can't "break the fever"), the cause is
serious.
Fact: Fevers that don't respond to fever medicine can be caused by viruses or
bacteria. It doesn't relate to the seriousness of the infection (AAP, 2014).
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Myth: Once the fever comes down with medicines, it should stay down.
Fact: The fever will normally last for 2 or 3 days with most viral infections.
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Therefore, when the fever medicine wears off, the fever will return and need to be
treated again. The fever will go away and not return once your child's body
overpowers the virus (usually by the fourth day) (AAP, 2014).
My Favorite Comfort Measures:
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Cuddles: Impossible to overdose on them, 100% safe and completely effective.
Increasing fluids: It is common for children to have a decreased appetite when feverish, and
while it is not important to force food, children must keep consistently drinking fluid. Fight
dehydration and keep those little ones drinking!
Increasing rest: So important for them, such a blessing for you. That's what I call a win-win.
Lukewarm Baths: If you would like to give your children a bath, then do so. You do not need
to bathe children with a fever any differently than children without one. Baths are only
given for comfort; sometimes it can reduce fever, but it is not proven to consistently do so.
The key is keeping the water temperature lukewarm. Do NOT put your children in cold
water! This can often cause the fever to rise and induce chills. Also, do NOT sponge
children with alcohol. This antiquated measure of fever reduction is dangerous and can
cause poisoning.
Danielle Stringer, CPNP| www.KidNurse.org
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Medications
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The group of medications used for reducing fevers are called antipyretics. Antipyretics that can
be used for children include Tylenol (Acetaminophen) and Motrin (Ibuprofen, Advil).
Following the dosing guidelines is extremely important for these medications. Dosing charts
for Tylenol and Motrin have been included in this book for your convenience.
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Tylenol (Acetaminophen)
Tylenol should not be given to infants under the age of 3 months.
Tylenol cannot be given more than every 4 hours.
Do NOT give more than 5 doses of Tylenol in 24 hours.
Many medication products include Acetaminophen. It is important to read
ingredient labels and give your children medication that
exclusively has Acetaminophen in it and not other products.
Motrin (Ibuprofen, Advil)
Motrin cannot be given to infants under the age of 6 months.
Motrin cannot be given more than every 6 hours. Almost 50% of caregivers
give this medication too frequently (Crocetti, 2001)! That is very dangerous!
Do NOT give more than 4 doses of Motrin in 24 hours.
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One of the leading causes of overdosing medication in children is parents who "alternate"
both Tylenol and Motrin. We must STOP alternating! Pick one or the other. Usually parents
alternate these medications in an attempt to make the fever go away completely, but that
shouldn't be our goal! Remember the goal is comfort. Comfort should be achievable with one
medication, and if it's not, than your child needs to be seen by a
pediatric health provider.
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Aspirin Warning!
Aspirin CANNOT be given to child at ANY age!
"Baby Aspirin" is one of the most misleading
products available. Aspirin is only for adults and when given to
children it can cause a rare but serious disease known as Reye's
Syndrome. Danielle Stringer, CPNP| www.KidNurse.org
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!Tylenol
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Dosage Instructions
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Danielle Stringer, CPNP| www.KidNurse.org
!Motrin
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Dosage Instructions
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Danielle Stringer, CPNP| www.KidNurse.org
I hope this guide on fevers has helped
you put away former misconceptions and
fears regarding fever and empowered you
to knowledgeably help your child when
fever strikes. Now you know how to
appropriately take your child's
temperature, avoid unnecessary
medication, provide proven comfort
measures, and know when you should
contact your pediatric health provider.
So, don't sweat it! Fevers will happen
time and time again as your little one
grows, but from now on, you will be
ready!
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Much Love,