Childhood fevers are common — as every parent or caregiver knows all too well. But which fevers should you worry about? When should you call your pediatric provider? What are the best treatments? Find the answers to your biggest fever-related questions here. So keep reading to help both you and your child feel better ASAP.
How high does the temperature have to be for it to be considered a fever?
If your child has a temperature of 100.4F (38C) or higher, they have a fever. Fever happens when the body’s internal “thermostat” raises body temperature above normal.
It might seem obvious, but if you suspect your child has a fever, take their temperature with a thermometer. Feeling their forehead or other parts of the body is not accurate, especially if they’re having chills. While other symptoms and how they are acting are important clues, your child’s healthcare provider will want to know an accurate temperature when considering what medical advice to give you.
A child’s normal temperature can vary depending on age and activity level. Body temperature is highest in the late afternoon and early evening, for example, and lowest at night and early morning. Infants tend to have higher temperatures than older children. In older children, an oral temperature is the most accurate. Any oral temperature over 100 is considered a fever. According to the American Academy of Pediatrics, parents of babies should use rectal thermometers for the most accurate reading. Generally, in infants and babies, a rectal reading of above 100.4 degrees Fahrenheit (38 degrees Celsius) is considered a fever. It’s also okay to use a digital ear or forehead thermometer on older babies and children. Keep in mind they can have more user errors, so you may want a basic backup at home as well. Use 100.4 as a cut-off for fever with an ear or forehead thermometer.
When should you call your child’s healthcare provider about a fever?
The American Academy of Pediatrics (AAP) advises caregivers to call a healthcare provider any time their child has a fever and:
- Looks very ill, is unusually drowsy, very fussy, or is not eating or drinking
- Has been in a very hot place, such as an overheated car
- Other symptoms include a stiff neck, severe headache, sore throat, severe ear pain, unexplained rash, or repeated vomiting or diarrhea
- Has immune system problems, such as sickle cell disease or cancer, or is taking steroids
- Has had a seizure
- Is younger than three months (12 weeks) and has a temperature of 100.4°F (38.0°C) or higher even without any other symptoms
- Is having trouble breathing or breathing more forcefully or quickly than normal.
- The fever rises above 104°F (40°C) repeatedly for a child of any age.
- Still “acts sick” even after their fever is brought down with medication (see below)
- Your child seems to be getting worse.
- The fever persists for more than 24 hours in a child younger than two years.
- The fever lasts for two to three days (even a low-grade fever) in a child older than three years.
You should also check in with your child’s provider if you gave your child acetaminophen or ibuprofen (see fever medicines section below) to lower their fever, but their temperature did not return to normal (98.6F or below).
It is not always necessary for a child with a fever to see their provider.
How to help your child with a fever feel better.
Sometimes children with fevers don’t drink as much as they should and can become dehydrated. Running a fever and sweating cause dehydration. If you notice that your infant has fewer wet diapers than normal or your older child is going to the bathroom less frequently or has darker yellow-colored urine, give your pediatrician a call. Keeping your child well-hydrated is an important part of feeling better.
And there are plenty of comfort measures you can offer your child with a fever.
- If your child won’t drink, try having them slurp frozen juice pops.
- Try a lukewarm sponge bath if they are hot and sweaty. The water should still feel warm, not cold — 85-90 degrees if you have a bath thermometer.
- Dress them in lightweight, breathable clothing (cotton, for example).
- Cover them with light sheets or cotton blankets. Layers will help them stay comfortable depending on if they are hot or have chills.
- Encourage them to rest and take it easy.
- Try a cool compress (like a wet face cloth chilled in the refrigerator) on the back of their neck or forehead.
- Keep room temperatures at their norm and run a fan if it’s hot or stuffy inside
- Drinks or popsicles with electrolytes can be helpful for older feverish children (if your child is under 1 do not give electrolytes or large amounts of water without consulting your provider, breastmilk or formula is usually all you need)
It is a good sign if your child plays and interacts with you after any of these fever-busters- that means they are feeling more like themselves.
When should I give my child medicine to treat their fever?
Sometimes, your child may still not feel better even after all of the tried-and-true fever comfort measures listed above. You can try giving them some over-the-counter medication to lower their fever. Acetaminophen (Children’s Tylenol) and ibuprofen (Children’s Motrin) reduce fevers. Both are available in infant and child formulations. Check the label or call your pediatrician for the correct dosage for your child. There are two critical cautions for over-the-counter fever relievers:
- Ibuprofen is not safe for infants under six months of age.
- Do not give aspirin to children 18 or younger.
If your child is acting fine and drinking, let the fever run its course. This will help your child’s body do its job and fight off the illness. If your child vomits the medication, going back to the basics above — especially sponging in a bath — can be helpful.
Can fevers cause children to have seizures?
Yes, but fortunately, not often. Febrile seizures are most common in 12-18 month-olds but can happen in any child under 5. They tend to happen with higher fevers, but can even happen during a less severe fever. Only two to four out of 100 children with a fever will have febrile seizures.
A seizure is an uncontrollable convulsion or jerking of the arms and legs. Sometimes children’s eyes will roll back, briefly lose consciousness, or their limbs will become stiff. Febrile seizures tend to run in families. Fevers from common childhood infections like the flu, strep throat, and ear infections can cause febrile seizures. Children are not diagnosed with a seizure disorder such as epilepsy if they have a febrile seizure.
If you think your child is having a febrile seizure, take the following steps to keep them safe:
- Note the start time of the seizure. If the seizure lasts longer than five minutes, call an ambulance. Take your child immediately to the nearest medical facility to be evaluated.
- Call an ambulance if the seizure is less than five minutes, but your child does not seem to be recovering quickly.
- Gradually place your child on a protected surface, such as the floor or ground, to prevent accidental injury. Do not restrain or hold them down during a convulsion.
- Position your child on their side or stomach to prevent choking. When possible, gently remove any objects from their mouth. Don’t put anything in their mouth during a seizure.
- Seek immediate medical attention if this is your child’s first febrile seizure. Call your child’s healthcare provider once the seizure has ended to check for the cause of the fever. Also, seek emergency medical attention if your child has a febrile seizure with a stiff neck, is very weak, or is frequently vomiting – they can be signs of meningitis, a life-threatening brain infection.
Although they may seem to last forever, febrile seizures typically only last a minute or two. The vast majority of febrile seizures do not cause any long-term damage.
Trust your parental instincts.
While reading about the possibility of febrile seizures may cause some anxiety, remember that most fevers are nothing to worry about and pass in a day or two. In addition, it is normal for children to get several viruses or infections a year, and running a fever is their body’s way of killing the virus or bacteria. Most importantly, though, remember that you know your child better than anyone else does. Always trust your parenting instincts. If you feel something isn’t right with your child, call their healthcare provider to discuss their fever and any other symptoms they might have.
Sources
“Febrile Seizures Fact Sheet.” National Institutes of Health. National Institute of Neurological Disorders and Stroke. June 16, 2021. https://www.ninds.nih.gov/febrile-seizures-fact-sheet
“Fever and your baby.” Healthychildren.org. American Academy of Pediatrics. July 19, 2021. https://www.healthychildren.org/English/health-issues/conditions/fever/Pages/Fever-and-Your-Baby.aspx
“Fevers in babies and children: When to Worry.” Cleveland Clinic. Cleveland Clinic. September 27, 2022. https://health.clevelandclinic.org/kids-fevers-when-to-worry-when-to-relax/
“Fever in children: How can you reduce a child’s fever?” InformedHealth.org. Institute for Quality and Efficiency in Health Care. June 6, 2019. https://www.ncbi.nlm.nih.gov/books/NBK279453/
McCarthy C. “When to worry about your child’s fever.” Harvard Health Publishing. Harvard Health Publishing. June 1, 2020. https://www.health.harvard.edu/blog/worry-childs-fever-2017072512157
“When to call the pediatrician: Fever”. Healthychildren.org. American Academy of Pediatrics. Updated November 21, 2015. https://www.healthychildren.org/English/health-issues/conditions/fever/Pages/When-to-Call-the-Pediatrician.aspx.
