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When is a child's fever too high?

Published June 1, 2011 at 4:00 a.m.

Colds, the flu and stomach bugs are a normal part of childhood, as are the fevers that accompany them. Parents, especially new ones, often worry whenever their child's temperature goes above 100 degrees Fahrenheit. But is an above-normal reading on the thermometer cause for concern?

Not necessarily, says Dr. Lewis First, chief of pediatrics at Vermont Children's Hospital at Fletcher Allen Health Care. This month, Dr. First offers parents advice for keeping their cool when the little ones feel hot.

KIDS VT: Should parents always be concerned when a child runs a fever?

LEWIS FIRST: Fever is not a disease; it's a symptom that points to an "insult" to the body. In most children that's an infectious germ, but it can also be something as simple as over-bundling a baby. So, it helps to do some detective work to figure out what's wrong with your child. It's also important to know that a fever sets a child's thermostat higher, and when that thermostat goes higher, some pretty good things happen. Viruses and bacteria are killed off more quickly.

KVT: When is it best to treat a fever?

LF: If your child is irritable or uncomfortable and clearly has an elevated temperature, you're going to want to do something about it. What I'm more concerned about is, what else is associated with the fever? If a child demonstrates difficulty breathing and irritability, and isn't able to drink, then I would want to see that child and find out what's causing the problem. If a child is breathing comfortably, is well hydrated and still feels warm to the touch, that's where the fever is working to get rid of the germ, and I would not be overly aggressive in treating it.

KVT: So, let fever run its course.

LF: Assuming your child has been immunized, the vast majority of insults that cause an elevation in the body's temperature are due to viruses, and they get better with time. So, we need to make our kids comfortable, keep them well hydrated and, if they're really uncomfortable, give them acetaminophen or ibuprofen, which are essentially equivalent in their effectiveness. And we dose these products by weight, not by age.

KVT: Can these drugs be taken simultaneously?

LF: Some studies suggest that alternating the use of both may result in a prolonged period of lower body temperature than if you're using one at a time. However, all acetaminophen and ibuprofen do is lower the body's thermostat. They don't kill germs. Also, ibuprofen is dosed every eight hours, and acetaminophen is dosed every four to six hours. And multiple products contain acetaminophen and ibuprofen under various brand names. So, you can imagine the confusion that can occur as you start mixing products.

KVT: What's the risk there?

LF: All of a sudden you may be dosing your child with too many acetaminophen or ibuprofen products, both of which can have serious side effects. Acetaminophen can damage the liver. Ibuprofen can irritate the stomach and result in kidney damage. My suggestion is to start with acetaminophen at an appropriate dose for your child's weight and go from there.

KVT: So parents should avoid overtreating fevers?

LF: My bottom line is that fever is really our friend, not our enemy. If parents know that, then they're not going to overtreat, and instead will treat the symptoms that make their child uncomfortable.

KVT: What else do you advise?

LF: Tell your child to rest, engage in quiet activities, and don't let them overheat. If they want a sponge bath, use lukewarm water. When you use cool water for a sponge bath, the body suspects that the child's feeling cold, so the thermostat goes even higher, and they start to shiver to generate heat.

KVT: How hot is too hot?

LF: I'm less worried about the number on the thermometer than how your child is acting. If your child has a temperature of 103 and is playing with blocks on the floor, you can certainly call the doctor, but we're going to want to know what other symptoms your child is experiencing. In the same way, you can have a child with a 99 temperature and a pneumonia who's having difficulty breathing and won't drink. We're going to want to see that child. The only time when the height of a fever may be important is in infants under 1 month of age and, some would argue, up to 3 months of age. We tend to want to be called to see the baby if the temperature is over 100.4. These are the unimmunized children whose bodies can't take much of an infection, so we don't want to miss a bacterial infection that may require antibiotics.

KVT: What kind of thermometer do you recommend?

LF: Ear thermometers tend to be less reliable for infants under the age of 1, particularly under 6 months of age. An armpit temperature may be absolutely fine, assuming the proper technique is followed, keeping the thermometer under their arm for three to five minutes. Digital thermometers are fine. Mercury thermometers, if they're still in the household, should be discarded. A rectal temperature for infants is fine, but proper technique must be used. The accuracy of the fever strip or fever pacifier is not particularly good.

Ken Picard is a staff writer at Seven Days. He lives with his wife and daughter in Colchester.

This article was originally published in Seven Days' monthly parenting magazine, Kids VT.

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