02/20/2025
Just a reminder about fever:
Do you need to treat a fever? What if it doesn't completely resolve with Tylenol or Motrin? Should you rush to the ER? For my devoted parents out there suffering from a hint of fever phobia, I’m here to offer a cure.
A true fever is 100.4°F and above. 🤒 Babies less than 3 months old should be measured rectally to get an accurate temperature. After 3 months, you can measure at the ear, forehead, or armpit for a decent temperature estimation... But before you rush out to buy a thermometer, hear me out:
Fevers are the body’s HEALTHY, natural way of ramping up the immune system to fight off infections. By far, most fevers are due to pesky viral illnesses (common colds) presenting as cough, congestion, runny nose, and fever. Viruses usually go away within a week or two WITHOUT any prescription medicine, so you can safely keep your peanut at home to rest. 🛌 Antibiotics will not make a virus go away any faster because they ONLY work on bacteria.
A doctor’s visit is not necessary under most fever circumstances, but there are some VERY important exceptions that I need to mention. Seek urgent medical care if your child is less than 3 months old, has chronic medical conditions such as sickle cell or heart disease, or has any of the following 🚩 RED FLAG SIGNS: Bulging soft spot, inconsolable crying, bright green vomit, confusion, disorientation, difficult to arouse, poor urine output, stiff neck, new seizures, difficult or rapid breathing, refusal to move an arm or leg as normal, widespread peeling/blistering/bruising of skin, or simply appearing very ill.
The common cold can lead to secondary infections, so schedule an office visit for persistent ear pain or fever lasting greater than 4 days. If your intuition is overall telling you that your child is really sick, by all means, please bring them in.
Otherwise, there is no set temperature at which you need to give Tylenol or Motrin to your little one. 💊 There is no need to wake a sleeping child to give these medications. If your child’s fever is making them UNCOMFORTABLE, then go ahead and offer Tylenol (for all ages) or Motrin (6 months and up). Notice how the decision to treat is based on the way that they feel/act – no numbers involved. Try to use the WEIGHT-based chart for the most accurate dosing.
Remember that fever medications only knock the temp down by 1-3 degrees at the most. The fever WILL likely come back after several hours. That's okay. Again, the body is doing this to fight off the infection. Be careful if you choose to alternate between Tylenol and Motrin, as this can lead to dosing errors. Do NOT give aspirin to children - it is potentially toxic to little livers.
Some children tolerate fevers to 104°F without problem while others become cranky right at 100.4°F. Some kids get so fussy that they refuse to eat, sleep, or drink enough fluids. 💦 It’s actually fine if your child won’t eat solid food for a few days, but they need to stay HYDRATED enough to urinate roughly every 8 hours. Encourage breast milk, formula, Pedialyte, or any other age-appropriate fluids that you can. Having less than 3 wet diapers a day is a sign of dehydration, and dehydration is a reason to bring your child in.
Again, any sign of respiratory distress (sucking in between the ribs or flaring nostrils to breathe, rapid breathing, head bobbing, turning blue or pale) is another reason to bring them in as soon as possible.
Febrile seizures are a common concern. They occur among roughly 2-5% of all children. A seizure is terribly frightening for parents to watch, but I have good news: only rarely is it dangerous. There is no evidence that routine Tylenol or Motrin use will prevent first-time febrile seizures in general, so I do not typically recommend using them for that specific purpose. Unfortunately, the seizure itself often happens before anyone is aware that a fever even exists.
The fear of “brain damage” is another common fear, but I have more good news: No study suggests that fever itself poses a threat to an otherwise healthy brain except in the rare event that body temp exceeds 107°F - but these kids likely had hyperthermia due to dehydration on top of their high fevers. 🧠
I get passionate about fever because it is a HUGE source of anxiety, time, money, and resources for so many families. The next time that your child feels warm, no need to rush to the nearest ER. If they require testing for school or daycare, call your provider's office for further instructions.
Fever is not the enemy; dehydration and respiratory distress are the enemies. Those are what you need to look out for.
Remember, this information does NOT replace parental judgment nor a medical assessment by your provider. Stay healthy, everyone.
