Fever in Kids

Myth #1: Fever causes brain damage.

Fever in response to infection does NOT cause brain damage. I have seen plenty of kids that come into the ER with a fever of 106.5 and they are just as likely to go on to Harvard as the next kid. True, if you are locked in a hot car or playing football in full pads in the 105 degree summer heat, you can get brain damage if your temperature rises above 108 degrees. However both of theses scenarios are environmental - situations when an external heat is applied to the body and causes a dangerous temperature. The body in the normal process of fighting off a routine infection can not, and will not, produce a damaging or dangerous temperature.

Myth #2: Fever causes seizures.

This is NOT true either. Some children have an underlying predisposition that causes them to have a brief seizure when they have a rapid change in their body temperature. The seizures are brief and are NOT harmful in any way. In fact roughly 3/4 of the kids that have this type of seizure will never have another seizure. However, kids that do not have this disorder (96% of kids) will NEVER have a seizure no matter how high their fever goes or how quickly it rises.

Myth #3: If I reduce my child's fever, they will get better sooner.

This, again, is FALSE. This is what the makers of tylenol and motrin would like you to believe. However it is undeniably wrong. In studies of children with routine infection those who were treated with fever reducers stayed sick longer. If you think about it - it just makes sense. If the body is making a fever to stop an infection from thriving and you give a medicine to bring the body temperature back down to normal, the infection is likely to start thriving again. This translates into more work for the immune system and a duration of illness that is LONGER if you take a fever reducer.

Now the down side to fever is that it makes you feel very bad. Again, through intelligent design, our body wants us to lay in bed all day long so that all resources and energies can be diverted to getting well. It turns out though that we in Western society are just too busy to take a few days off, rest, and get well. Thus we pop in a few pills, bring the fever down, feel better for a few hours, go on about our business, and then repeat the cycle over and over again. Sure this may get you through work or your kid through school, but the overall duration of illness is generally longer and you will be sharing your illness with all of your co-worker and your kid with all their classmates.

Myth #4: If the fever gets too high you should put your child in a cool water bath.

I am not sure where this came from, but it is also false. Just think about it (and I don't just have to think about it, I can remember it from my childhood). You get the flu when you are in grade school. You have fever and pretty much feel miserable. Maybe you have just had an episode or two of vomiting. What you need is a bed, some fluids, and a few days to let your body fight off the flu. Instead, though, you get tossed into a cold bath. Does this make any sense? I can think of no better way to keep your child sick than tossing them into a cold bath when they are suffering from an illness of any kind.

Then there are some who go to the opposite extreme and put their kids into a subarctic sleeping bag after wrapping them in several layers of pajamas. This makes little sense either. Resist the urge to DO something. Just let your child rest, give them a blanket if they need it, and let the body get on with ridding itself of the infection in the best way it knows how (which mind you, is much better than anything we doctors have come up with).

FACT #1: Fever reducers make you feel better.

This is undeniably true. When kids have fever they are fussy, irritable, do not eat well, do not sleep well, and the list goes on. Giving tylenol and/or motrin will make your child feel better although the overall duration of illness may be longer. I suggest using these medications sparingly particularly at bedtime or if kids are refusing to drink any fluids. Kids need both sleep and fluid to get better. If the fever is preventing either of these, then a fever reducer may be indicated. Using these medications every 4-6 hours, around the clock, however, is NOT suggested and both can cause serious side-effects even when used as directed for a prolonged period of time.

Fact #2: High fever is worse than low fever.

This is both fact and myth. In general, minor illnesses (like a cold) will produce a lower fever response (less than 102). More serious infections (like pneumonia) will produce a higher fever response (greater than 102) This is a generalization though as the flu is a minor illness that may cause fevers as high as 106. More important though, is fever associated with lethargy or difficulty breathing. These types of fevers should, at a minimum, result in a call to your doctor, and probably result in a trip to the ER or doctor's office.

That being said, often kids with high fever act lethargic and breath faster. This is probably another GOOD indication for a fever reducer. If your child has a high fever, looks lethargic, and is breathing rapidly you might try a dose of fever reducer. If the fever comes down and they start running around the room like nothing is wrong - well then it's probably nothing serious.

Fact #3: My doctor wants to see my child when they have a fever.

This in only true if your doctor is more interested in padding his pocketbook than in the health of your child. The absolute worst place to be when you have a minor illness is the doctor's office. At any give time there are probably children with 5 or 10 different contagious infectious illnesses sitting in the waiting room. If you want your child who has a cold to also have the flu and a stomach virus, then a trip to the waiting room at the doctor's office is the place for you.

Now there are three reasons fever must be evaluated by a physician:

1. Fever in a baby less than 3 months old.

2. Fever associated with lethargy, neck pain, or difficulty breathing.

3. Fever in kids with a chronic medical condition.

Virtually all other fevers can be managed at home with rest, plenty of fluids, and judicious use of fever reducers.

Fact #4: Fever is good for you.

This should be self-evident by now. Fever is what the body does to heal itself and fight off infection. In this setting it is always good. If you can avoid giving fever reducers to your child, you will probably help your child get better faster. In certain settings judicious use of a fever reducer may be helpful in keeping your child hydrated and well rested. Most kids with fever have a minor illness when they have a fever and a trip to the doctor's office will do little more than expose them to other contagious infectious diseases and prevent them from getting the rest they need.

Surgical Infections:2005

This was conducted on patients admitted to the Surgical ICU. Half of the patients were treated with aggressive fever reduction and half were allowed to have a fever. In the half that had aggressive fever reduction there were more days in the hospital, more infections, and 7 patients died (versus only one patient in the group that was not treated for fever). The results from this study were so compelling that they had to stop the study early because it was felt to be unethical to continue putting patients into an aggressive treatment group. The moral of the story ... if the body is making a fever it is probably good. Interfere with this response at your own peril.

The Journal of Pediatrics:1995

This classic study showed that acetaminophen (tylenol) did not prevent febrile seizures. Also shows that the risk of recurrence is low.

The Journal of Pediatrics: 1989

This study shows that in children with varicella (chickenpox), symptoms and overall duration of illness was longer in the group that received acetaminophen (tylenol) versus the placebo (no tylenol) group.

Always remember the Hippocratic Oath: "First do no harm."

Remember that a fever is generally GOOD for your child. Try to avoid the temptation to DO something, unless you have good reason to think that it will benefit your child.

1. Avoid fever reducer medications if at all possible, especially for fevers that are less than 102 degrees.

2. Consider a fever reducer in these situations:

A. Your child is refusing to drink fluids.
B. Your child is unable to go to sleep.
C. You child is in pain.
D. Your child is breathing rapidly.
E. Your child is lethargic.

3. If after giving a fever reducer A,B,C,D,&E resolve, then it is very unlikely that a trip to the doctor's office will result in anything other than a painfully long wait in a room full of sick kids ready to exchange their cold and flu symptoms.

4. If your child is having difficulty breathing, is in severe pain of any kind, or is lethargic despite giving a trial of a fever reducer, then a call to your pediatrician or a trip to a health care facility is indicated. Likewise a child who refuses to drink anything for more than 24 hours may be at risk for dehydration and a call to the pediatrician is probably warranted.

5. Remember that you know your child best. If you are uncomfortable, call your doctor. However don't let parental anxiety and fear overwhelm you. Just because you DO something does not mean that you have done something helpful. Most time the most helpful thing you can do for child, is to do nothing at all.

6. Lastly, these guidelines are for otherwise normal children. If your child has any chronic medical condition (like sickle cell, cancer, etc.) or is less than 3 months old, call your health care provider at the first sign of fever.

Hopefully if you are asking the first part of the question you are also asking the second. Now while the FDA may not be the best regulator of the pharmaceutical industry, it is better than no regulator at all, which is just the situation with all the Natural & Herbal Remedies. There is absolutely no regulation and very little way to know if what you think you are giving your child is actually what your child is getting. There are many examples of innocent supplements containing very harmful substances (like mercury toxins in oyster shell calcium supplements). Unless you have been living in a vacuum you must be aware that anything that comes from China (and many other developing countries) is suspect.

Now that said, I do believe that there is a rational way to select safe products, but the burden of proof should be placed firmly on your own shoulders. You should first make sure that there is some independent evidence that shows some sort of benefit. Then you must find a product that has been independently reviewed and shown not only to contain what the supplier asserts that it contains, but also that it does not contain other harmful substances.

Read my page on choosing safe Home & Natural Remedies for more information.

There are basically Four different categories to think about when you consider Home & Natural Remedies

1. Over-the-counter (non-prescription) medications(tylenol. motrin, etc.)
2. Nutritional Supplements(vitamin C, Zinc, etc.)
3. Naturopathic Remedies(medicinal plants, herbs, foods, etc.)
4. Non-medical Interventions(Luke-warm bath, nasal suction, etc.)

So we will look at each category as it applies to fever.

Over-The-Counter Medications

Basically there are 3 medications that fall into this category ... tylenol, motrin, and aspirin. Now for the most part we never use aspirin in kids because of its association with Reye's Syndrome. Tylenol(acetaminophen) and Motrin(Ibuprofen) on the other hand are commonly used. Again I encourage parents not to use these medication simply because your child has a fever, especially if it is a low fever. However, as mentioned above there are some times when a fever reducer might help you avoid a trip to the ER or help both you and your child get a much need night of sleep.

If you choose to use either or both of these medications you should make sure that you use them in the safest and most effective way possible. Now there are two basic strategies:

1. The alternating strategy: This means that you alternate with tylenol and motrin as often as every 3 hours. This way your child is getting some medicine every 3 hours but only gets the same medicine every 6 hours. For example, you give tylenol at 8am, then motrin at 11am, then tylenol again at 2pm, then motrin again at 5pm ....

2. The Back-up strategy: This means that you first give a dose of tylenol, wait about 45 minutes, then if things are not improved, you give a dose of motrin. Most parents will find that they mainly give tylenol and only occasionally need to give a dose of motrin. This strategy requires a little more work on your part because you must wait at least 4 hours between each dose of tylenol and 6 hours between each dose of motrin. I recommend this approach because you are using these medications based on your child's symptoms and the response to medication. It is much better than simply doing things on an arbitrary 3 hour schedule.

Regardless of the strategy you choose make sure you are giving the proper dose of each.

Tylenol is 15mg/kg as often as every 4 hours.
Motrin is 10mg/kg as often as every 6 hours.

For example if your child is 22 pounds and you use the calculator below to convert to kg you will find that your child is 10kg. This means that your child can have 15mg x 10kg = 150mg of tylenol every 4 hours ... and 10mg x 10kg = 100mg of motrin every 6 hours.

If you need to know how many kg you child is click here to use the pounds to kg converter.

Nutritional Supplements

There are 5 supplements to consider in this category and they generally surround fever related to infection. The supplements to consider are Vitamin C, Zinc, Vitamin A, DHEA, and High Lactoferrin Whey Protein. There is a great deal of controversy surrounding these supplements and the studies looking at the risk:benefits, especially in kids, are conflicting. Probably these supplements only have a role in those patients who are deficient in one or more of these. If your child eats a normal diet with ample servings of fruits and vegetables, there is little reason to think that they would be deficient in any of the above things. If however your child exist mainly on Cheetos and McDonald's you might give them some consideration. Then as soon as their illness has resolved read my page on Healthy Parents ... Healthy Kids

If you have decided to give your child some supplements click here to review the products I consider to be safe and effective.

Naturopathic Remedies

There are many Naturopathic / Botanical Remedies for fever and the illnesses that cause them. Those that have at least some scientific support are:

1. Elderberry (Sumbucus nigra)
2. Echinacae
3. Garlic
4. North American ginseng (Panax quinquefolium)
5. Kan Jang (Eleutherococcus & Andrographis)
6. Larch Arabinogalactans (Western Larch)
7. Olive Leaf Extract
8. Astralagus (Astralgalus membranaceus)
9. Baptista (Baptista tinctoria)
10. Isatis (Isatis tinctoria & indigotica)

For the most part there is scant or conflicting evidence for the effectiveness of any of these compounds. The one clear exception in my mind is Elderberry or Sumbucus nigra. Extracts from the berry contain many compounds know to have anti-viral and immune supporting properties. Further in-vitro tests have shown Elderberry extracts to be effective at preventing the replication of Influenza. Several other studies have gone on to show that patients with influenza are less sick and recover faster when they take Elderberry extracts.

For a complete review of Elderberry see my section on Home & Natural Remedies or go to our online store to view recommended products.

Non-Medical Interventions

This basically involves helping the body lose heat through normal mechanisms. Actively cooling the body is a BAD idea though. So DO NOT place your child in a cold water bath. This is likely to do little other than make them miserable. However, if you remove warm blankets, dress them in light clothing, and use a cool wash cloth on their forehead this will allow you to work with the normal body mechanism to dissipate heat and help the fever come down.

There are countless possible reasons that your child could have a fever. A wise man once said "common things are common and uncommon things just that ... uncommon." Zebras, while they do exist, are something you are unlikely to encounter walking down the street anywhere in the Western world. The same holds true for pediatric medical practice. Below is a list of common causes of fever in children and links to more detailed pages.

Upper Respiratory Infection(URI)

This is a broad category of illness almost exclusively consisting of viral infections. An infection of the upper respiratory tract basically includes every thing that you use to breath above the level of the lungs. This in includes the throat, nose, and sinuses. Anytime your doctor tells you that you have a cold, sinusitis, rhinitis, or nasal congestion then you have a URI. Anytime you have runny nose, congestion, mild sore throat, and cough, you probably have a URI. Again these illnesses are almost exclusively caused by viruses which are completely resistant to ALL antibiotics. The typical URI will resolve in 3-5 days, and while uncomfortable, is not associated with any difficulty breathing. A trip to your doctor when you have a URI will either be a waste of time and resources or result in a prescription for unnecessary and potentially harmful medication. The time to see your doctor for a URI is when it lasts longer than 3-5 days or if it is associated with difficulty breathing, lethargy, or severe pain.

Influenza and other flu-like illness

Influenza is a common source of needless trips to the ER. Mainly this results from "fever phobia," or the high fever that is characteristic of Influenza. It is not uncommon to have a fever that is 105 or 106 degrees. Remember this is not a cause for concern unless associated with any of the other concerning signs mentioned above. Symptoms of Influenza are high fever, runny nose, congestion, cough, and generalized body aches. Influenza and other flu-like illnesses are seasonal and generally epidemic in nature. Treatment and prophylaxis is controversial for influenza and you can read my page on influenza to decide for yourself. I generally do not test for or treat influenza. Influenza and other flu-like ilnesses are self-limited and the body will fight them off on 5-9 days. Influenza itself almost never causes any serious problems and most of the "deaths" reported by the media are exceedingly rare. When they do occur though it is generally because a patient with influenza got a secondary pneumonia - the symptom of which is shortness of breath or difficulty breathing. Overall if your child is not having any difficulty breathing there is little to be gained by a visit to your doctor.

Ear Infection

Ear Infection is probably the number #1 misunderstood of all pediatric infections. It is probably also the number #1 reason there is so much antibiotic resistance in children. Probably 90% of ear infections are caused by viruses, which are unaffected by antibiotics. Furthermore, even if your child has an ear infection, taking antibiotics probably only helps them get better about 1 day faster and does not appear to reduce the rate of the very, very rare complications. In return for treating the ear infection with antibiotics you expose your child to the risk of allergic reactions, upset stomach, often intolerable diarrhea, and the development of resistant bacteria. Studies show that most ear infections resolve well on there own with simple symptomatic home therapies.

Read my page on Ear infection to learn more.

Strep Throat

How many times have you taken your child into the pediatrician to have them checked for strep? This is cultural phenomenon unsupported by the medical literature. Studies show that the risks of treatment outweigh the benefits. Despite the wealth of information supporting a "no treatment, no testing" approach, the "strep phobia" is so ingrained in the medical culture that you will be hard pressed to find a doctor whose practice corresponds to the facts about strep. But, then why should they, remember the medical system at present in unbalanced capitalism. It is not in the best interest of the doctor, the hospital, the pharmaceutical company, or the medical testing industry to follow this approach ... it is only in the best interest of YOUR child, whom you must advocate for.

To learn more about the FACTS read my page on strep throat.

This is the section to apply what you have learned to some real life scenarios. Of course the patients are not real but the concept that they represent are. In this section you will meet Charlie, Hope, and Kaden... Three patients and three different fevers.

Alex is a 21 day old neonate who has been previously healthy. He was born a few weeks early but only spent 48 hours in the hospital for routine newborn and maternal postpartum care. Today he has not been himself. He normally bottle-feeds about 2 ounces every 2-3 hours. It normally takes him about 20 minutes to finish a feed. After he feeds he normally is playful for a brief time and then takes a nap for about an hour.

Today however, Alex is intermittently fussy. He is only taking about 1/2 an ounce at each feed and his mom thinks he probably spends more time crying than he does sleeping. He is breathing comfortably when he is not fussy and is still making several wet diapers per day. Since Alex is not himself his mother decides to check his temperature under his arm and notes that it is 99.5 degrees F.

1. What should Alex's mom do next?

A. Call his pediatrician immediately.
B. Rush Charlie to the ER.
C. Recheck Charlie's temperature rectally.
D. Give Charlie a dose of tylenol.

Check Your Answer

Hope is a 2 1/2 year old previously healthy little girl. She is normally full of energy and very rambunctious. She attends daycare 3 days a week and loves to play outside during the summer. Over the last several days Hope has been having nasal congestion and runny nose. She has an occasional cough throughout the day which seems worse at night-time. Although she is coughing some through the day she is not having any trouble breathing even though she does seem to be breathing a little more rapidly than normal.

She is not eating as much as normal and seems to prefer juice and clear liquids to milk. She did not sleep well last night on account of coughing and of course neither did either of her parents. Overall she is more "clingy" and fussy than normal. However she does not complain that anything hurts. Although she is not going to the bathroom as much is normal she has already urinated once this morning.

She feels warm so her mother measures her temperature using an ear thermometer and it reads 101.3 degrees F.

What should Hope's mom do now?

A. Rush her to the ER, she could have pneumonia or meningitis.
B. Call her pediatrician immediately to schedule an appointment to check for ear infection.
C. Give her tylenol or ibuprofen to bring the fever down.
D. Continue to encourage fluid intake, give her plenty of rest, and watch closely for the development of any more worrisome signs.

Check Your Answer

Kaden is a 9-month old infant. His mom breast fed him up until he was about 4 months old. His mom, who is a teacher, had to return to work at the end of the summer and found it too difficult to pump at work to maintain her milk supply. Since this time he has been on formula, rice cereal and a variety of baby foods. Kaden also started attending daycare about this same time.

Up until 4 months, Kaden never had any problems at all. However, it seems that he has been sick constantly since his 4-month birthday. On most days it seems Kaden has all or some combination of runny nose, nasal congestion, or cough. Today he has been extra irritable and his mom decided to take off work to stay at home with him.

He is much more fussy than normal and did not sleep well at all last night. He is normally a very good feeder but today he only takes about 1 ounce of formula at a time and is not interested in eating any thing else at all. He has occasional coughing fits, especially when he lays down, and sometimes he even coughs so much that he throws up. He is not having any diarrhea or acting like he is in any severe pain, although his mom is concerned that he seems to be pulling at one of his ears.

When he wakes up from his afternoon nap, he is "burning up," and his hands and feet are very cold. He seems to be breathing pretty rapidly and his breathing is very "raspy." His mom gets very concerned and immediately checks his temperature under his arm which reads - 104.5 degrees F.

What should Kaden's mom do next?

A. Rush him to the ER he probably has pneumonia.
B. Call the pediatrician, he probably has an ear infection.
C. Plan a trip to ER for IV fluids, he is probably dehydrated.
D. Give his a dose of fever reducer and reevaluate in about an hour.

Check Your Answer

Dr. Reynolds writes a blog at SmartParentsBlog.com, where you can find more information about fever and other topics of interest to you and the health of your child. Visit the Blog or click on the link below for eNews and Updates delivered straight to your inbox.

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It is important for everyone to understand that the purpose of this website is educational - to provide information. It is not a replacement for your doctor and I am not entering into a doctor-patient relationship with any of the readers of these pages or their children. It is my goal that by providing you with easy to understand information based on the latest research you will be empowered to work with your doctor to raise...healthy kids!