Fever and Taking Your Child’s Temperature

You’ve probably experienced waking in the middle of the night to find your child flushed, hot, and sweaty. Your little one’s forehead feels warm. You immediately suspect a fever, but are unsure of what to do next. Should you get out the thermometer? Call the doctor?

In healthy kids, fevers usually don’t indicate anything serious. Fever itself causes no harm and can actually be a good thing — it’s often the body’s way of fighting infections. And not all fevers need to be treated. High fever, however, can make a child uncomfortable and make problems (such as dehydration) worse.

Here’s more about fevers, how to measure and treat them, and when to call your doctor.

Fever Facts

Fever happens when the body’s internal “thermostat” raises the body temperature above its normal level. This thermostat is found in a part of the brain called the hypothalamus. The hypothalamus knows what temperature your body should be (usually around 98.6°F/37°C) and will send messages to your body to keep it that way.

Most people’s body temperatures even change a little bit during the course of the day: It’s usually a little lower in the morning and a little higher in the evening and can vary as kids run around, play, and exercise.

Sometimes, though, the hypothalamus will “reset” the body to a higher temperature in response to an infection, illness, or some other cause. Why? Researchers believe turning up the heat is the body’s way of fighting the germs that cause infections and making the body a less comfortable place for them.

Causes of Fever

It’s important to remember that fever by itself is not an illness — it’s usually a symptom of another problem.

Fevers have a few potential causes:

Infection: Most fevers are caused by infection or other illness. A fever helps the body fight infections by stimulating natural defense mechanisms.

Overdressing: Infants, especially newborns, may get fevers if they’re overbundled or in a hot environment because they don’t regulate their body temperature as well as older kids. However, because fevers in newborns can indicate a serious infection, even infants who are overdressed must be checked by a doctor if they have a fever.

Immunizations: Babies and kids sometimes get a low-grade fever after getting vaccinated.

Although teething may cause a slight rise in body temperature, it’s probably not the cause if a child’s temperature is higher than 100°F (37.8°C).

When Fever Is a Sign of Something Serious

In the past, doctors advised treating a fever on the basis of temperature alone. But now they recommend considering both the temperature and a child’s overall condition.

Kids whose temperatures are lower than 102°F (38.9°C) often don’t need medicine unless they’re uncomfortable. There’s one important exception to this rule: If you have an infant 3 months or younger with a rectal temperature of 100.4°F (38°C) or higher, call your doctor or go to the emergency department immediately. Even a slight fever can be a sign of a potentially serious infection in very young infants.

If your child is between 3 months and 3 years old and has a fever of 102.2°F (39°C) or higher, call your doctor to see if he or she needs to see your child. For older kids, take behavior and activity level into account. Watching how your child behaves will give you a pretty good idea of whether a minor illness is the cause or if your child should be seen by a doctor.

The illness is probably not serious if your child:

• is still interested in playing
• is eating and drinking well
• is alert and smiling at you
• has a normal skin color
• looks well when his or her temperature comes down

And don’t worry too much about a child with a fever who doesn’t want to eat. This is very common with infections that cause fever. For kids who still drink and urinate (pee) normally, not eating as much as usual is OK.

Is it a Fever?

A gentle kiss on the forehead or a hand placed lightly on the skin is often enough to give you a hint that your child has a fever. However, this method of taking a temperature (called tactile temperature) doesn’t give an accurate measurement.

Use a reliable thermometer to confirm a fever, which is when a child’s temperature is at or above one of these levels:

• measured orally (in the mouth): 99.5°F (37.5°C)
• measured rectally (in the bottom): 100.4°F (38°C)
• measured in an axillary position (under the arm): 99°F (37.2°C)

But how high a fever is doesn’t tell you much about how sick your child is. A simple cold or other viral infection can sometimes cause a rather high fever (in the 102°–104°F/38.9°–40°C range), but this doesn’t usually indicate a serious problem. And serious infections, especially those in infants, might cause no fever or even an abnormally low body temperature (below 97°F or 36.1°C).

Because fevers can rise and fall, a child might have chills as the body’s temperature begins to rise. The child may sweat to release extra heat as the temperature starts to drop.

Sometimes kids with a fever breathe faster than usual and may have a faster heart rate. Call the doctor if your child is having trouble breathing, is breathing faster than normal, or continues to breathe fast after the fever comes down.

Types of Thermometers

Whatever thermometer you choose, be sure you know how to use it correctly to get an accurate reading. Keep and follow the manufacturer’s directions for any thermometer.

Digital thermometers usually give the quickest, most accurate readings. Available in a variety of sizes and shapes, they’re sold at most supermarkets and drugstores. Read the manufacturer’s instructions to see what the thermometer is designed for and how it signals that the reading is complete.

Usually, digital thermometers can be used for these temperature-taking methods:

• oral (in the mouth)
• rectal (in the bottom)
• axillary (under the arm)

Turn on the thermometer and make sure the screen is clear of any old readings. Digital thermometers usually have a plastic, flexible probe with a temperature sensor at the tip and an easy-to-read digital display on the other end. If your thermometer uses disposable plastic sleeves or covers, put one on according to the manufacturer’s instructions. Throw away the sleeve afterward and clean the thermometer according to the manufacturer’s instructions before putting it back in its case.

Electronic ear thermometers measure the tympanic temperature (the amount of heat made by the eardrum). Although they’re quick and easy to use in older babies and kids, ear thermometers aren’t as accurate as digital thermometers for infants 6 months or younger and are more expensive. They can also give inaccurate readings if not placed properly in the ear canal or if a child has earwax buildup.

Temporal artery thermometers, which are swiped over the forehead to behind the ear, measure the temperature of temporal arteries, which are blood vessels in the forehead. Using this type of thermometer takes practice and good technique to be as accurate as oral or rectal digital thermometers. Sweating can affect their accuracy, so it’s important to make sure the child’s forehead is dry and to take multiple readings to confirm the temperature.

Pacifier thermometers can be convenient, but their readings are less reliable than rectal temperatures and shouldn’t be used in infants younger than 3 months. Kids also need to keep the pacifier in their mouth for several minutes without moving, which is a nearly impossible task for most babies and toddlers.

Plastic strip thermometers (small plastic strips that you press against the forehead) might tell you whether your child has a fever, but they don’t give an exact measurement, especially in infants and very young children. If you need to know your child’s exact temperature, plastic strip thermometers are not the way to go.

Glass mercury thermometers were once common, but should not be used because of possible exposure to mercury, an environmental toxin. (If you still have a mercury thermometer, do not throw it in the trash because the mercury can leak out. Talk to your doctor or your local health department about how and where to dispose of a mercury thermometer.)

Tips for Taking Temperatures

As any parent knows, taking a squirming child’s temperature can be a challenge. But it’s one of the most important tools doctors have to determine if a child has an illness or infection. The best method will depend on a child’s age and temperament.

For babies younger than 3 months, you’ll get the most reliable reading by using a digital thermometer to take a rectal temperature. Electronic ear thermometers aren’t recommended for infants younger than 6 months because their ear canals are usually too small. Research shows that temporal artery thermometers may give accurate readings for kids in this age group.

For babies between 3 months and 6 months old, a digital rectal thermometer is still the best choice, but you can also use a temporal artery thermometer.

For kids between 6 months and 4 years old, you can use a digital thermometer to take a rectal temperature, a temporal artery thermometer, or an electronic ear thermometer. You could also use a digital thermometer to take an axillary temperature, although this is a less accurate method.

For kids 4 years or older, you can usually use a digital thermometer to take an oral temperature if your child will cooperate. However, kids who are coughing a lot or breathing through their mouths because of stuffy noses might not be able to keep their mouths closed long enough for an accurate oral reading. In these cases, you can use the tympanic method (with an electronic ear thermometer), forehead method (with a temporal artery thermometer), or axillary method (with a digital thermometer).

To take a rectal temperature: Before becoming parents, most people cringe at the thought of taking a rectal temperature. But don’t worry — it’s a simple process:

1. Wash the end of the thermometer with soap and water and rinse with water.
2. Moisten the tip of the thermometer with a lubricant, such as petroleum jelly.
3. Place your child:
   – belly-down across your lap or on a firm, flat surface and keep your palm along the lower back
   – or face-up with legs bent toward the chest with your hand against the back of the thighs
4. With your other hand, insert the lubricated thermometer into the anal opening about ½ inch to 1 inch (about 1.25 to 2.5 centimeters), or until the tip of the thermometer is fully in the rectum. Stop if you feel any resistance.
5. Steady the thermometer between your second and third fingers as you cup your hand against your baby’s bottom. Soothe your child and speak quietly as you hold the thermometer in place.
6. Wait until you hear the appropriate number of beeps or other signal that the temperature is ready to be read. Write down the number on the screen, noting the time of day that you took the reading.

To take an oral temperature: This process is easy in an older, cooperative child.

1. Wait 20 to 30 minutes after your child finishes eating or drinking to take an oral temperature, and make sure there’s no gum or candy in your child’s mouth.
2. Place the tip of the thermometer under the tongue and ask your child to close his or her lips around it. Remind your child not to bite down or talk, and to relax and breathe normally through the nose.
3. Wait until you hear the appropriate number of beeps or other signal that the temperature is ready to be read. Write down the number on the screen, noting the time of day that you took the reading.

To take an axillary temperature: This is a convenient way to take a child’s temperature. Although not as accurate as a rectal or oral temperature in a cooperative child, some parents prefer to take an axillary temperature, especially for kids who can’t hold a thermometer in their mouths.

1. Remove your child’s shirt and undershirt, and place the thermometer under an armpit (it must be touching skin only, not clothing).
2. Fold your child’s arm across the chest to hold the thermometer in place.
3. Wait until you hear the appropriate number of beeps or other signal that the temperature is ready to be read. Write down the number on the screen, noting the time of day that you took the reading.

Whatever method you choose, keep these additional tips in mind:

• Never take a child’s temperature right after a bath or if he or she has been bundled tightly for a while — this can affect the temperature reading.
• Never leave a child unattended while taking a temperature.

Helping Kids Feel Better

Again, not all fevers need to be treated. And in most cases, a fever should be treated only if it’s causing a child discomfort.

Here are ways to ease symptoms that often accompany a fever:

• If your child is fussy or uncomfortable, you can give acetaminophen or ibuprofen based on the package recommendations for age or weight. (Unless instructed by a doctor, never give aspirin to a child due to its association with Reye syndrome, a rare but potentially fatal disease.) If you don’t know the recommended dose or your child is younger than 2 years old, call the doctor to find out how much to give.

  Infants younger than 2 months old should not be given any medicine for fever without being checked by a doctor. If your child has any medical problems, check with the doctor to see which medicine is best to use. Remember that fever medication will usually temporarily bring a temperature down, but won’t return it to normal — and it won’t treat the underlying reason for the fever.

• Dress your child in lightweight clothing and cover with a light sheet or blanket. Overdressing and overbundling can prevent body heat from escaping and can cause a temperature to rise.
• Make sure your child’s bedroom is a comfortable temperature — not too hot or too cold.
• While some parents use lukewarm sponge baths to lower fever, this method only helps temporarily, if at all. In fact, sponge baths can make kids uncomfortable. Never use alcohol (it can cause poisoning when absorbed through the skin) or ice packs/cold baths (they can cause chills that may raise body temperature).
• Offer plenty of fluids to avoid dehydration since fevers cause kids to lose fluids more rapidly than usual. Water, soup, ice pops, and flavored gelatin are all good choices. Avoid drinks with caffeine, including colas and tea, because they can make dehydration worse by increasing urination (peeing).
• If your child also is vomiting and/or has diarrhea, ask the doctor if you should give an electrolyte (rehydration) solution made especially for kids. You can find these at drugstores and supermarkets. Don’t offer sports drinks — they’re not made for younger children and the added sugars can make diarrhea worse. Also, limit your child’s intake of fruits and apple juice.
• In general, let your child eat what he or she wants (in reasonable amounts) but don’t force eating if your child doesn’t feel like it.
• Make sure your child gets plenty of rest. Staying in bed all day isn’t necessary, but a sick child should take it easy.
• It’s best to keep a child with a fever home from school or childcare. Most doctors feel that it’s safe to return when the temperature has been normal for 24 hours.

When to Call the Doctor

The exact temperature that should trigger a call to the doctor depends on the age of the child, the illness, and whether there are other symptoms with the fever.

Call your doctor if you have an:

• infant younger than 3 months old with a rectal temperature of 100.4°F (38°C) or higher
• older child with a temperature of higher than 102.2°F (39°C)

Call the doctor if an older child has a fever of less than 102.2°F (39°C) but also:

• refuses fluids or seems too ill to drink adequately
• has lasting diarrhea or repeated vomiting
• has any signs of dehydration (peeing less than usual, not having tears when crying, less alert and less active than usual)
• has a specific complaint (like a sore throat or earache)
• still has a fever after 24 hours (in kids younger than 2 years) or 72 hours (in kids 2 years or older)
• is getting fevers a lot, even if they only last a few hours each night
• has a chronic medical problem such as heart disease, cancer, lupus, or sickle cell disease
• has a rash
• has pain while urinating (peeing)

Seek emergency care if your child shows any of these signs:

• crying that won’t stop
• extreme irritability or fussiness
• sluggishness and trouble waking up
• rash or purple spots that look like bruises on the skin (that were not there before the child got sick)
• blue lips, tongue, or nails
• infant’s soft spot on the head seems to be bulging outward or sunken inwards
• stiff neck
• severe headache
• limpness or refusal to move
• difficulty breathing that doesn’t get better when the nose is cleared
• leaning forward and drooling
• seizure
• abdominal (belly) pain

Also, ask your doctor for his or her specific guidelines on when to call about a fever.

Fever: A Common Part of Childhood

All kids get fevers, and in most cases they’re completely back to normal within a few days. For older babies and kids (but not necessarily for infants younger than 3 months), the way they act is more important than the reading on your thermometer. Everyone gets cranky when they have a fever. This is normal and should be expected.

But if you’re ever in doubt about what to do or what a fever might mean, or if your child is acting ill in a way that concerns you even if there’s no fever, always call your doctor for advice.