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What to know about kids and fever
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Q. If I suspect my child has a fever, what steps should I take to care for her, and when is it time to call a physician?

A. Caring for a child with a fever can be a nerve-racking ordeal for any parent, especially if the child is young or has a high temperature. As you care for your child, remember that fever is not an illness, but a symptom of an underlying cause.

A fever occurs when a person's body temperature is elevated above its normal level. For most of us, our normal level is around 98.6 degrees Fahrenheit; however, this number may vary slightly from person to person. It's also normal for our temperature to change slightly throughout the day.

Taking Your Child's Temperature

While many thermometers offer convenience, they may not excel when it comes to accuracy (i.e. forehead thermometers or pacifier thermometers). Electronic ear thermometers are a quick and easy option for use in older babies and children, but they will not be as accurate for babies 3 months old or younger.

Digital thermometers often provide a fast and accurate reading. They are readily available, versatile and fairly affordable. Digital thermometers can be used for any of these temperature-taking methods: oral, rectal and axillary (under the arm).

Once you have a reliable thermometer, you should follow the enclosed directions to select the most appropriate means of taking your child's temperature. At the time you take your child's temperature, you'll want to take into consideration any environmental factors that may be produce an elevated temperature, such as over-dressing, physical activity, hot weather, a warm bath or warm food/beverages.

Your child's age, symptoms, and ability to remain still can impact which method is best for you. Here are some general guidelines:

1) Infants under 3 months: A rectal temperature with a digital thermometer is most accurate. New parents may see this as an intimidating process, but it's actually fairly simple.

2) Children between 3 months and 4 years: A rectal temperature with a digital thermometer or an electronic ear thermometer are both good options. You can also use the axillary method with a digital thermometer, but it probably won't yield as reliable of a result.

3) Children 4 years and older: An oral temperature with a digital thermometer is appropriate, unless your child is unable to keep her mouth closed during the process. Sometimes respiratory symptoms can make it difficult to do this. In such cases, an electronic ear thermometer is the best option. Again, the axillary method is also an option, though it may be less accurate.

While your thermometer should come with enclosed instructions, below is a brief overview of common temperature-taking methods using a digital thermometer:

Rectal method: Using a clean thermometer (it may come with disposable plastic sleeves), place a bit of petroleum jelly on the probe. Insert the thermometer into the anus about a half to one inch, stopping if you feel any resistance.

Axillary method: Place the thermometer under the arm, touching only bare skin. Fold your child's arm across their chest to hold the thermometer in place.

Oral method: Place the thermometer under your child's tongue and ask her to close her lips around the thermometer. Your child should try to relax, breath normally, and avoid biting down on the thermometer.

Behavior and Symptoms

A fever can be a common symptom of infection and illness, such as a cold. If your child has a fever but is displaying otherwise normal behavior and appearance (is playful and alert, has normal skin color, is drinking and eating), her condition is probably not too serious. Even a lack of appetite is a fairly common symptom on its own, provided the child is drinking and urinating.

In mild cases where the child appears otherwise comfortable, the fever doesn't necessarily require any form of treatment, though you should still keep your child home from childcare or school if she has a temperature.

When to Seek Medical Attention

In general, get medical help if your child has a fever and:

• is under 3 months of age.

• is under 6 months of age and has a fever more than 102 degrees Fahrenheit.

• has a fever that lasts more than 24 hours.

• is lethargic, unresponsive, has a rash, or has difficulty breathing.

• refuses to drink or shows signs of dehydration (dry mouth, a sunken soft spot, few wet diapers or little urination).

• has a seizure.

• has a stiff neck.

Making Your Child Comfortable

If your child is showing signs of discomfort, you may be able to make her more comfortable by using some of the following to tips:

• Give them a sponge bath using lukewarm water, but avoid cold water, which may ultimately aggravate their symptoms.

• Dress them lightly or use lightweight bedding, and keep their room at a comfortable temperature.

• Encourage them to drink fluids (water, diluted fruit juices, gelatin-flavored water), especially if they are also dealing with vomiting or diarrhea. Special pediatric drinks with electrolyte solutions can help combat dehydration.

• Let them eat according to their food preferences, within reason. Avoid pushing them to eat if they don't feel up to it.

• Give them age-appropriate pain relief medicine, such as acetaminophen or ibuprofen. Follow the directions and dosage instructions for their age and weight. If you are unsure about the product or dosage, call your child's healthcare provider for dosage instructions. Do not give aspirin to your child, as it has been linked to Reye syndrome, a rare but serious disease, when given to children.

- Angela Miller, MD, is a pediatrician who provides health care for children from birth through young adulthood. Miller is board-certified in Pediatrics and sees patients at Monroe Clinic and Monroe Clinic-Freeport.