Fever is a symptom, not an illness or condition

DEAR DR.PAUL: How long is a fever safe in a child of 13 months? The fever was as high as 103°F (39.5°C). Antibiotics were started on the 4th day and the fever disappeared on the 7th day. Thank you.

PEDIATRICIAN DR.PAUL Answers: Your question and concerns are shared by many parents, in whom fever is a source of anxiety. Fever is a symptom and not a diagnosis or a medical condition.

The most common cause of a fever in children is an infection, mostly viral but in some cases bacterial. One of the challenges we have in evaluating children with fever is trying to determine the cause, or at least to make sure it is not due to a bacterial infection. This distinction is important, as viral infections do not need antibiotic treatment, but bacterial infections usually do. So the signs and symptoms that we keep an eye on in children with fever are clues to the cause.

In general, the younger the child, the sicker looking the child and/or the longer the fever persists, the higher the chance of a bacterial infection. As important as the degree of fever, is how a febrile child generally looks. I personally worry more about a sick looking child with a low fever, than a very well, active child with a higher fever. Having said that, most children with fever do not need antibiotics. Your situation sounds like it was more than just a virus. In fact, parents should consult their doctor if the fever persists beyond 4 days, even if a child is not sick looking.

The antibiotics were likely given to fight a bacterial infection, like an ear, sinus or chest infection. Importantly, once on antibiotics, the fever does subside right away. It usually takes at least a full 48 hours of antibiotic treatment before the fever falls completely.

The normal body temperature is usually 98.6°F (37°C). A child is said to have a fever depending on how the temperature is taken. If the temperature is over: 100.4°F(38°C) rectally, 100°F (37.8°C) orally or 99°F (37.2°C) axillary (armpit), the child is considered to have a fever.

Lowering the temperature with Acetaminophen (Tylenol or Tempra) can help your child feel better and less irritable. Aspirin(acetylsalicylic acid) should not be used. It usually takes up to 60-90 minutes for the fever to go down. If this doesn’t work, then the child could be given a luke warm sponge bath. Do not use cool or cold compresses or baths and never use alcohol sponging.

Here are some hints (alarm signs) on when to call your doctor about your child’s fever:

  • if the fever is higher than 103°F (39.5°C) or
  • if your child appears unwell or unusually ill (this applies even when there is no fever) or
  • persistent fever or
  • if your child is less than 6 months of age

My bottom line is that fever is usually not dangerous, and can be handled at home. Understanding the possible causes of fever and knowing what alarm signs to look for in a febrile child, is a great source of comfort to many of my patients.

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Pediatrician DR.PAUL Roumeliotis is certified by the American Board of Pediatrics and Royal College of Physicians and Surgeons of Canada. The information provided above is designed to be an educational aid only. It is not intended to replace the advice and care of your child’s physician, nor is it intended to be used for medical diagnosis or treatment. If you suspect that your child has a medical condition always consult a physician.