Fevers in children

Featured pediatric expert

Reshmi Basu, MD, FAAP

Dr. Reshmi Basu is a pediatrician with Children’s Health of Orange County (CHOC). She graduated from the University of California, Irvine with a degree in Biological Sciences, and went on to pursue a medical degree at the University of California, San Diego. She completed her residency training in pediatrics at CHOC. Dr. Basu has been involved with the American Academy of Pediatrics — Orange County chapter as an executive board member since 2017 and currently serves as Vice President. She chose pediatrics because she has always been amazed by the great resiliency of children. She has an interest in child advocacy and is now specifically involved in bringing new developmental screening and trauma-informed care initiatives to Orange County. She has a special interest in educating her patients about resiliency and has completed training as a Resiliency Coach.

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Transcription

Melanie Cole (Host): So many parents worry if their child has even the slightest fever, but what are fevers actually and when is it time to call your pediatrician? Welcome to Long Live Childhood, a pediatric health and wellness podcast presented by Children’s Health of Orange county. Together, we can keep kids happy and healthy.

I’m Melanie Cole, and joining me is doctor Reshmi Basu. She’s a pediatrician with Children’s Health of Orange County. Dr. Besu, thank you so much for joining us today. So I’d like you to start by telling parents a little bit about fevers. What is a fever? Why does our body do this and tell us some of the most common causes.

Dr. Reshmi Basu: Thank you so much for having me here today. And, you know, I can tell you, having been in practice for about 13 years, that we get these questions about fevers pretty much every single day, and probably every child will have a fever at some point during their childhood. And the definition of fever in the doctor’s office is a 100.4 or higher. Sometimes that can seem like a little bit of an odd number, but where that comes from really is 38 degrees Celsius, which translates to a 100.4 in Fahrenheit. And the cause of the fever typically is going to be an infection and what we want to really figure out in that child, is it an infection that will go away on its own or is it something that needs more care from your doctor?

A lot of viral infections will cause fevers and these will self-resolve. And then there are other causes, like bacterial reasons, such as strep throat, urinary tract infections, ear infections or pneumonia. And those will need more medicine and more evaluation from your pediatrician. And so the key is trying to figure out when to bring your child into the doctor and when you can treat it at home.

Melanie Cole (Host): Certainly is the key. Now, when does a fever indicate something more serious? How high does it have to be? Because I remember when my kids were little and my pediatrician said if it’s not 104, you don’t have to worry. But I guess doesn’t it depend on the age of the child as well? So little babies different than five-year-olds different than teenagers.

Dr. Reshmi Basu: Yes. So there’s different levels of concern depending on the age of the child. If the baby’s less than three months old, then really any temperature higher than that a 100.4 degrees Fahrenheit, I would take the child in to be evaluated by your pediatrician. They may not necessarily need any treatment at that point, but it is a good idea at least to be evaluated. Between three months and three years of age, you may be able to wait up to three days with the caveat that you really should determine what your child is looking like in terms of their regular activity or their drinking and eating, if they’re doing those things regularly and don’t seem overly sick other than the fact that they have that fever, you can maybe wait three days. If they’re older than that, even older than three years, you may be able to wait until five days of fever. And again, the key is to make sure that your child doesn’t look sick otherwise. If they’re complaining about things like pain during urination, their throat hurting, their ears are hurting, you may not want to wait that long. But if they don’t have those other symptoms, they’re eating and drinking fine, they’re jumping around playing, you might be able to wait that long.

A lot of parents ask what temperature is too high. And I actually tell them, it’s not necessarily the height of the temperature I worry about, but rather the length of the fever. So, like I mentioned before, more than five days of fever in any case, regardless of the actual temperature, I’m going to worry about and probably evaluate further, but a fever of only two days, even if it is 104 and it goes away, I’m not so worried.

Melanie Cole (Host): So that’s very reassuring. And I know for parents, when they hear you say, you can wait five days, boy, some parents, they don’t even want to wait two hours if their kid has a fever. So I’d like to first break up a few myths about things that can cause it while we’re sort of on that area of this discussion. What about things like teething? Because you mentioned infections and urinary tract and all that, but there are myths out there and parents say, “Oh, he’s running a fever because he’s teething.” Can those kinds of things cause fever?

Dr. Reshmi Basu: There really isn’t great scientific evidence that teething causes fever. But anecdotally, certainly many parents will mention that their child feels a little warmer when they’re teething. And so I don’t know that it’s completely untrue. However, if a fever is persisting, if they consistently have a temperature over a 100.4 degrees more than a few hours, and definitely more than a day, I will not attribute it to teething and I will look for another cause.

Melanie Cole (Host): So doctor, while we’re also discussing how long we wait and when it’s more serious, there are serious fever spikes like a febrile seizure, which I told you about off the air, because my daughter had one. So tell us how an elevated temperature like that can cause a seizure and what you want parents to know about this really high spike in a fever that can cause this very scary situation.

Dr. Reshmi Basu: So another question I also get often is can a high fever cause brain damage, and the answer to that is no. However, there is this thing called febrile seizures, where in a child, in certain children, if the fever spikes too fast, if it goes too high too fast, then it can induce a seizure. And yes, that can be incredibly scary as a parent and will likely need a 911 call, because when you’re seeing your child seize, there’s really no other option at that point. At the end of it though, febrile seizures are fairly benign. The children do grow out of them. They are most common between six months and six years of age. And after that, they tend to go away on their own. So, especially if there has been a history of a febrile seizure in a child, we definitely will want to medicate that child at the beginning of their illness when they’re starting to have a fever so that it doesn’t spike too fast. In other children, when we talk about treating their fever, it’s probably okay to wait, again, as long as they don’t seem too uncomfortable from the fever.

Melanie Cole (Host): Well, I think that’s a really key message here, is that we have to know our own children and we have to look at them and see if they’re lethargic, see if they’re going to the bathroom, see if they’re interested in playing, all of those things that you mentioned before we worry about any other complications from those fevers. So along those lines, do all fevers have to be treated?

Dr. Reshmi Basu: So, no, they don’t. Again, it really depends on your child. So if a child has 101 degree temperature, but they’re acting incredibly fussy, they don’t want to drink, you’re afraid that they’re going to get dehydrated because they’re refusing to eat or drink, then treat that fever. On the other hand, a child may have 102 fever and be jumping around and playing in that case, you don’t need to treat it at all.

You know, we need to remember that a fever is our body’s way of trying to help us fight an infection. And the fever itself is not something that’s necessarily harmful to the body. It’s really when that fever makes us uncomfortable and, as parents, and if you remember having a fever yourself, sometimes, you know, you get those chills, you feel hot, you feel cold, and it just makes you uncomfortable. And in children, that can lead to things like dehydration, if they’re not wanting to eat or drink because of that. So in those cases, we do want to treat the fever.

Melanie Cole (Host): Well, and as you just stated, fever is our defense mechanism. It’s our warning sign. It’s our body’s saying, “Hey, I need to work on this a little bit. You might get a little bit hot for a while, but I’m going to be working on this infection” or whatever it is our body’s trying to do. So if we do want to make our child more comfortable, talk to us about over-the-counter medications, because there is ibuprofen, there is acetaminophen, there’s all different brand names of those. What do we give our children? And is there a reason?

Dr. Reshmi Basu: Yes. So the two you mentioned are the two over-the-counter medication for a fever that we recommend, acetaminophen and ibuprofen, and those are the generic names. They come in all different brands, like you said, acetaminophen is Tylenol, ibuprofen can be Motrin or Advil. And the brand really doesn’t matter. You can buy the store brand as well. And so really looking for those generic names, either acetaminophen or ibuprofen is what you want to use. Many parents ask about alternating the medications, if they need to. And I do say that that’s okay, but I don’t generally recommend it. the less medicine, the better, as just a general rule.

However, sometimes there are cases when you give one of the medicines and a few hours later, the temperature is spiking again, and it’s too soon to medicate again with that same medicine. In that case, you can alternate about every three hours. But I definitely stress this to my parents that if you’re doing that, write it down. It can get confusing. You know, you’re tired, you’re taking care of a sick child, you can get confused. You can forget which one you gave and you don’t want to overmedicate with the same medicine. So write down which one you’re giving. Three hours later, you can alternate with the other ones. And if the fever is not spiking after those three hours or so, then again the preference is to pick one medicine and stick with it, whether it’s acetaminophen or ibuprofen. That can be a personal preference. It may depend on what your child tolerates better. Some like the taste of one versus the other one. In that matter, it’s okay. It doesn’t matter which one you use.

Melanie Cole (Host): It doesn’t. So do you have a particular favorite? I mean, myself, I preferred ibuprofen just because it has the anti-inflammatory effect as well. So if they have muscle aches along with the fever, I kind of figured it goes along with that, but the acetaminophen is really just that fever reducer, painkiller. Do you have favorite?

Dr. Reshmi Basu: You know, just as a parent, I did prefer ibuprofen as well, because I felt that it acted a little faster and lasted a little bit longer than the acetaminophen. But there isn’t necessarily one being superior than the other. And also in certain medical conditions, if your child has an underlying medical condition, one may not be okay to use. For example, if your child has an underlying kidney disease or liver issue, there might be one that is not okay to use. So make sure you have to discuss that with your doctor if they don’t recommend one.

Melanie Cole (Host): And also things like Motrin can upset the stomach sometimes if the child hasn’t eaten and that sort of thing. So you’re right, it is certainly up to the parents. And as we get ready to wrap up, I’d like you to tell us when we call our pediatricians and what we can do, at-home care, for our children that have fevers aside from medication. What would you like us to know about helping to bring the fever down if we even want to bring the fever down and making our children more comfortable?

Dr. Reshmi Basu: Yeah. So if your child is uncomfortable, you’ve already done some medicine and you’re kind of waiting for that to kick in, some other things you can do is, one, make sure your child is hydrated. Fevers themselves are dehydrating. So make sure they’re drinking fluids. You can use like a lukewarm washcloth or put them in a lukewarm bath, make sure water’s not too cold or that washcloth is not too cold though. And then in terms of when to call your doctor, the big guideline is not just five days I spoke about earlier, anything more than five days, we are absolutely concerned about.

And then the other thing I tell my parents is that if a fever is gone for 24 hours, it should stay gone. It should not come back. So a fever that recurs, that comes back, can be a sign of a secondary infection. So a cold that has turned into a pneumonia or turned into an ear infection. So if a fever has gone away, it should not come back. And if it does, call your doctor,

Melanie Cole (Host): Great advice. Thank you, Dr. Basu, so much for joining us. Really helping to clear things up because being a parent is hard enough, but when your child has a fever, it can be so really scary, but also sad if you feel bad for your child and they’re not comfortable. So thank you for all of this great information today.

And for more pediatric health and wellness tips, please visit choc.org. Thanks so much for listening to Long Live Childhood, a pediatric health and wellness podcast presented by Children’s Health of Orange County. Together, we can keep kids happy and healthy. And be sure, parents, to share these shows on your social channels. We’re learning from the experts at CHOC together, and today was no different. I’m Melanie Cole. Thanks so much for listening.