medical mondays: fever

First things first: A big thanks to E for the shout-out last week and many thanks to all you lovely mamas who have been so supportive and enthusiastic! I have loved "meeting" you and hearing your suggestions for future posts. Believe me, I take all these ideas to heart.

Several of my previous MM posts have mentioned fever. Such a simple little word that has so many different connotations and meanings and assumptions. Hopefully I can clear up some misconceptions and offer some helpful advice when it comes to this mysterious entity!

. . . .

At the office

So what defines a fever? 

You'd think this was a simple answer, but I hear this a lot: "My kid has a fever! At 1 am I went in and checked her temperature under her arm so I added a degree but she usually runs 96 so that means I always add two degrees but she had soup for dinner so I take away half a degree." I look down at the chart and it says 98.4. What do I make of this? There is a lot of conflicting, and frankly, confusing information out there about what fever is. Your thermometer will have specific instructions, and even medical websites publish different numbers depending on the body site that is used to take the temp. PLUS, add in the fact that we are all different people, with different average baseline body temperatures. Yikes. And you thought this was going to be a simple post...

Bottom line: it is generally accepted that anything over a rectal temp of 100.4 degrees Farenheit is considered a fever. 

So, if 100.4 is the lower threshold for fever, and 104 is entering concerning territory, what about all the numbers in between? They are considered the beneficial fever range. That's right. Crazy to think that 103.9 is considered a benefit to your child by your trusty pediatrician, eh? I talk to parents a lot about fever phobia. I may not use that specific term, but that's what it is. Fever is not the enemy, and should not be regarded as so. Some kids get a fever with any little cold. That is ok. Some kids have a raging double ear infection and are 97.5. That is ok too. Some kids feel miserable when their temp crests the 100 mark. No big deal. Others are happily skipping into my exam room while the thermometer reads 103. Surprising, but also, ok. I always tell parents: treat the kid, rather than the fever. Once you take that temperature, look at your child. If he is uncomfortable, make him comfortable. If she is fine, she is fine. If your mommy-gut is telling you that later tonight this fever might get higher, then treat it now. If your mommy-gut is telling you that she really doesn't need more medicine in her system, then she doesn't need more medicine in her system.

How come in the pictures I find the sick kids are always so adorable?

A discussion about fever would be incomplete without talking about thermometers. There are of course LOTS of different kinds of thermometers and thus LOTS of different ways to take a kid's temp. Almost any method you use can be accurate if the method is performed correctly and under the right circumstances. Did you catch that if? It's a big IF, because we moms (I include myself) aren't too good at thermometer methodology. Hey, most of us aren't taking our child's temperature when the birds are chirping and the sun is shining and little Sally is happily sitting very still on a chair for five minutes with a thermometer gently placed under her armpit. Conditions are usually less than ideal when it comes time for checking that temperature, but that is something you should take into consideration when deciding when, where, and how to check.

For example: is your kid prone to ear infections? Or is he super ear-waxy? Or does he HATE to have his ears touched? Probably best not to purchase or use an ear thermometer, since some studies suggest that having an ear infection or wax can significantly alter the reading. AND even in an non-ear-infected-kid, the ear canal must be positioned properly for the infrared light to reach the ear drum and get an accurate reading.

The most accurate way to take a kid's temperature is rectally. Hands down. Everybody knows it. All the studies agree.  If you REALLY need to know your baby's specific temperature, take it rectally.

We generally regard an axillary (armpit) reading as the least accurate, probably because it is the least likely to be performed correctly. An oral temperature, while having the potential to be more accurate, also falls victim to questionable technique, and is especially inaccurate in younger kids for this reason. Same goes for ear thermometers for the reasons mentioned above. Temporal artery themometers are the newest technology, and so we don't have a lot of data to prove or disprove their accuracy. They are generally regarded as reliable, though, as long as they are used properly.

Are you discovering a theme here? Bottom line is this: whatever thermometer you buy, make sure you learn how to use it. And assess your family's situation before you make the purchase: age of kids, wiggliness of kids, individual preferences of kids (aka some kids can't stand anything in their mouths, others won't let you near their armpits with a 10-foot-deodorant stick. Only you, their lucky mother, can know of these endearing quirks, and can therefore use this information when making family decisions). As long as you feel comfortable with the method you choose, and learn how to do it right, you should be good to go.


{The Academy of Pediatrics outlines the best way to take an oral, axillary, and rectal temperature here. If you are in the mood for some quality entertainment, you can watch an educational video about how to use a temporal artery thermometer here.}

So let me give some scenarios of when it really really truly matters to know what a kid's temperature actually is. Getting a to-the-tenth-of-a-decimal reading is important mostly for very young babies. For all very young babies (under 8-12 weeks) you really have to check a rectal temp if you are concerned about fever. For a 2-week-old, a reading of 99.8 is very different from 100.4 and will mean a completely different work-up. For a 1-year-old, however, 101.5 or 102.5 won't make much different in how I treat her. It doesn't really matter to me if it was an oral or rectal or temporal reading. She has a fever; that's all I need to know. Even in the 1-year-old, 99.5 verses 100.4 still won't make that much of a difference in my decision making. Her list of other symptoms and physical exam will tell me enough to make a sound judgement about what she needs. Now, in this same 1-year-old, if her mom gets a temperature reading at home of 105, and then dad takes it and it is 103, that is a big difference. 105 is high. It would behoove these parents to hold that baby down and get a rectal temp, because in this case, it would change our medical decision making. Are you with me?


So what can you do to treat a fever? Remember in Little Women when Marmie started rubbing Beth's feet to "bring the fever down from her head"? I always wondered if that actually works. Your kid might like the foot rub, but best not to rely on that method alone. Acetaminophen or ibuprofen will work to bring a fever down. Have her drink lots of fluids. Take a warm sponge bath if needed. Remember, too, that it's common for fever reducer to bring the fever down by a couple of degrees, not necessarily wipe out the whole fever. It is not a sign of something more serious if the temperature is still over 100 even after medicine is given.  While most fevers can be treated at home, if your thermometer is reading 104 (and you've been using it correctly), it's time to see your Pediatrician just to get things checked out.

I discussed Tylenol and Motrin ad nauseum extensively in a previous post. Have a look if you like.

In the textbook

Just a couple of key points here.

1. Fever is our immune system's response to an infection. A lot of viruses or bacteria can only survive in a narrow range of temperatures, so our body tries to heat things up to kill off those bad bugs.

2. Everybody's temperature is highest in the early evening and into the night (6pm to midnight-ish) and lowest in the early morning hours (midnight-ish to 6am). So when your baby wakes up on day 3 of his cold without a fever, and then it reappears at dinner-time, that is to be expected.

3. Brain damage from a high fever doesn't happen until the REALLY high fevers--like the 108 range. Our body is pretty good at not letting that happen.

At the Buck house

Jonathan has only had a true fever once, and it was only about 100.5, and it was the day after he got his 4-month vaccines. He felt pretty crummy, even though it was a low fever, but he was fine. We gave him Tylenol to help his discomfort. Well, I think Jon did. I was at work having a freak-out. Of course.

Improper technique.

I could really rename this section, "And Now it's Time for Lea to Fess Up," because I go through all this trouble to give you lots of good advice and information, and now I have to tell you what we really do at our house. The truth is, we don't even have a rectal thermometer. I just forgot to get one when he was really little, and I haven't felt a need to have one since then. And I guess if we REALLY needed to know Jonathan's temperature, we could use our regular ole digital one (which would then become permanently for rectal use only).

We have the Exergen Temporal Artery Scanner. I like it. I think it was worth the 50 bucks. It is easy to use and, while studies haven't been conclusive, I think the research points towards these being more accurate than the other non-rectal options. Plus, Jonathan loves, I mean really LOVES when I take his temperature because he gets to watch that red light slide across his forehead. He gets so happy. And really, isn't that the most important thing?

The most thrilling moment of his day.

. . . .

Read the disclaimer if you want

Have a Happy Fever-free Monday!