When your child has a fever

How high is high? How can temperature be brought down? Tylenol or Motrin? Doctor offers tips

By CYNTHIA RAMNARACE
Evening News staff writer

A forehead hot to the touch may be the first sign. Or maybe your child wants to snuggle up to you instead of playing a game. It might be as blatant as the dreaded, "I don't feel good."

When a child has a fever, parents are understandably concerned, says Dr. Stephen R. Grider, medical director of Mercy Memorial Hospital Emergency Services. But parents can tend to overreact to what is the body's normal way of fighting an infection.

A misconception parents have "is that a fever means something, that a degree means how sick you are, that 103 is worse than 101," Dr. Grider says.

In reality, a child can have a fever of 103 and be at no risk for anything else other than dehydration. Or the child can have a 101 temperature, have trouble breathing and be dangerously ill.

"They may be really sick at 101," says Dr. Grider. "Don't wait until a fever reaches 105."

A fever is the body's way of fighting an infection. Some type of virus has been detected in the bloodstream, so the body turns up its thermostat as a way of killing the intruders. When the threat is gone, the body cools down. It allows itself to sweat again. A normal, healthy immune system will fight off most of these infections, Dr. Grider says.

When it comes to determining how sick your child is, Dr. Grider says, the number is only one part of the diagnosis. Other things to look for include:

Check your child's mood. Is he running a fever, yet still able to play and still has an appetite? Or is he listless, irritable and sleeping excessively? The latter is cause for concern.

Is breathing difficult?

Do you have trouble rousing him from sleep?

Does he complain of a stiff neck?

If your child has any of these symptoms, a call to your doctor or emergency room is warranted, Dr. Grider says.

Seizures are a big concern of parents, Dr. Grider says. But there is no magic number that triggers a seizure. Of more concern, he says, is how fast the fever comes on.

"Kids are more susceptible to febrile seizures," Dr. Grider says. "In kids, the wiring of their brains isn't as insulated."

And a seizure doesn't mean the child will develop epilepsy, although people who go on to develop that disorder are more susceptible to febrile seizures.

"Once a child is 4, 5, 6 years old, they are less likely to have febrile seizures," he said.

The biggest risk fevers present is dehydration, especially if it is accompanied by vomiting. Parents should try to get their children to drink Pedialyte or other liquids an ounce at a time. Even that little bit will help, Dr. Grider says.

Bringing the temperature down is the overall goal, so don't bundle your sick one up in blankets and flannel pajamas. That will only help his temperature rise, Dr. Grider says.

Try to lower the fever with tepid, not cold baths.

Don't rub them with alcohol, as it can seep through the skin and enter the bloodstream.

And don't let a child shiver, because that will encourage the body to heat up even higher. The key is to uncover a child as much as possible that they are not shivering but not sweating either.

Tylenol (acetaminophen) or Motrin (ibuprofen) are the remedies of choice for lowering fever.

"Many times, parents (coming to the emergency room) don't give a child Tylenol," Dr. Grider says. "They think the doctor wants to see how high the fever is."

Doctors are now recommending that Tylenol be given every four hours during the day and Motrin can be given before bed. That's because Motrin lasts eight hours and so provides a more restful night's sleep. Motrin works to lower fever, but it has not been around as long as Tylenol, so doctors prefer acetaminophen.

"Tylenol has been around 40 years," Dr. Grider says. "Motrin has been around for 10 years. Aspirin has been around over 100 years, and we know aspirin shouldn't be given to anyone under 18 (because of the risk of Reye's syndrome). But with Motrin, we just don't know yet."

Rest can be one of the best remedies for fever, so school nurses recommend children stay home. Karen Sparer, nurse at Bedford Public Schools, tells parents if a child's fever is over 100 they should not come to school.

"We encourage them to be fever free for 24 hours before they return," Ms. Sparer said.

A child who develops a fever at school will have a parent called to take him home. This is to limit the spread of infection to other students and make the child more comfortable.

"Usually when they start a fever, they're not up to sitting there and learning," Ms. Sparer said.

Your child has a fever if:

Mouth temperature is higher than 99.5 degrees.

Rectal temperature is higher than 100.4 degrees.

Armpit temperature is higher than 98.6 degrees.

When to call the doctor:

If a fever is higher than 103 degrees and has not responded to medication.

If child is younger than 3 months and has a fever higher than 100.4.

If child is less alert or less active.

If child has a seizure.

If child has difficulty breathing.

Dehydration is a major concern with fever. Signs include:

Sunken eyes.

Crying without tears.

Complaints of dry mouth.

Infrequent urination. Infants should urinate at least three times a day, children at least twice.

In infants, a depression on the soft spot in his skull.