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Fever In Children

Intro

You should call your child's doctor if any of the following are present with fever.

  • Your child is younger than 6 months of age since birth (regardless of prematurity).
  • You are unable to control the fever.
  • You suspect your child may become dehydrated  from vomiting, diarrhea, or not drinking (sunken eyes, dry diapers, tented skin, unarousable, etc.).
  • You have been to your child's doctor, and your child is now getting worse or new symptoms have developed.

Although you may have done your best to care for your child, sometimes it is smart to take your child to the emergency department. Your child's doctor may meet you there, or your child may be evaluated and treated by the emergency doctor.

You should take your child to an emergency clinic when any of the following happen:

  • You have serious concerns and are unable to contact your child's doctor.
  • You suspect your child is dehydrated.
  • A seizure occurs.
  • Your child has a purple or red rash.
  • A change in consciousness occurs.
  • Your child's breathing is shallow, rapid, or difficult.
  • Your child is younger than 2 months of age.
  • Your child has a headache that will not go away.
  • Your child continues to vomit.
  • Your child has complex medical problems or takes prescription medication on a chronic basis (medication ordered for more than two weeks' duration).

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Self-Care at Home

The three goals of home care for a child with fever are to control the temperature, prevent dehydrated, and monitor for serious or life-threatening illness.

The first goal is to make the child comfortable by monitoring and reducing the fever below 102°F (38.9°C). This is achieved using a thermometer and medications and dressing the child appropriately. A warm water bath can also be helpful but should be used for no more than 10 minutes each hour.

To check your child's temperature, you will need a thermometer. Different types of thermometers are available, including glass, mercury, digital, and tympanic (used in the ear).

Most doctors do not recommend tympanic thermometers, because their use outside the clinic is unreliable.

Glass thermometers work well but may break, and they take several minutes to get a reading.

Digital thermometers are inexpensive and obtain a reading in seconds.

It is best to check an infant's or toddler's temperature rectally.
Hold the child chest down across your knees.
Spread the buttocks with one hand and insert the thermometer lubricated with a water-soluble jelly no more than 1 inch into the rectum with the other hand.

Oral temperatures may be obtained in older children who are not mouth breathing or have not recently consumed a hot or cold beverage.
Acetaminophen and ibuprofen are used to reduce fever.

  • Follow the dosage and frequency instructions printed on the label.
  • Remember to continue to give the medication over at least 24 hours or the fever will usually return.
  • Do not use aspirin to treat fever in children, especially for a fever with chickenpox.aspirin has been linked to liver failure in some children. Ibuprofen use has also been questioned to treat chickenpox.

Children should not be overdressed indoors, even in the winter.

  • Overdressing keeps the body from cooling by evaporation, radiation, conduction, or convection.
  • The most practical solution is to dress the child in a single layer of clothing, then cover the child with a sheet or light blanket.

A sponge bath in warm water will help reduce a fever.

  • Such a bath is usually not needed but may more quickly reduce the fever.
  • Put the child in a few inches of warm water, and use a sponge or washcloth to wet the skin of the body and arms and legs.
  • The water itself does not cool the child. The evaporation of the water off the skin does, so do not cover the child with wet towels (which would prevent evaporation).
  • Contrary to the popular folk remedy to reduce fever, under no circumstances should rubbing alcohol be used in a bath or rubbed on the skin. Alcohol is usually dangerous to children.

The second goal is to keep the child from becoming dehydrated. Humans lose extra water from the skin and lungs during a fever.

  • Encourage the child to drink clear fluids such as non-carbonated drinks without caffeine or juice (not water). Water does not contain the necessary electrolytes and glucose. Other clear fluids are chicken soup, Pedialyte, and other rehydrating drinks available at your grocery or drug store.
  • Tea should not be given because it, like any caffeine-containing product, causes you to lose water through urination and may contribute to dehydrated.
  • Your child should urinate light-colored urine at least every four hours if well hydrated.

The third goal is to monitor the child for signs of serious or life-threatening illness.

A good strategy is to reduce the child's temperature to under 102°F (39.0°C).
Also, make sure the child is drinking enough clear fluids (not water).
If both these conditions are met and your child is still ill-appearing, a more serious problem may exist.

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Follow-up

Usually, the emergency department doctor will ask that, within the next 24-48 hours, you contact or see your child's doctor or return to the emergency department.

Your child's condition can be further observed at home or in the clinical area.
Any treatment prescribed by the doctor in the emergency department should be monitored for effectiveness.
You should receive information about any tests and cultures performed for your child and follow-up instructions if necessary.

Prevention

Prevention of illnesses that cause fever revolves around personal and household hygiene. Use these strategies to prevent the spread of viruses and bacteria:

  • Wash your hands with soap and water.
  • Cover your mouth and nose when sneezing and coughing.
  • Handle food with clean hands.
  • Properly immunize your child (see the children's immunization schedule).
  • Eat a healthy diet including fruits and vegetables.
  • Get the proper amount of sleep.

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Outlook

The prognosis for a child with a fever is excellent.

  • Most illnesses that cause fever last three to seven days.
  • Sometimes, at-home treatment of bacterial infections fails and the child will need to be hospitalized.
  • Meningitis and bacterial blood infections have a much more serious prognosis than the far more common viral infections.

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