Fever Management

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If Your Child has a fever what should you do??

Don't Panic and Follow these step below.

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Department of Pediatrics
Children's Hospital of Iowa
Peer Review Status: Internally Peer Reviewed
First Published: 1996
Last Revised: 2000

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Fever

• Fever is a rise in the body temperature to 101° Fahrenheit or greater
• Fever is the body's natural response to a viral or bacterial infection
• Fever is considered beneficial to help the body fight infection and usually not dangerous
• Feeling your child's forehead, face, or stomach may help to decide if he has a fever, but is not very accurate unless the fever is fairly high
• Taking a temperature is the only sure way to know if your child has a fever I Normal body temperatures may go up in the late afternoon or early morning

Call the clinic

• If your baby less than 6 months of age has a temperature 101° F or higher
• If your child's fever is 104° or higher
• If your child has other signs of illness (see When to Call the clinic)

Treating a Fever

Without medications

• If your child has a fever yet is content, eating, drinking, or playing he may not need medication
• Dress him in lightweight clothing or remove clothing to allow heat loss through the skin
• Use a lightweight blanket if he feels cold or is shivering
• Try to keep your child quiet - activity increases body temperature
• Give your child extra fluids to prevent dehydration or extra loss of water (water, iced drinks, popsicles, Jello, juices, or whatever he will drink)

With medications

• Medication is only needed to make your child more comfortable
• Give Acetaminophen (Tylenol/Tempra/Liquiprin/Panedol) every 4 hours
• If your health care provider orders lbuprofen (Pediaprofen/Motrin /Advil), give it every 6-8 hours
• Do not use Aspirin for fever (it has been related to a serious illness, Reye's Syndrome)
• Always give your child medication for fever if he has had febrile seizure (seizures when your child has a fever)
• Give your child a sponge bath with lukewarm water only (no cold water) if fever is higher than 104° F and fever is not decreased 30-60 minutes after medication is given-- NEVER LEAVE HIM ALONE IN THE TUB
• Stop the sponge bath if your child starts to shiver I Never use rubbing alcohol for baths or sponging
• Alcohol can cool your child too quickly and can be absorbed through the skin causing alcohol poisoning

Age	0-3 months	4-11 months	1-2 years	2-3 years	4-5 years
Weight (lbs)	7-15 lbs	16-23 lbs	24-28 lbs	29-40 lbs	41-50 lbs
Acetaminophen (Tylenol/Tempra/ Lipuiprin/Panedol) dose in mg	40 mg	60-80 mg	100-120 mg	120-160 mg	240 mg
Drops (1 dropperful = 80 mg/0.8 ml)	0.4	0.6-0.8	1-1.2	1.6	--
Elixir (160 mg/5 ml or 1 teaspoon	--	2.5 ml or 1/2 tsp	3.75 ml or 3/4 tsp	5 ml or 1 tsp	7.5 ml or 1 1/2 tsp
Chewable Tablets (80 mg each)	--	--	1 1/2	2	3
Ibuprofen * (Pediaprofen/Motrin/Advil) dose in mg		50-75 mg	100 mg	150 mg	150-200 mg
Ibuprofen (100 mg/5 ml or 1 teaspoon)	--	2.5-3.75 ml or 1/2-3/4 tsp	5 ml or 1 tsp	7.5 ml or 1 1/2 tsp	7.5-10 ml or 1 1/2-2 tsp

* prescription medication

Temperature Conversion

Celsius* or Centigrade*

Temperature Conversion
Fahrenheit (F) to Centigrade (C)
°F	95.0	95.2	95.4	95.6	95.8
°C	35.0	35.1	35.2	35.3	35.4
°F	96.0	96.2	96.4	96.6	96.8
°C	35.6	35.7	35.8	35.9	36.0
°F	97.0	97.2	97.4	97.6	97.8
°C	36.1	36.2	36.3	36.4	36.5
°F	98.0	98.2	98.4	98.6	98.8
°C	36.7	36.8	36.9	37.0	37.1
°F	99.0	99.2	99.4	99.6	99.8
°C	37.2	37.3	37.4	37.6	37.7
°F	100.0	100.2	100.4	100.6	100.8
°C	37.8	37.9	38.0	38.1	38.2
°F	101.0	101.2	101.4	101.6	101.8
°C	38.3	38.4	38.6	38.7	38.8
°F	102.0	102.2	102.4	102.6	102.8
°C	38.9	39.0	39.1	39.2	39.3
°F	103.0	103.2	103.4	103.6	103.8
°C	39.4	39.6	39.7	39.8	39.9
°F	104.0	104.2	104.4	104.6	104.8
°C	40.0	40.1	40.2	40.3	40.4
°F	105.0	105.2	105.4	105.6	105.8
°C	40.6	40.7	40.8	40.9	41.0
°F	106.0	106.2	106.4	106.6	106.8
°C	41.1	41.2	41.3	41.5	41.6

Body Temperatures

Normal		Fever	High fever
Axillary	98.0°F 36.7°C	99.4°F 37.5°C	104.4°F 40.8°C
Oral	98.6°F 37.0°C	100.0°F 37.8°C	105.0°F 41.1°C

Taking a Temperature

• Do not use devices such as temperature strips placed on your child's forehead or pacifier thermometers since they are not accurate
• Take your baby or young child's temperature under the arm (axillary)
• Rectal temperatures are not recommended because they are more difficult to take safely
• Never leave your child alone while taking his temperature

Types of Thermometers and Temperature Taking

Glass thermometer with mercury

• Most common thermometer
• Available as a rectal (shorter bulb) or oral (longer bulb) thermometer
• Shake the mercury down past where the numbers start on the thermometer before and after each use
• Always wash the thermometer after use with warm (not hot) soapy water or swab with rubbing alcohol
• Rinse with cool water and dry after each use
• Store thermometer in a safe place out of the reach of children in a container to prevent it from breaking
• Pros - less expensive, very accurate
• Cons - Fragile, numbers are hard to read, fussy children may not stay still for use of this type of thermometer

Axillary temperature

Hold tip of thermometer in the middle of the armpit with one hand Use your other hand to hold your child's arm snugly against his side Hold the thermometer in place 3 to 4 minutes

Oral temperature

Take an oral temperature only if your child is cooperative, and is 5 years of age or older Younger children may bite and break the thermometer Wait at least 10 minutes after your child drinks hot or cold liquids before taking temperature Have your child sit or lie down Put the tip of the thermometer under your child's tongue Tell your child to close his lips tightly but not to bite the thermometer Keep the thermometer in place for 2 to 3 minutes Never leave your child alone with the thermometer in his mouth

Reading a mercury thermometer

• Use your thumb and first 2 fingers to hold the thermometer by the end opposite the bulb
• Hold the thermometer horizontally at eye level
• Slowly turn the thermometer until the mercury column can be clearly seen
• Compare the mercury column against the row of numbers along the side
• The space between the longer lines is 1��ne degree)
• The space between each short line is 0.2��wo-tenths of a degree) read the short lines as two-tenths, four-tenths, six-tenths, eight-tenths
• Read the long line just to the left (toward the bulb end). of the mercury, count the short lines past the long line you just read, to the end of the mercury

• If your thermometer is in the Fahrenheit scale, the numbers will read 95..96..97..etc.
• I If your thermometer is in the Centigrade scale, the numbers will read 35..36..37..etc.

Digital thermometer

• Wipe with soapy water or rubbing alcohol and rinse with cool water
• Turn on the switch
• Place the sensor under your child's armpit or under his tongue
• Hold in place until it beeps when the highest temperature is reached
• Pros - easy to read, beeps when ready, faster (about one minute)
• Cons - more expensive, needs batteries, need to be careful to hold thermometer in place if your child is fussy

Tympanic (ear) thermometer

• Indicate if oral or rectal equivalent with a switch near top of the thermometer
• Put tip of thermometer gently into your child's ear canal
• Press the start button
• After one second, a digital reading appears in the small window
• Pros - very fast reading, easier to use with a fussy child
• Cons - most expensive (about $100), needs batteries, needs to be placed in the ear canal correctly for an accurate reading

References

Gunderson Clinic, Ltd. (1987). The baby book. (pp. 39-41) La Crosse WI: Author

McCormick, R., Gilson-Parkevich, T. (Eds.). (1979). Taking a temperature. In Patient and family education: Tools, techniques, and theory (pp. 272-273). Now York: John Wiley & Sons.

McCormick, R., Gilson- Parkevich, T. (Eds.). (1979). How to reduce a fever. in Patient and family education: Tools, techniques, and theory. (pp. 250-251). Now York: John Wiley & Sons.

Moss, J., The ups and downs of fever management. Small Talk, 5 (1) 1-7.

UIHC Department of Nursing (1991). Normal newborn instructions

UIHC Department of Nursing (1992). Fever telephone protocol

Weinstock, C., (1994). Focus on your child's fever. Healthy Kids, 1(3) 26-30.

Whaley, L., & Wong, D. (1983). Nursing care of infants and children (pp. 417-627). St. Louis: C. V. Mosby Co.