Franklin Roosevelt once said, The only thing we have to fear is fear itself. After 30 years of practice, I can tell you that, in addition to fear itself, parents fear fever! What is fever, when is it a concern, when and how should it be treated, and why should we care about it?

Fever is an absolutely normal body response to many conditions. The most common cause of fever in children is infection, and the most common cause of infection in children is viral illnesses. Rarely, other non-infectious inflammatory illnesses will cause fever, as can overheating in an extremely hot environment. Occasionally, some childhood immunizations can cause fever, and your child’s physician will discuss this with you when immunizations are given. Although there’s no scientific evidence that teething causes fever, many parents often associate fever with teething. Temperature greater than 101.4 should never be attributed to teething. An alternate source of the fever must always be sought.

Your child’s temperature can be measured orally (if your child is older than 4 or 5 and can cooperate), rectally (the most accurate but least pleasant method), or axillary (under the armpit). Ear and forehead (temporal artery) thermometers are available, but I don’t recommend ear thermometers as they’re sometimes inaccurate and inconsistent. It’s never accurate to measure a child’s temperature by merely feeling his skin.

Fever itself rarely needs to be treated. Instead, evaluate your child to gauge if she needs treatment for her fever based on the amount of discomfort it causes. The degree of temperature isn’t usually the best indicator of this. Some children tolerate temperatures of 103 without difficulty, and others are miserable when their temp hits 100. Fevers also need to be treated if your child has an underlying illness or a history of seizures associated with fevers.

Contact your doctor about your child’s fever include if he or she:

• Is less than 3 months old and has a rectal temp of more than 100.4.

• Is fussy and appears ill.

• Is between 3 and 36 months old and has a temp of 102 or greater.

• Has a temp of greater than 104 rectally or 103 axillary.

• Has a febrile seizure.

• Has had recurrent fevers for five to seven days

• Has a chronic illness such as heart disease, cancer, sickle cell, etc.

• Has a fever associated with a new skin rash.

If you’ve decided to treat your child’s fever, use appropriate doses of acetaminophen (Tylenol) or ibuprofen (Advil or Motrin) as recommended by the manufacturer and your doctor. Increase fluids, keep your child well-hydrated, allow him to rest and keep calm. Sponging isn’t particularly effective and never sponge your child with alcohol. Always call your child’s physician with questions, but remember that fever is a normal response to infection and is a symptom, not an illness.

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