Friday, September 14, 2007

Fever and Babies

It's hard to keep your cool when your kid is burning up. We asked doctors what you should (and shouldn't) do the next time it happens.

Before You... Panic

Remember: A fever is not an illness. It's usually just a sign that your child's immune system is fighting off a bacterial or viral infection, says Michael Devon, MD, a pediatrician in private practice near Philadelphia. Most of the bugs that cause a fever -- such as a cold, the flu, a stomach virus -- aren't dangerous and are treatable at home.

Check your child's other symptoms. How she acts and feels is usually a better indicator of how sick she is. (In fact, if your child has a high fever that doesn't mean she's sicker than if she has a low-grade one.) "If your child is lethargic, irritable, has a sore throat, ear or stomach pain, or pain when she urinates, call your doctor," says Dr. Devon. (Can't find any obvious source of infection? That also warrants a call.) And always get help immediately if you have a feverish baby under 3 months old, no matter what her symptoms are. Infants that young are more susceptible to certain types of infections, so your pediatrician needs to rule out serious illnesses right away.

Before You... Take Your Child's Temp

Ditch your glass thermometer. Those old-school thermometers contain mercury, a potent toxin that affects the brain, spinal cord, liver, and kidneys, and can cause learning disabilities. If it breaks, you risk exposing your family to mercury's harmful vapors. Still have one lurking in your medicine cabinet? Don't just toss it into the trash. Take it to your pediatrician (she can dispose of it safely), or drop it off at your local hazardous-waste collection site.

Pick the right method. For babies, you'll get the most precise reading using a digital rectal thermometer; you can switch to an oral one when your child turns 3. An ear thermometer, although it's fast and convenient, can actually be deceptively tricky to use: You have to place it correctly in the ear canal for an accurate result. (Too much earwax can throw off the reading as well.) Underarm and pacifier varieties are also less reliable than the gold-standard rectal and oral thermometers.

Perfect your technique. To take a rectal temp, first dab petroleum jelly on the bulb of the thermometer. Place your baby belly-down on your lap or on a bed or changing table, then gently insert the bulb 1/2 to 1 inch into your child's rectum. Loosely hold the thermometer in place with two fingers until it beeps. To get an accurate reading using an oral thermometer, wait at least 15 minutes after your child has had anything hot or cold to eat or drink before you take his temperature.

Before You... Give Fever-Reducing Meds

Realize that they're not cures. The main reason to give your child acetaminophen or ibuprofen is to make her more comfortable -- not to "break" the fever. Fever is actually a good thing, since it helps the body fight infection. Most illness-causing germs thrive at a person's core body temperature (98.6 F.), so when the immune system detects an infection, it responds by cranking up the body's thermostat to help kill the germs. Just don't expect an immediate recovery. "At most, the meds will bring a fever down a degree or two -- just enough to make your child feel better," says Ari Brown, MD, a Parents advisor and author of Baby 411.

Choose the right fever-reliever. Give acetaminophen to babies under 6 months; ibuprofen isn't approved for kids that young because its safety hasn't been established. For older kids, ibuprofen seems to bring fever down faster, according to a research review in the Archives of Pediatrics & Adolescent Medicine. But since acetaminophen is less likely to cause stomach upset, it may be a better bet for kids with a sensitive tummy.

Once you've chosen a medication, stick with it. Though a recent Archives study found that alternating doses of acetaminophen and ibuprofen is more effective than using just one, some experts warn that mixing meds can be confusing and increase the risk that you'll overmedicate your child.

Read all medication labels carefully. If you're giving your child over-the-counter cold medicine, make sure that it doesn't contain acetaminophen or ibuprofen if she's already taking medication for fever. Otherwise, you could end up giving your child a double dose, says Dr. Devon. And you should never "eyeball" the dose; follow the instructions on the bottle. "Choose the amount that matches your child's current weight, and use the dropper that came in the package," says Dr. Brown. Because fever medications are sold in different strengths, the dropper for one bottle might not be right for another.

What If My Child Has a Seizure?

About 4 percent of children under age 5 have fever-induced seizures (febrile seizures), which are often caused by a sudden spike in body temperature. They seem scary -- your child may lose consciousness, shake, or stiffen -- but they're usually harmless. Most febrile seizures end in a minute or two, though some last just a few seconds or for more than 10 minutes.

If your feverish child starts convulsing, place her on a soft surface and roll her onto her side so she won't choke. Never put anything in her mouth or try to hold her down. When the seizure ends, call your pediatrician -- if this is the first time it's happened, she needs to be evaluated right away. "Once your child has been diagnosed with febrile seizures, you can relax a bit if it happens again -- as long as you know why she has a fever," says Dr. Brown.

What's Hot, What's Not

Your child officially has a fever when the thermometer reads 100.4 F. and above, according to the American Academy of Pediatrics. When it warrants a call to your doctor, however, varies by age:


When to Call

Under 2 months

100.4° F

3 to 6 months

101° F

Over 6 months

103° F


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