Fever Facts

What is fever? Fever is a body temperature that is higher than normal. Since the average body temperature is 98.6 degrees Fahrenheit, fever is typically used to describe a body temperature above 100 degrees.

Fever is not a disease but a symptom. It is a complicated response of the body to an outside stimulus, usually an infection. Low or moderate fever alone is generally not harmful, though it may cause discomfort to the child.

Fevers, even mild ones, are of much more significance in younger children, particularly babies. A temperature of 100 degrees F or more in an infant or in a child less than one year of age is serious, and a physician should be consulted. After a year or more of age, low grade fever is usually not as significant, but the caregiver should still contact the parents of any child with fever.

Taking the child's temperature

If you want to measure a child's temperature, the right tools are important for accuracy. Do not rely upon a sensation of warmth when you put your hand on the child's forehead. Ear, or tympanic membrane, thermometers are accurate, quick, and convenient. They are easy to use, even on a squirming or sleeping child. Follow the directions provided by the manufacturer, placing the tip of the instrument firmly, but not forcefully, into the outer part of the ear canal.

Glass, mercury-filled oral thermometers are very accurate, but difficult to use with children who will not hold still for the necessary two-three minutes these thermometers require. In addition, they can be difficult to read. Plastic digital thermometers are fine for taking temperature either in the mouth (oral) or under the arm (axillary), and they usually take less than a minute to register the temperature. When taking the temperature under the arm, hold the thermometer under the arm against the bare, dry skin, with the arm tight against the chest. Inserting the thermometer into the child's bottom (rectum) is not recommended in childcare programs because of the real (although slight) danger of injury to the intestine.

If a child has a fever, the parents should be notified. However, the caregiver should make some additional observations to help the parents and their health care professionals assess the significance of the fever. For example, temperature may rise slightly during intense physical activity, so you may want to repeat the temperature taking 30 minutes later if the child has been running around or playing vigorously. Next, observe the child's actions and behaviors. A child who acts sick or who is listless (lethargic) can be developing a major problem even if there is little or no fever and a physician should be consulted.

The presence of a fever alone may not require that a child be sent home from the childcare program. However, if the fever is accompanied by a change in behavior or other signs of illness, the child should be sent home.

Complications

On rare occasions, fever itself can cause major problems. Young children may have convulsions (seizures) because of the fever, not because of the illness that caused the fever. In those instances, the temperature may be 103 degrees F. or higher and have come on suddenly. Emergency help should be called. Place the convulsing child on the floor or on a firm cot and check to be sure the child's airway stays clear. (Childcare programs should ALWAYS have on site a provider trained in infant/child CPR.) Do not try to put a stick, your finger, or anything else in the mouth; the child will not swallow his or her tongue, and the stick is not likely to help keep the airway open. Sponge the child with lukewarm or cool water to help lower the temperature. Slosh it on; do not drape the child with wet towels because they immediately become insulating blankets and hold the heat in. Do not try to give a convulsing or very lethargic child anything by mouth that he or she might choke on. The seizure should not last more than three or four minutes and generally will not harm the child.

Heatstroke is a distinctive and very serious condition related to body temperature. When humans are overdressed and/or overactive outside in hot and humid weather, body temperatures can quickly rise to 107 degrees F. or higher. People who are in enclosed spaces without air-conditioning during very hot weather also can suffer from heat stroke. This most often affects the elderly but also may include situations such as when a child has been left in a vehicle during hot weather. Heatstroke must be treated immediately and emergency help should be called. Cool the child by sloshing him with cold water or even ice water, or immerse the child's body in a tub of cold water. Although you are not likely to encounter heat stroke, being prepared may save a life should the circumstance arise.

Remember that fever is a signal that something is happening within the body. Fever can cause discomfort, but it is rarely dangerous. Fever facts are important to know as children in childcare settings do develop fevers. Knowing what to do when a child develops a fever can help keep this "hot" situation. Fever facts are good to know!

By Don Palmer, MD, Chairman of the Child Care Committee,
Alabama Chapter, American Academy of Pediatrics

www.drkoop.com