One of the biggest chief complaints I see in the ER from parents is fever related to common infections. The dreaded fever!! Now why is a fever so damn scary? Because it means your child is sick and no parent wants to see his or her child suffer.

The first time my daughter had a fever was after her one-year immunizations. I thought the world was literally ending. I knew deep down that she was TOTALLY fine, but the fear of anything bad happening to your child takes over your body and all rational thought goes right out the window. So I understand why some may think a fever is a death sentence. But get this:

FEVERS are NOT always bad! FEVERS, believe it or not…can be GOOD!

I know…It’s hard to believe right? Your probably thinking I am totally full of it. How can a fever be good when it makes you feel so bad? Take a look for yourself. Read on and see what the American Academy of Pediatrics has to say about this.

*Disclaimer: Just a heads up guys this is not medical advice. Please consult with your primary care provider before making any decisions that will impact your health. For further information, see my disclaimer page.

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What is a fever?

A fever is a rise in body temperature equal to or above 100.4 F (37.8 C). When it comes to illness, it is your body’s defense mechanism against fighting infection. Think of it as your body raising its temperature to incinerate the nasty bug that has invaded your body. Your body actually needs the fever to help fight the bad guys.

Why parents fear the dreaded fever?

One of the biggest misconceptions that parents have today is that their child must maintain a normal temperature. According to the American Academy of Pediatrics, the main concern for caregivers is that if high fevers are left untreated, it could lead to seizures, brain damage, or even death. However, the AAP (American Academy of Pediatrics) states that there is no evidence that a fever itself will cause long-term neurological complications or worsen the course of an illness. In order to cause brain damage, one’s temperature has to reach as high as 107.6 F and stay there for an extended period of time. This is rare and according to Dr. Green (<- check out his website! Great resource!) your body will stop the fever from climbing at 106 F.  Occasionally, a child might go over 105 F, but this is usually due to excessive clothing, blankets, or being kept in a hot area.

It is also important to point out that the degree of fever does not always correlate with the severity of illness. Fever actually retards the growth and reproduction of bacteria and viruses. Now a fever may indicate the presence of a serious illness, but usually it is caused by a common infection. However, I have to mention that if you have an infant less than 3 months old with a temperature above 100.4 F (37.8 C) that is a medical emergency. They have absolutely no immune system and need to be seen immediately.

Fever caused by illness vs heat:

Now there is also a difference between a fever caused by illness as opposed to a fever caused by heat stroke, medications, or illicit drugs. Basically a fever caused by illness is your body resetting the hypothalamic set point (the part of the brain that controls body temperature) in response to the infection. Where as with heat stroke or drugs, your body’s temperature goes above the hypothalamic set point. This is because your body’s heat dispersing mechanisms have failed.

So even if my daughter has a temp of 104 from the common cold, I’m going to think her body raised it to help incinerate those nasty bugs. But if she has been playing outside in the heat and then has a temp of 104, I’m going to think it’s because:

  1. Her body’s heat dispersing mechanism has failed
  2. I failed to keep her hydrated and cool.

Now why do we care that there is a difference? When your body has lost it’s ability to cool itself down, the temperature is going to continue to increase, reaching those incredibly high levels that cause brain damage and seizures.

What do I do if my child has a fever?

So now your thinking, well my child isn’t eating or drinking and they are just lying there miserable. What am I supposed to do now? Just let the fever run its course?

Ill answer that question with what I have learned working in the ER and that is, treat the symptoms and not the fever (granted if your child has a serious health condition please consult your primary care provider immediately). Sometimes my daughter will be running around with a temperature of 104 drinking her juice, other times she has been lying on the couch watching Disney Jr refusing anything I give her, but her temperature is only 101.

So in which instance did I give her medication to make her feel better? The latter, because even though her fever was mild, it was affecting her ability to take in fluids. Dehydration is a whole nether beast in itself that you do not want to mess with.

Symptoms to watch out for:

Of course any parent that is concerned for their child will be watching them like a hawk. So take note, are they up playing with toys or are they lying on the couch not responding to you? If my daughter wasn’t responding I would be calling an ambulance, but if she is playing like normal I am inclined to think that the fever isn’t bothering her too much. Be sure to encourage fluid intake (PUSH THOSE FLUIDS), watch for signs of dehydration, and any new signs/symptoms that would indicate serious illness.

Signs of dehydration that warrant medical attention:

  • Parched/dry mouth
  • Cracked lips
  • No tears or very few
  • Sunken fontanel in infants
  • Sunken eye sockets
  • Decreased urine output (1-2 wet diapers in a day or none at all)
  • Very fussy (infants can be very irritable)
  • Or excessively sleepy (do you have trouble waking them up?)

Other symptoms to watch for that could indicate something more serious is going on:

  • Seizure (please see this article on febrile seizures)
  • Stiff neck, severe headache (meningitis)
  • Unexplained rash
  • Severe ear pain
  • Vomiting and diarrhea
  • Severe abdominal pain
  • Change in level of consciousness (listless, lethargic)

Additional questions a triage nurse might ask:

  • Is the fever after surgery or major trauma?
  • Is the child having trouble breathing? Are the respirations shallow or rapid? Is there any grunting, nasal flaring, or retractions? These are signs that your baby is in respiratory distress!
  • Does your child have a chronic medical problems, such as sickle-cell, lupus, heart disease, cancer, or is on steroids. If so, please contact your primary care provider.

Medications for fever:

Please consult with your family doctor before administering Tylenol or Ibuprofen. Children, unlike adults, are given medication dosages based on their weight in kilograms. So what you would give your 1-year-old is not the same dose you would give your 8-year-old. Even though Tylenol and Ibuprofen are generally regarded as safe, you want to minimize the risk of adverse drug effects and toxicity by administering them correctly.

  • Too much Tylenol can damage the liver. People die from Tylenol overdose!
  • Too much Ibuprofen can cause gastritis, ulcers, and kidney disease
  • Ibuprofen is not approved by the FDA for use in infants under 6 months

If you have any questions regarding this topic or about administering medications to your child, please consult your primary care provider.

Tips from a nurse:

  • Be aware of what I call the triple threat; fever, vomiting, and diarrhea all at the same time. Yikes! This is a recipe for severe dehydration, especially if your child is not taking in fluids. Kids have a higher percentage of body water than adults and therefore dehydrate more quickly. So if your child has the triple threat and is unable to keep down fluids, please contact your physician.
  • Most care providers will not see a temperature as a fever until it reaches 100.4
  • If you have an infant, the most accurate way to get a temperature is rectally. Some of you may be thinking HELL NO, but this is the most accurate way to obtain a core body temperature. Now if I am not concerned about a fever then I will do axillary, but if I am concerned then rectal it is. I can’t tell you how many times I have checked an axillary temperature and got a normal reading, then checked it rectally which showed the baby had a fever. Check out this awesome resource on fevers and how to take an accurate temperature.
  • Alcohol baths and ice packs are no longer recommended.
  • Please invest in a good thermometer. I will be doing a review soon on my favorite thermometers
  • If your child won’t drink and they are old enough, try a Popsicle!

To re-cap, a fever initially can seem very scary, but in most cases it is actually beneficial in helping our body fight against infection. If your child is healthy, acting relatively normal, and taking in fluids without any other concerning symptoms, then the newer recommendation says to let the fever run its course. I know it sounds crazy but it also makes sense! Go figure!

What do you think? How comfortable are you with fevers?


Candid RN

2 comments on “Fever: Is Medication Really Necessary?”

  1. I love this post – very practical and easy to follow. Dr Green has great information. So happy to see medical professionals recommending something other than to take Tylenol 🙂

    • Lauren, thank you so much!! I recently learned of Dr. Green and found his site to be an awesome resource. I agree that as health professionals we sometimes medicate when we don’t need to! Stay tuned for my post on antibiotics!

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