One of our Facebook readers asked, “How long should a child have a fever before you should start to worry?”
Hear what three of our family medicine physicians had to say.
You may remember Dr. Nichole DeLaPlante from Lone Peak Primary Care in Draper from some of her other posts. She’s a frequent blogger with us and she said, “This is a particularly difficult area of medicine because there really is no clear cut answer and a lot of times deciding to treat a child depends on many factors such as their age and the symptoms and signs observed by caretakers or medical professionals.
I think that it is important first to establish what is technically considered a fever: Core Temperature > 100.3 degrees farenheight or 38 degrees Celsius. It is important to obtain an accurate body temperature reading and this can be done several ways. While rectal temperature is the most accurate and preferred modality for infants, using oral or ear temperature readings for children is also acceptable. If you are using an ear thermometer just make sure the instrument is in the correct position within the ear canal for the most accurate reading.
A child with a fever usually exhibits other symptoms that are important to look out for. If a child is lethargic, inconsolable or won’t stop crying, has severe headache/neck stiffness, rash, refusal to drink and liquids or exhibiting signs of dehydration such as decreased urine output or dry lips/mouth or if a child has specific symptoms such as throat or ear pain then they should see a doctor.
In most cases children do not require treatment for fever. If a child is 3 months of age or older, otherwise healthy and acting appropriate with a temp greater than 102 degrees observation is probably Ok. If a child is less than three months and has any chronic medical conditions or appears ill treatment and evaluation is recommended. Here are some other specific guidelines :
- Infants who are less than three months of age who have a temperature of 100.4ºF (38ºC) or greater, regardless of how the infant appears (even if they appear healthy) need to go immediately to the Emergency Room!!
The following should be evaluated by their primary care physician:
- Children who are three months to three years who have a temperature of 100.4ºF or greater for more than three days or who appear ill (i.e. fussy, clingy, refusing to drink fluids) should be evaluated by their primary care provider
- Children who are three months to three years who have a temperature of 102ºF (38.9ºC) or greater.
- Children of any age who have a febrile seizure.
- Children of any age who have recurrent fevers on and off even if healthy appearing for more than four weeks
- Children of any age who have chronic medical conditions such as heart disease, cancer, renal disease, seizure disorder etc.
- Children who have fever and a rash
Dr. Robert Corson from Millcreek Primary Care in Salt Lake City shared the same opinion as Dr. DeLaPlante stating, “Infants that are younger than 90 days old with a temperature above 100.4 F need to be seen urgently, usually at the ER. This can represent serious infections and usually requires a thorough exam and testing which includes bloodwork, urinalysis, chest x-ray and possibly a spinal tap.
Children who appear well and are eating and drinking OK that have a fever can be safely treated with Tylenol or ibuprofen (never aspirin) to lower the fever for three days or so.
If the fever persists for more than three days, they aren’t eating or drinking, there is a rash, an altered voice (‘hot potato voice’), any breathing difficulty, severe headache or stiff neck, or the child just doesn’t look well, they should be seen by their doctor for an evaluation.
Dr. David Jack from Lone Peak Family Medicine in Draper agreed with both doctors saying, “A fever that lasts more than 3 days should most definitely be evaluated, and an evaluation should be considered if a fever lasts greater than the 24 hour period if there are other concerns such as decreased feeding, persistent vomiting, change in mental status, etc. That being said, a fever in an infant less than 6 months of age is unusual because the thermoregulatory mechanisms and aspects of the body are not fully developed yet. This mandates a physician review.”
There you have if folks! One question, three physician opinion and one solid answer.
If you do find that your child has a fever and needs to be seen today contact our See Me Same Day hotline. Each of the physicians in this article are accepting new patients.