It’s alarming when your child’s forehead feels hot. Fever is a common symptom in children, and as a parent, it’s natural to worry and wonder, “When Should You Go To The Doctor For A Fever?”. Understanding when a fever warrants a doctor’s visit is crucial for your child’s health and your peace of mind.
To shed light on this common concern, we spoke with Christopher Tolcher, MD, FAAP, a pediatrician at Agoura-West Valley Pediatrics, part of the esteemed CHLA Health Network. Dr. Tolcher provides essential insights into fevers in children, helping parents understand when to seek medical attention and how to care for their child at home.
Understanding Fever in Children
First, let’s clarify what constitutes a fever. A normal body temperature in children typically ranges from 97 to 100 degrees Fahrenheit (36.1 to 37.8 degrees Celsius), with an average around 98.6°F (37°C). A fever is defined as a temperature of 100.4°F (38°C) or higher. It’s important to use a reliable thermometer to accurately measure your child’s temperature. Rectal thermometers are generally considered the most accurate for infants and young children, while oral, temporal artery (forehead), or axillary (armpit) thermometers can be used for older children.
Why Fever Can Actually Be a Good Sign
While fever can be distressing for both children and parents, it’s important to understand that fever itself is not an illness, but rather a symptom and often a helpful bodily response. In most instances, a fever is a sign that your child’s body is actively fighting off an infection.
Dr. Tolcher emphasizes that “Fever helps the immune system.” He explains that an elevated body temperature plays several beneficial roles in combating infections. Firstly, it can slow down the replication and spread of viruses and bacteria. Secondly, fever aids the body in producing more antibodies, which are crucial proteins that target and neutralize pathogens. Furthermore, it enhances the mobility of immune system cells, allowing them to reach infection sites more efficiently and effectively. Therefore, in many cases, a fever is an indication that your child’s immune system is working as it should to restore health.
When Does a High Fever Become Too High?
It’s natural to worry about how high a fever can climb. Dr. Tolcher reassures parents that “Fevers are almost never dangerous, with the exception of ‘hyperthermia’”. Hyperthermia refers to a dangerously high body temperature caused by external factors, such as being in an extremely hot environment, rather than the body’s internal response to illness.
According to Dr. Tolcher, a fever needs to reach a very high temperature of 107°F (41.7°C) to potentially cause tissue damage, and this is exceptionally rare in typical fever cases caused by infection.
However, even though dangerous temperatures are rare, it’s still wise to be vigilant. Dr. Tolcher advises that “if your child’s fever reaches 105°F (40.6°C), call your doctor.” While this temperature doesn’t automatically indicate immediate danger, it signals a need for medical evaluation to determine the underlying cause and ensure appropriate care. Prompt medical advice can help identify any potential issues and guide the best course of action.
Specific Scenarios: When You Should Call the Doctor
Knowing when to seek medical help is paramount. While most fevers resolve on their own, certain situations require prompt consultation with a healthcare professional. Dr. Tolcher outlines specific scenarios when you should immediately contact your child’s doctor:
- Prolonged Fever: A fever that persists for more than four to five days warrants medical attention. This duration could indicate a more persistent infection that requires specific diagnosis and treatment.
- Fever in Newborns (Under 2 Months): A fever (100.4°F or higher) in a baby younger than 2 months old is always considered a serious concern. Infants in this age group have vulnerable immune systems and fevers can quickly become serious. Immediate medical evaluation is crucial. If you cannot reach your pediatrician, Dr. Tolcher advises, “go to the emergency department.”
- Extremely High Fever: A fever of 105°F (40.6°C) or higher in a child of any age, including teenagers, requires immediate medical consultation. While rarely dangerous in itself, such a high temperature needs to be evaluated to determine the cause.
- Fever in Infants (Under 1 Year) Over 102°F for More Than Two Days: If an infant under one year old develops a fever over 102°F (39°C) that lasts for more than two days without an obvious reason (like a mild cold), it is important to seek medical advice to rule out any underlying serious infections.
When Fever is Accompanied by Warning Signs
Beyond the height and duration of the fever, certain accompanying symptoms should prompt immediate medical attention. If your child has a fever AND experiences any of the following signs, Dr. Tolcher advises to call your doctor immediately or go to the emergency department:
- Extensive Rash: A widespread, red, or purple rash, particularly one that doesn’t blanch (fade) when pressed, could indicate a serious infection like meningitis or sepsis.
- Stiff Neck and Severe Headache: These symptoms, especially when combined with fever, can be signs of meningitis, an inflammation of the membranes surrounding the brain and spinal cord, which requires urgent medical intervention.
- Intense Pain: Severe pain, including significant abdominal pain, could be a symptom of various conditions like appendicitis or other serious infections.
- Breathing Difficulties: Shortness of breath or labored breathing is a red flag. It could indicate respiratory infections like pneumonia or bronchiolitis, or other serious conditions.
- Extreme Weakness or Altered Mental State: Lethargy, unusual drowsiness, confusion, or decreased responsiveness are concerning signs that warrant immediate medical evaluation. These could indicate the infection is affecting the brain or body systems more broadly.
- Dehydration: Signs of dehydration, such as dry diapers, infrequent urination, dark urine, dry mouth, and lack of tears when crying, indicate that your child is not getting enough fluids. Dehydration can be a serious complication of fever, particularly in young children.
Fever and Febrile Seizures
Febrile seizures, seizures triggered by fever, can occur in children, particularly those under the age of 5. Dr. Tolcher acknowledges that “Seizures are scary as heck to watch,” which can be very alarming for parents. However, he reassures that “most of the time, you don’t need to go to the ER” for brief febrile seizures.
Here’s Dr. Tolcher’s guidance on febrile seizures:
- Seizure Less Than Two Minutes: If your child experiences a seizure that lasts less than two minutes, contact your doctor for advice. They can assess the situation and provide guidance.
- Seizure Lasting More Than Four to Five Minutes: If a seizure persists for more than four to five minutes, it’s considered a medical emergency. In this situation, call 911 (or your local emergency number) immediately. Prolonged seizures require urgent medical attention.
Fever and COVID-19, MIS-C, and Kawasaki Disease
With the emergence of COVID-19, parents have additional concerns regarding fever. Dr. Tolcher advises: “Call your doctor if your child has any fever for more than four or five days.” This is especially important in the context of potential COVID-19 infection and related conditions.
He also highlights the importance of being aware of Multisystem Inflammatory Syndrome in Children (MIS-C) and Kawasaki disease, rare but serious conditions that can be associated with fever, particularly following COVID-19 infection. Dr. Tolcher recommends seeking medical advice if your child has a high fever AND any of the following symptoms, which can be associated with MIS-C and Kawasaki disease:
- Cracked red lips
- Red tongue (“strawberry tongue”)
- Red eyes (conjunctivitis)
- Swollen hands and feet
- Rash
- Abdominal pain
- Enlarged lymph nodes
Dr. Tolcher offers reassurance regarding MIS-C, stating, “I want to reassure parents that MIS-C is rare. We need to watch for it, but don’t freak out.” However, awareness and prompt medical attention if these symptoms arise are crucial.
Practical Tips for Managing Fever at Home
While knowing when to seek medical help is vital, you can effectively manage many fevers at home, keeping your child comfortable while their body fights off infection. Dr. Tolcher offers these helpful tips for treating a fever at home:
- Treat the Child, Not Just the Number: Dr. Tolcher emphasizes a crucial point: “Focus on how the child is doing, not the number on the thermometer.” Assess your child’s overall condition. If they are relatively comfortable, playing, and drinking fluids, even with a high fever, close monitoring and home care may be sufficient. Conversely, if a child is distressed, lethargic, or in pain, even with a lower fever, they may need more attention and potentially medication to alleviate discomfort. “If the fever is 100.5°F, but the child is crying from a headache or earache, give a pain reliever. But if they have a 104°F and aren’t that bad, just give them fluids and keep them comfortable.”
- Avoid Over-Bundling: It’s a common instinct to bundle up a child with a fever, but Dr. Tolcher advises against it. “Too many layers and heavy blankets will raise the fever higher—and make your child more miserable.” Dress your child in comfortable, lightweight clothing. Light pajamas and a light blanket are usually sufficient.
- Ensure Hydration: “The body burns through water a lot faster when it has a fever, which is why extra fluids are important,” Dr. Tolcher explains. “You don’t want your child to get dehydrated.” Encourage your child to drink plenty of fluids. Water, clear broths, diluted juice, electrolyte solutions (like Pedialyte), or popsicles are all good options. Monitor urine output – dark urine or decreased urination frequency are signs of dehydration.
- Focus on Comfort, Not Zero Fever: “You don’t have to get the fever down to 98.6°F,” says Dr. Tolcher. The goal of fever-reducing medication is to improve your child’s comfort, not to eliminate the fever entirely. “If a child has a 104°F and a lot of body aches, giving one medicine will bring it down two or three degrees. That’s enough. You just want to make the child more comfortable.” Trying to aggressively suppress the fever to a normal temperature might not be beneficial and could even slightly hinder the immune response.
- Medication Dosing and Safety: If you are using fever-reducing medication, be meticulous with dosing. “Keep track of what medicine you give and when. You don’t want the child to get extra doses. And don’t exceed the dosing intervals on the medicine label. If the directions say wait six hours, wait at least six hours.” Acetaminophen (Tylenol) and ibuprofen (Advil) are generally recommended for fever reduction in children. Never give aspirin to children, especially during a fever, due to the risk of Reye’s syndrome, a rare but serious condition. If COVID-19 is suspected or confirmed, acetaminophen is often preferred as the first choice.
The Takeaway Message
The key message from Dr. Tolcher is to prioritize your child’s overall well-being. “Keep your child comfortable, hydrated, and at home” when appropriate. Rest is also a vital part of recovery. “We all need to rest when we’re sick,” Dr. Tolcher concludes. “That’s one of the benefits of fever. It slows you down and gets you to take a break.” By understanding when to seek medical attention and how to provide supportive care at home, you can confidently navigate fever in your child and ensure their speedy recovery.
