Fever in and of itself isn’t dangerous. It’s the body’s natural way to respond to infection and helps the immune system fight infection. Most such infections are viral and don’t require antibiotics. Even many bacterial infections won’t require antibiotics as our immune systems are equipped to fight most things. We expect kids to have a faster heart rate and feel worse when fevers are higher, then improve when a fever comes down.
- Don’t treat a fever with Tylenol (acetaminophen) or Motrin/Advil (ibuprofen) unless a child is miserable. Use cooling measures (luke-warm baths) as needed. Use medication if a child is in significant pain or is miserable from the fever. Otherwise, allow the fever to run as it will help the body respond to infection. We prefer ibuprofen over acetaminophen if you do need to give a medication. It’s our opinion that it is safer and works better. Search ibuprofen on AskDrSears.com for our dosing chart. You will also find a Tylenol dosing chart there, if needed.
- Beware that some fever-reducers are labeled as “natural,” but their main ingredient is still acetaminophen (Tylenol). They simply don’t have as many artificial ingredients. If you can find a dye-free ibuprofen, that may be the best choice.
- Any infant younger than 3 months with a fever of 101 or higher should be seen that day.
- Any child who has a fever of 101 or higher for more than 3 days (72 hours) should be seen.
- Any child with fever and signs of meningitis should be seen: painful stiff back of the neck such that your child won’t look down at her belly button without pain, severe headache, lights hurt the eyes, and nausea or vomiting.
- Any child who is lethargic with a fever should be seen. Lethargic means limp, won’t open eyes and focus on you, semi-conscious, and not moving much. Simply being less active and more quiet than usual, or wanting to be held more and not wanting to play, are NOT lethargy, but are normal responses to fever.
- Any child with a petechiae rash should be seen. These are small red spots on the skin that don’t disappear (don’t blanch) when you stretch the skin around them. There usually would be several dozen on an area of the body. They look as if someone wrote small red dots on the skin with a red felt tip pen. If you stretch the skin around the spot (pulling away in two directions away from the spot) and the spot disappears, then these are NOT petechiae and likely not an emergency. If they are on the face or neck, they are likely just from the pressure of coughing or vomiting and likely not an emergency. If your child has fever and petechiae anywhere else on the body, it’s possibly a bleeding disorder or serious bacterial infection and you should call us to be seen if during the day or go to an ER if after hours.
Likely causes of fever and when to be seen:
- High fever for 3 days then a rash (Roseola): This is the most common cause of fever in young children 6 months to 2 years of age when there are no other symptoms besides fever. This harmless virus causes 3 days of moderate to high fever and fussiness, then a rash. Search it on AskDrSears.com for details. If an infant reaches 4 days of fever, with no rash yet, we recommend being seen.
- Common colds and coughs: These are expected to cause 1 to 3 days of fever. See guidelines above about whether or not to be seen.
- Flu: if it’s flu season, and your child has flu symptoms and fever, then it’s likely the flu. Search Flu on AskDrSears.com for several articles on treatment, prevention, and when to be seen. Also, see our “Natural Supplements During Illnesses” handout above.
- Fever and sore throat: For kids under 4 years old, sore throat infections are usually viruses and don’t need antibiotics, especially if the throat/tonsils don’t look red and there is no pus on the tonsils. We likely don’t need to see a young child for this. Kids four and older with fever, sore throat, swollen lymph glands in the neck, and a red throat and/or tonsils with or without pus means it could be Strep throat. We can see your child to test for this. Sore throats that do not look red and are accompanied by cold and cough symptoms are likely not Strep and is likely to just be a common cold virus. If you see what look like canker sores (white blisters surrounded by red) in the back of the mouth and on the throat, this is a viral sore throat that likely doesn’t need to be seen (see Hand/Foot/Mouth disease below). Therefore, most simple sore throats that don’t look like strep usually don’t need to be seen.
- Hand/foot/and mouth disease. If your child has several days of fever, canker sores in the mouth or on the back of the throat, and/or blisters on the hands or feet, this is likely HFM disease. This is ultimately harmless, requires no medical treatment, and usually isn’t contagious to teens and adults. We usually don’t need to see this. This illness is contagious for 1 to 3 weeks, depending on your strain of virus (which you won’t know and there isn’t a test for). You are most contagious for the first week, as long as there is fever (and a couple days after), and as long as the mouth sores hurt. You will have to decide whether to quarantine until these signs are gone or for a whole 3 weeks. For a longer discussion on Hand/Foot/Mouth, and how to distinguish it from an oral Herpes infection, visit our Mouth Sore page here.
- Ear infection. If a baby is just pulling on his ears, but doesn’t have a runny nose and fever, then it’s likely not an ear infection and doesn’t need to be seen. Infants pull on their ears because of teething or simply curiosity. If sick with runny nose, fever, and ear pain or extreme fussiness, see the Ear Infection page for info on home treatment and whether or not to be seen.
