Dr. MJ Bazos MD, Patient Handout
Fever in Children

What is a normal temperature?
A normal temperature is about 98.6° when taken orally (by mouth). Temperatures taken rectally (by rectum) usually run 1° higher than those taken orally. So a normal temperature is about 99.6° when taken rectally. But temperatures may vary several degrees during the day, even in healthy children. Many doctors define a fever as an oral temperature above 99.4° or a rectal temperature above 100.4°.

What’s the best way to take my child’s temperature?
You may think you can tell if your child has a fever by touching his or her forehead. But this isn’t an accurate way to tell. Fever strips, which are placed on the child’s forehead, are also not accurate. A new type of thermometer takes the temperature in the ear. This type of thermometer works by “taking a picture” of the infrared heat given off by the eardrum. The most accurate way to take your child’s temperature is orally or rectally with a mercury or digital thermometer. (Temperatures taken from under the arm are not as reliable.) In a child younger than about 4 years, take the temperature rectally. In an older child, take it orally.

Here are some tips for taking your child’s temperature:

When should I try to lower my child’s fever?
Fevers are more frightening than they are harmful. They’re usually just a sign that the body is fighting an infection. The main reason to treat your child is to make him or her feel better. When your child is achy and fussy, you may want to give him or her some medicine.

How much medicine is needed to lower a fever?
Acetaminophen (brand names: Children’s or Infants’ Tylenol) is a medicine that relieves pain and lowers fever. How much acetaminophen your child may need depends on his or her weight and age, as shown in the chart below. When the age and weight don’t match, use the weight of your child as the main guide in figuring out how much acetaminophen to give. The doses in the chart may be a little higher than what’s on the medicine package. If you have any questions about the right dose, ask your family doctor. Be sure to read the directions on the label carefully. Acetaminophen comes in different forms: drops, elixir, chewable tablets and caplets. The different forms have different strengths. To get the same amount of medicine might mean using 2 dropperfuls of the drops but 1 teaspoon of the elixir. The chart below gives suggested doses in milligrams (abbreviated as mg). One dropperful equals 80 mg; one teaspoon equals 160 mg; one chewable tablet equals 80 mg; one caplet equals 160 mg.

Age Weight Acetaminophen dose(every 4 hours)
0 to 3 months Less than 13 pounds Ask your family doctor
4 to 7 months 13 to 17 pounds 80 mg
8 to 18 months 18 to 23 pounds 120 mg
1.5 to 3 years 24 to 32 pounds 160 mg
4 to 5 years 33 to 45 pounds 240 mg
6 to 7 years 46 to 61 pounds 320 mg
8 to 9 years 62 to 78 pounds 400 mg
10 to 11 years 79 to 98 pounds 480 mg
12 to 13 years 99 to 131 pounds 640 mg
14 years or older 132 or more pounds 640-1,000 mg

Ibuprofen (brand names: Children’s Advil, Children’s Motrin) is another pain-relieving and fever-reducing medicine. Talk to your family doctor before giving this medicine to your child. Your doctor will tell you the correct dose for your child based on his or her age and weight. Never give naproxen (brand name: Aleve) or ketoprofen (brand name: Orudis) to your child unless your doctor says it is okay, and then follow your doctor’s directions carefully.

Why not use aspirin to lower my child’s fever?
Aspirin can cause Reye’s syndrome in children who have the flu or the chickenpox. Reye’s syndrome is a serious illness that can lead to death. Because it may be hard to tell if your child has one of these infections, it’s best not to use aspirin unless your family doctor says it’s okay. Acetaminophen is a safer choice to use in children with a fever.

Tips on giving medicine
• Don’t give more than 5 doses in one day.
• Don’t give a baby younger than 4 months old any medicine unless your family doctor tells you to.
• Read labels carefully. Acetaminophen comes in different forms and strengths. Make sure you are giving your child the right amount of medicine.
• Fill the dropper to the line when using drops.
• For liquid elixir, use a liquid measuring device to make sure you give the right dose. Get one at your drug store or ask your pharmacist.

Are there other ways to help my child feel better?
Yes. Here are a few:
• Give your child plenty to drink to prevent dehydration (not enough fluid in the body) and help the body cool itself. Check with your doctor before giving your child special rehydrating formulas, drinks or popsicles
• Keep your child quiet. Moving around can raise the temperature even more.
• Keep the room temperature at about 70° to 74°.
• Dress your child in light cotton pajamas so that body heat can escape.
• If your child is chilled, put on an extra blanket but remove it when the chills stop.

Will a bath help lower my child’s fever?
Used together, acetaminophen and a lukewarm bath may help lower a fever. Give the acetaminophen before the bath. If the bath is given alone, your child may start shivering as his or her body tries to raise its temperature again. This may make your child feel worse. Your doctor may suggest giving your baby a sponge bath after giving acetaminophen if the fever reaches 103° or if your baby or child has ever had a seizure during a fever. In a few children, seizures can be caused by a fast rise in temperature. Don’t use alcohol for baths. It can be absorbed through the skin. Also, don’t use cold water. It can cause shivering.

When should I call the doctor?
A saying doctors use is, “Don’t treat the thermometer, treat the child.” This means that your child’s behavior is more important than the number on the thermometer. You can follow the guidelines below to help decide when to call your doctor, but it’s important to call your doctor whenever you feel that your child needs help or if you have any questions.

Call your doctor if your child has any of these warning signs: