Fevers in children are common.  In the first 5 years of life, the average child will have about 4 febrile illnesses per year!  Given how common they are, it is obvious that most fevers are not a cause for concern.  However, occasionally they should prompt evaluation by a doctor.  Here are some things to consider:

How High is the Temperature?

A person is considered to have a fever when their temperature is 100.4 F or greater. Therefore, temperatures less than this are rarely a concern and usually are the result of natural fluctuations of body temperature.

It’s important to take a child’s temperature accurately. In babies, a rectal temperature is the most accurate. When your child gets older, you may want to do an oral thermometer or an ear thermometer. A temporal or forehead thermometer can be challenging to use and does not always give accurate results.

In general, the height of a fever does not have much significance, especially in children, who tend to run higher fevers than adults do.  However, most doctors would recommend a child be evaluated if the fever exceeds 105.0 F.

How Long Has Your Child had a Fever?

It is common for children to run fever more often and for longer periods of time than we are used to as adults.  Any fever that persists beyond 7 days, however, is worth discussing with a doctor.

How Old is the Child?

The older your child gets, the less concerning a fever becomes. If your child is under two months of age, you need to take your child to your doctor or the emergency room if he or she has a fever above 100.4F. This could be a sign of a serious infection, and the immune system of a newborn baby is not as capable of fighting infection.

If your child is under a year old, you should still call your doctor when they have fever. Your doctor can discuss things like vaccine status, other symptoms, etc. to help determine if there is any reason for concern and recommend treatment.

Finally, school-age children with fever are usually of less concern than younger children, but if there are other concerning symptoms, your child should see a doctor.

Other Considerations?

Fever in combination with certain other symptoms should cause increased concern.  Below are some examples of symptoms that are concerning in the setting of fever:

  1. Abdominal pain.  Usually, fever and abdominal pain indicate a more serious illness, such as appendicitis or other abdominal infection.
  2. Headache or stiff neck.  Fever with headache and stiff neck can occasionally indicate meningitis or other serious infection.
  3. Cough and chest pain.  These symptoms along with fever can indicate pneumonia.
  4. Rash.  Some rashes in the setting of fever indicate a serious illness, especially if the rash consists of dark purple spots. 

Fever along with any of these symptoms is particularly concerning and should lead to a visit to your doctor or an emergency room.

Fever is much more concerning in those who have not been vaccinated, especially children.  Have a lower threshold for concern if your child has a fever and is not up to date with their vaccines.  This is especially true for infants.

Fever in the day or two after a vaccine is usually not a reason for concern, but instead indicates that the immune system is responding appropriately to the vaccine.

Should You Give Over the Counter Medications?

In children over 6 months, it is probably okay to give over-the-counter medications to reduce the fever if there are no other concerning factors.  No significant benefits have been identified to leaving a fever untreated.  In other words, not treating a fever does not significantly hasten a return to health.

In children less than 6 months old, it is best to speak with a doctor before medicating a fever, especially if there are other concerns.

When To Call a Doctor

Infants less than 2 months old, or any unvaccinated infant should be seen at the emergency room when they have fever.  If your child is under a year of age and has a fever, you should call your pediatrician. If you have a school-age child who appears unwell or has had a fever for more than a few days, you should call your pediatrician. Any child who has fever along with the concerning factors described above should see their doctor or an emergency room.