Pediatric Fever: A hot topic

Lt. Alessandra Ziegler, RN, BSN, CCRN, CEN

Emergency Medicine Department

Robert E. Bush Naval Hospital

            Fever is a common reason many of us seek medical care for either ourselves or our children. A sick loved one is a worrisome sight. Most of the time fevers are manageable from home with patience, vigilance and a little bit of tender love and care. In this article, I wish to talk to you about what a fever is, why it’s important, what to do at home if a fever occurs, when to see your primary care provider, and when it is necessary to come to the Emergency Room for further care.  

            Fever alone is not an illness but rather a symptom or sign of a sickness. A fever is actually a good thing for your body to have and is a positive sign an infection of some sort is being battled. It is the body’s way of creating a warmer environment to essentially have the good guys, white blood cells, “cook” the bad guys, or bacteria. 1 Fever, especially in the pediatric population, is commonly associated with respiratory illness (pneumonia or croup), ear infections, influenza (flu), sore throats, and severe colds. 2 Since a fever is the body’s natural response to invading organisms, it is important to understand why we care so much about it.  

When a fever occurs, the body is placed in a state of stress and makes the child feel uncomfortable. The heart rate and breathing rate increase as the temperature rises to help the body compensate for the internal thermostat changes. Most medical professionals are taught, in a non-urgent setting to treat the patient not the numbers (i.e. vital signs). If the patient, your child, feels normal, is not experiencing pain, etc., no intervention is necessary. Thus, it is important to treat the patient not the “number” of the fever. For instance, if your child has a temperature but is behaving normally – eating and sleeping well, periods of playfulness, adequate urinary output – then it is not a priority to treat the fever. Once your child becomes quite bothered and uncomfortable you may treat it with the following methods. 2

First ensure that you have measured your child’s temperature appropriately. In the Emergency Department we get a rectal, or core, temperature on most children under the age of three. After this age, an oral temperature is acceptable. Again, remember to treat the child not the temperature. A temperature is considered a fever if a rectal is >100.4°F, an oral/pacifier temperature is >100.0°F, or an axillary (under the arm◦) is >99.0°F. 3 It is appropriate to treat your child’s fever with Ibuprofen (if older than 6 months) or Acetaminophen. Never administer aspirin to a child. These medications should be administered per weight based dosing. Most of the labels on these medications, however, are by age. Please do not give any cold/cough medicine to your child under 2 years of age. Call your primary care physician’s office or the Naval Hospital Twentynine Palms (NHTP) Patient Centered Medical Home Pediatrics or  Gold/Blue Team (Family Medicine) clinics if you have any questions regarding appropriate dosing. Discuss fever medications with your doctor during your next well-child exam to be proactive in treating your child. Here are some non-pharmacological, or non-medication, ways of treating a fever:

MANAGING A FEVER AT HOME WITHOUT MEDICINE:

-         Keep them home from school to rest and rehydrate in a comfortable environment -         Encourage them to drink extra fluids (water, Jell-O, popsicles, commercially prepared oral electrolyte solutions such as Pedialyte). -         Keep your child’s room and your home comfortably cool, and dress them lightly. -         Place a fan nearby to keep cool air moving around the room. -         Sponging your child with lukewarm water in a bath. 2

Now that you know how to treat your child’s temperature at home, here is when taking them to your primary care physician would be indicated.

            If you are concerned about your child’s fever, call your doctor to book an appointment or physically walk into the clinic to book a same-day appointment.  At the NHTP clinics, the Medical Home initiative allows you to continue to seek care from your primary care physician or primary care team for your non-urgent needs. You may also call the on-call Medical Officer of the Day (760-830-2190) who can give you advice over the phone on how to treat your child’s temperature. Lastly, you may use Relay Health, an online service, allowing you to email your primary care team. Please sign up at www.RelayHealth.com. Be advised: allow up to 72 hours for the staff to respond with an email message. 

REASONS TO CALL YOUR PRIMARY CARE PHYSICIAN

-         Signs of dehydration (dry mouth, urinating less than usual, no tears when crying, less alert and less active than usual) -         Has a skin rash -         The child gets worse in any way -         Persistent diarrhea and/or repeated vomiting -         The fever lasts more than 3-5 days despite consistent, around-the-clock medication administration (Acetaminophen or Ibuprofen) -         Has a chronic medical problem like cancer, lupus, heart problems, or sickle cell disease 4 -         Has a febrile convulsion 3, 4

It is also important to know if your child’s vaccinations are up-to-date. Make sure to keep a record of this on hand to provide to medical staff for quicker treatment.

If at any point in time you are gravely concerned for your child’s well being, seeking emergency care is warranted if their primary care physician is unavailable. Ensure that your child is also not suffering from heat stroke – fever due to environmental or external heat. If heat stroke is suspected, rapidly move the child to a cool place, remove all clothing, sponge them with cool water and fan them, then seek medical care immediately.

REASONS TO SEEK EMERGENCY CARE IMMEDIATELY

-         If your child is an infant or younger than 3 months of age and has a temperature of 100.4°F or higher. -         A febrile convulsion lasting more than fifteen minutes (be sure to turn your child’s head to the side so saliva and vomit can drain from the mouth – do not put anything into your child’s mouth) -         Suspected heat stroke especially when there is no improvement in condition.

Although sometimes frightening, especially to first time parents, fevers are virtually unavoidable and are a normal body process we all experience at one time or another. The key message is to ensure your child has adequate comfort and hydration until the fever passes and to seek the appropriate medical care when necessary.

References:

1.      Avner, J. R. (2009). Acute Fever. Pediatrics in Review, 30(1), 5-12.

2.      Shelov, S. P., M.D., M.S., F.A.A.P., Editor-in-Chief. (2009). Fever. Caring for Your Baby and Young Child: Birth to Age 5 (Fifth Edition ed., pp. 747-755). New York: Bantam Books.

3.      Hertz, A. R. (2011). Fever. Pediatric Nurse Telephone Triage (pp. 95-97). Elk Grove Village: American Academy of Pediatrics.

4.      Fever Instruction Sheet . (n.d.). KidsHealth - the Web's most visited site about children's health. Retrieved February 10, 2013, from http://kidshealth.org/parent/firstaid_safe/sheets/fever_sheet.html