Fever FAQs: Fighting Fever [F]obia (part 2/2)

Parents are always questioning me about fever. In fact, even some of my pre-natal consultations include a discussion about fever before the child is born. Let’s face it, fever freaks parents out. A clinical report in this month’s Pediatrics discusses parental “fever phobia,” and suggests how pediatricians should be educating parents aboutfever in a child.

In the spirit of continuing fever education, here are the most frequently asked questions about fever that parents ask me in clinic. Stay on the look out for the POP QUIZ!

1. What’s the difference between ibuprofen and acetaminophen, and which one should I give my child?

Acetaminophen (Tylenol) is an analgesic (pain reducer) and antipyretic (fever reducer.) The medication may be given to infants over the age of 3 months, or sooner if approved by your health care provider. It is available in both oral (by mouth) or rectal suppository form. Acetaminophen keeps working in the body for 4-6 hours after administration.

Ibuprofen (Advil, Motrin) is an analgesic, antipyretic, and also is an anti-inflammatory (anti-swelling) medication. Ibuprofen can be given to infants over the age of 6 months and is taken by mouth. The duration of action for ibuprofen is 6-8 hours.

Both of these medications begin to work less than one hour after being given to your child. When used as a fever reducer, these medications will take a fever down 1-2 degrees. In other words, fever of 103F degrees will not get to “normal” after one dose of medication.

There are a few situations in which you may choose one medication over the other. If your child is dehydrated, I would choose to use acetaminophen. If your child has swelling, I would choose to use ibuprofen. Otherwise, I think either medication is generally appropriate for fever and pain reduction when used in appropriate doses for acute illness. If you have questions regarding fever reducers and your child’s special condition, please ask your pediatrician.

Please note: Aspirin is no longer an option for fever reduction in children. It was common 30 years ago to use aspirin for fever. Since that time, an association between aspirin and a condition called Reye syndrome has been discovered. Please keep aspirin away from your childhood medications. If your child is under the care of older caregivers, like grandparents, please remind them of this concern.

2. When can I give my child a fever reducer, and what is the dose?

If you feel that your child is uncomfortable, please administer some medicine. Remember to always dose your child’s medicine by his or her weight, not age. For charts including dosage information, click here for acetaminophen or click here for ibuprofen.

3. Acetaminophen can hurt the liver, so isn’t giving ibuprofen a “safer” choice?

Complications may exist after giving any medication. Fever reducers are no exception.

Generally speaking, fever reducing medications are considered safe if administered properly (correct age, dose amount, dosage device, and frequency.) However, when the medications are not taken properly, intentionally or unintentionally, kids can get hurt.

In order to decrease the risk of improperly using these medications, follow these suggestions.

  • Medications need to be stored in a safe place to prevent overdosing. Fight the urge to “just keep the medication out” during times your child is ill. Always return medication to a properly stored area between dosage times.
  • Use the dosage device that came with the medication.
  • Do not buy multi-symptom formulations, such as many cold and cough products. These products increase the risk of accidental overdose because parents may unintentionally give a fever reducer and a multi-symptom medication containing fever reducer, at the same time.

4. When my child gets a fever, I heard it is best to alternate acetaminophen and ibuprofen. Is that true?

Alternating both fever reducing medications to control fever is a common suggestion made by many health care professionals. And when asked, parents have reported many different ways doctors have instructed them in this method. The bottom line - using fever reducers in this way has not been standardized.

Although the results of a few studies have suggested fever reduction was slightly greater in a combination therapy group, the risk of making a mistake while alternating fever reducers is higher than the increased relief your child may experience by using this method. I think it is best to find one medication your child will easily take, and use that medication according to its labeled use.

5. Do I need to wake my child up in the middle of the night to give her more medicine?

No. Really.

Giving medicine is only to make your child comfortable. If your child is asleep, she is comfortable.

6. What is the best way to take a temperature?

For children over the age of 3 months, extreme accuracy of your temperature taking device (ear, forehead, mouth, armpit, etc.) is not something to stress about. All devices have their strengths and weaknesses. Thermometer accuracy will more likely determine if your child should stay home from school, rather than how sick they are.

7. Do you add a degree to an armpit temperature?

Maybe.

An axillary (armpit) temperature is generally not that precise.After trying to take an axillary temperature on a wiggly 4-month-old, you know what I mean. It is most useful to simply state the reading on the thermometer, and what method you used to take it.

8. POP QUIZ! (you should know the answer to this one)

I gave Tylenol to my child 20 minutes ago. His fever has only decreased from 103F to 102F. What do I do now?

Look at your child, not the thermometer.

Remember, fever reducers are not meant to bring a fever down to a “normal” temperature, and they may take up to an hour to work. The goal of the medication is to make your child feel a better. His comfort is what you want to be evaluating.

Great job to all of you for answering this correctly!

9. When do I take my child to the doctor with fever?

If your child has a fever and you are worried about her, please don’t hesitate to call your pediatrician’s office.

Fever is a symptom of illness, not a disease itself. Look for additional signs of illness to determine if your child needs to be seen by a doctor. Your child's comfort, mood, energy level, and hydration are all things to consider. A pediatrician's job is to examine kids if parents are concerned that they are ill. So again, if you are worried, call your pediatrician’s office.

10. When can my child go back to school after having a fever?

Rules vary among school districts, so check your child’s school health policies for specific information. Generally, a child has to be under 100F degrees for 24 hours prior to returning to school.

Hopefully these FAQs will decrease your fever fear. For more information about other fever-related topics, click here.