Fever

Alternative Names

Home Care

If the fever is mild and no other problems are present, no medical treatment is required. Drink fluids and rest. If a child is playful and comfortable, drinking plenty of fluids, and able to sleep, fever treatment is not likely to help.

Take steps to lower a fever if you or your child is uncomfortable, vomiting, dehydrated, or having difficulty sleeping. The goal is to lower, not eliminate, the fever.

When trying to reduce a fever:

• DO NOT bundle up someone who has the chills.
• Remove excess clothing or blankets. The environment should be comfortably cool. For example, one layer of lightweight clothing, and one lightweight blanket to sleep. If the room is hot or stuffy, a fan may help.
• A lukewarm bath or sponge bath may help cool someone with a fever. This is especially effective after medication is given -- otherwise the temperature might bounce right back up.
• DO NOT use cold baths or alcohol rubs. These cool the skin, but often make the situation worse by causing shivering, which raises the core body temperature.
• Drink cool liquids, as tolerated.

Here are some guidelines for taking medicine:

• Acetaminophen and ibuprofen help reduce fever in children and adults.
• Take acetaminophen every 4-6 hours. It works by turning down the brain's thermostat. Take ibuprofen every 6-8 hours. Like aspirin, it helps fight inflammation at the source of the fever. Sometimes doctors advise you to use both types of medicine. Ibuprofen is not approved for use in children less than 6 months old.
• Aspirin is very effective for treating fever in adults. DO NOT give aspirin to children unless specifically directed by your doctor.
• Fever medicines come in different concentrations, so always check the instructions on the package.
• Don't use any medicine to reduce fever in children under 3 months of age without first contacting a health care provider.

If someone has heat exhaustion or heat stroke, remove the person from the warm area. Sponge the person with tepid water. Place ice packs in the armpits, behind the neck, and in the groin. Give fluids if the person is alert. Seek medical attention. If heat illness is causing the fever, medicines may not lower the body temperature and may even be harmful.

When to Contact a Medical Professional

Call a doctor right away if:

• A baby less than 90 days old has a rectal temperature of 100.4°F (38°C) or higher.
• A baby 3 to 12 months old has a fever of 102.2°F (39°C) or higher.
• A child under age 2 years has a fever that lasts longer than 24 to 48 hours.
• A fever lasts longer than 48 to 72 hours in older children and adults.
• Anyone has a fever over 105°F (40.5°C), unless it comes down readily with treatment and the person is comfortable.
• There are other worrisome symptoms. For example, irritability, confusion, difficulty breathing, stiff neck, inability to move an arm or leg, or first-time seizure.
• There are other symptoms that suggest an illness may need to be treated, such as a sore throat, earache, or cough.
• You think you may have incorrectly dosed acetaminophen or ibuprofen.

Your doctor will perform a physical examination, which may include a detailed examination of the skin, eyes, ears, nose, throat, neck, chest, and abdomen to look for the cause of the fever. Your doctor may ask questions such as:

• How long has the fever lasted?
• Is it increasing? Is it increasing rapidly?
• Has the fever gone away?
• How many days did it take for the fever to go away?
• Do you have alternating chills and fever?
• How frequently does it alternate (days, hours)?
• Did it occur within four to six hours after exposure to something that you might be allergic to?
• Does the fever follow an up-and-down pattern (is it high, then lower, then high)?
• Did it develop suddenly?
• Does the temperature go up and down suddenly (spike) or does it change slowly?
• Does it go away and then come back again daily?

Treatment depends on the duration and cause of the fever, and on other accompanying symptoms.

The following diagnostic tests may be performed:

• Blood studies, such as a CBC or blood differential
• Urinalysis
• X-ray of the chest

References

American College of Emergency Physicians Clinical Policies Subcommittee on Pediatric Fever. Clinical policy for children younger than three years presenting to the emergency department with fever. Ann Emerg Med. 2003; 42(4): 530-545.

Roth J. Molecular aspects of fever and hyperthermia. Neurol Clin. 2006; 24(3): 421-39, v.

Goldman L, Ausiello D. Cecil Textbook of Medicine, 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007.

Behrman RE. Nelson Textbook of Pediatrics. 17th ed. Philadelphia, Pa: WB Saunders; 2004: 839-841.

This article uses information by permission from Alan Greene, M.D., © Greene Ink, Inc.