As a Registered Nurse and a parent myself, I understand the anxiety and worry that can come with dealing with a child's fever. And it’s a worry that we often face, especially during cold and flu season. It's natural to be alarmed when your little one is feeling under the weather, but it's crucial to approach the situation with knowledge and a clear plan of action. In my experience, fever management involves not only understanding the technical aspects but also recognizing your child's individual needs and behaviors. Let's delve into some practical advice and insights to help you navigate through these feverish moments with confidence and care. 

First, what is the definition of a fever? The definition of a fever is a body temperature of 100.4 or greater. 

Next, let me give you a quick disclaimer for all of my advice to follow:

When a child three months and younger has a fever (100.4 or greater), you must call your pediatrician. It will almost always result in a visit to the emergency room, some antibiotics, and a possible hospital stay. This is because babies less than 3 months are more susceptible to more serious illnesses, and so the approach to diagnosis and treatment is aggressive to avoid that. When you go to the emergency room, they will most likely do a blood test, urine test, and oftentimes also, a spinal tap.

This happened to me with my youngest when she was six weeks old. She had a fever and got a full workup in the emergency room, and it F!CKING SUCKED.

So I am not giving you this information in a cavalier way, I am telling you this because I think it’s important to:

• Know why there is a concern when your newborn has a fever.

• Be aware of what happens next because even as someone who knew, it still sucked.

If this does or did happen to you, I am sorry. Even though it’s necessary, it doesn’t make it suck any less. I get it. 

Ok, now that I’ve scared the sh!t out of you, let’s get into the logistics of kids 3+ months when it comes to fevers.

I’m going to explain this to you in Q&A style with the most common questions we get asked about fever…

Q: What temperature is bad/too high? 

A: (Don’t hate me)...there’s no number that’s bad/too high. Fevers are just a symptom of illness, and every person, including your child, responds to illness differently. Which is why you want to treat the child, NOT the fever. 

Q: Cool, but WTF does that mean? 

A: This means that if your child has a fever, regardless of whether it’s 101 or 104, you want to see how they are acting. Are they acting sick? I get it, I can’t answer a vague question with another vague question, so start with asking yourself questions like…

• What is their energy level like? Is their energy low, but they are still able to have periods of wakeful time where they are eating/drinking and acting somewhat normal? Or are they lethargic, and it’s hard to rouse them from sleep? 
• Are they peeing? Their appetite may be down, but are they still able to drink (breastmilk and/or bottles for younger kids, water, Pedialyte, or other fluids for older kids), and are they peeing/have wet diapers every few hours? Or have they not peed all day?
• Do they seem overall comfortable? Or are they inconsolable or seem to be experiencing any pain (or if they are older, can they identify the pain)?

All of the bolded “or” statements are reasons to call your doctor and/or seek urgent medical attention, depending on the severity of the symptoms. 

Q: So, do I ever call a doctor just for a fever?

A: As I said, fever is a symptom of infection. That infection is either viral or bacterial. If you can identify the underlying issue causing the fever, and it’s bacterial (you wouldn't necessarily know this!), then it can be treated with antibiotics. Think: your five-year-old wakes up with a fever and is screaming that their ear hurts. So you would call your doctor then to get treatment (because ear infections are a bacterial infection). But if it’s not bacterial, then you’re left with the four dreaded words no parent wants to hear “It’s just a virus.” This simply means that it’s a virus causing the infection and subsequent fever, and you just need to let it run its course. 

Q: Do I treat the fever?

A: Depends! Again, you are treating the child, NOT the fever. So you can treat the fever with Ibuprofen and/or Tylenol if your kid is feeling really sick, and those medications help bring down the fever and make them feel better, so they can do things like eat, drink, and sleep. But if your kid has a fever, and is otherwise acting relatively normal, then you don’t HAVE to treat the fever. 

Let me wrap up by telling you how I handle a fever or fevers. In my house...

If my kid is acting relatively normal, I just leave it alone. If they’ll take Ibuprofen or Tylenol without a major fight, I will give them that, but if they are acting normal and refusing meds, I don’t force it regardless of their temperature. For context, my youngest daughter had a fever of 104 recently, and she was running around, playing, drinking water, and literally would not STFU. She fought me hard on taking meds, so I just let it go!

If they are not eating or drinking much, sleep is being impacted, or they clearly don’t feel well/seem uncomfortable because their fever is high, I will give them meds. When I give them meds, it’s not to reduce the length of the illness but to treat the fever so that they feel better and subsequently will eat, drink, and sleep better! When I give them meds, I alternate between Ibuprofen (Ibuprofen can be given to kids 6 months and older and does a better job of treating fevers than Tylenol) and Tylenol every 3 hours. Remember, both of these meds are weight-based, NOT age-based, so be sure to have an accurate weight when looking at the dosing. Here’s a quick reminder on dosing. 

Without a clear symptom of what is causing the fever (ear infection, sore throat, urinary symptoms, respiratory concerns, etc.), and when my kids are acting relatively normal/I can manage their fever and the symptoms with Ibuprofen/Tylenol, I will let the fever go on for five days. After five days, if the fever has not resolved (which it does the majority of the time with a viral infection), I then bring them to the pediatrician to be examined to try and determine the cause.

One last point, you should always feel like you can go to or call your pediatrician at any time without feeling bad! So you might call on day two or three, just to run it by them, and they may have you come in to be examined, and if it’s “just a virus,” they will usually still tell you to call if your child has a fever after five days.

So this is just a reminder that you know you and your child best, and if it’s better for YOU to have them seen sooner, you can absolutely do that and should never feel bad about calling your pediatrician!