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Fever in Children: When to see a doctor

Fever is one of the most common childhood encounters. Yet, despite its frequency, the very thought of a child having a fever can fill even normally composed parents with worry and anxiety.

Parents often have questions like:  “When should I worry?”  “How high is too high?”  “Will my child have a seizure?” “Does my child need antibiotics?” “If I use ibuprofen or acetaminophen will that mask a serious illness?”

First of all, let me reassure you, it’s a great time to be a child. Modern vaccine advances have led to staggering protection from previously deadly and debilitating illnesses. For a healthy, vaccinated child the chances that a fever represents a life-threatening illness are much, much lower than years ago.

How a fever works

Fever is a healthy child’s normal response to an infection. By raising the body’s temperature, fever helps activate certain enzymes needed to fight infection and may also have some direct effect in killing the causative virus or bacteria.

However, a healthy child’s temperature will not just continue to rise unabated. The body has a very sophisticated thermostat, much like that in your house.  The upper limit of the body’s thermostat is around 106.  So even if your child’s temperature seems to be climbing (101… 102…103…104) it will not continue at that pace until your child spontaneously combusts.  The healthy brain will tell the body not to take the temperature over 106 and no brain damage will occur at temperatures of 106 and below.

Likewise, seizures are not a direct result of a high fever.  There is a phenomenon in children called a “febrile seizure.”  However, these seizures result from a rapid rise in fever that typically occurs even before the parents know the child is ill.  These seizures are usually benign and never cause any long -term problems.

When to see a doctor

Although I always advocate that parents should trust their parental instincts and seek care when they are concerned, below is some additional guidance.

See a doctor when:

  1. The fever associated is with other symptoms such as: trouble breathing, abdominal pains, persistent vomiting, sore throat, severe headache, neck pains, extreme body aches, or rash.
  2. A fever lasts for more than two days since hard- to-detect infections such as urinary tract infections can be the cause of fever particularly in children less than 2 years old.
  3. Any fever (defined as more than 100.4 on rectal temp) occurs in a child less than 3 months old.
  4. A fever occurs in children with other serious medical problems or immune deficiencies.

Dr. Courtney Mann is an emergency physician at WakeMed Health & Hospitals.