My Child Has a Fever. Should I Take Them to the ER?
A fever is defined as a core body temperature above 100.4°F (38°C). A child's fever might spike at a temperature that's quite high, and that is fairly normal because a fever is the body's natural defense against viruses and bacterial infections. While most fevers come down on their own, sometimes it is necessary to reduce a fever for a child's comfort. In some cases, the temperature will become extremely high and will need to be reduced as soon as possible (in cases where the body temperature is in excess of 104°F (103°F axillary), take the child to the emergency room immediately).
Reducing a child's fever may also prevent febrile seizures in those who are prone to them, as some children will respond to a rapid temperature change with a seizure. These seizures are usually benign but are extremely frightening to parents. By managing a child's body temperature, these seizures may be avoided altogether.
According to Doctor Heather Finaly-Morreale, a pediatrician, you should also take your child to the ER in these additional situations:
- "A child under 3 months or those with immune system issues or other issues (such as sickle cell anemia, Lupus, Cancer, HIV, etc.) should be brought to the ER for a fever over 100.4 rectal"
- "Even at lower temperatures, if a child is lethargic (unresponsive), has a dark spotted rash, or is experiencing breathing issues, they should be brought to the ER."
If your child's fever is at or over 104°F (103°F axillary), take your child to the doctor immediately.
Ways to Reduce a Child's Fever
There are several ways to help, including:
- Give the child the recommended dosage of ibuprofen. (Do not give if the child is under six months old.)
- Give the child the recommended dosage of acetaminophen.
- Give the child a sponge bath.
- Offer the child a popsicle.
- Change the child into light clothing.
- If the child's fever rises above or spikes at 104°F (103°F axillary), take the child to the doctor immediately.
The ultimate goal is to keep the child's fever below 102°F. If the temperature can be maintained below this level, and the child appears fairly alert, the fever can typically be managed at home. If the fever cannot be maintained below 102°F, the child experiences a stiff neck or extreme lethargy, or a rash that does not go away when pressed with a finger, go to the nearest emergency room for evaluation.
Reduce a Child's Fever With Medicine
The only medications that may be used for controlling fevers in children are
- ibuprofen (brand names include Advil and Motrin) and
- acetaminophen (Tylenol).
It's worth repeating that a child under 3 months old or those with immune system issues or other issues (such as sickle cell anemia, Lupus, Cancer, HIV, etc) should be brought to the ER. Even at lower temperatures, if a child is lethargic (unresponsive), has a dark spotted rash, or is experiencing breathing issues, they should be brought to the ER.
- How much ibuprofen should I give my child? Somewhere on the bottle or its packaging should be instructions for the appropriate dosage. However, don't be surprised to find something like "Children under 12 years: ask your doctor" on the back of the bottle. In general, you do want to check with your doctor to know what's appropriate for your child.
- Can I give my child "adult" ibuprofen? I can share this with you: St. Louis' Children's hospital says that you can give one 200mg pill to a child that weighs between 48-71 pounds. Their chart goes over appropriate dosage for a range of weights. You can also buy child-friendly versions.
- How often can I give my child ibuprofen? Generally speaking, ibuprofen may be given every 6-8 hours.
- Dr. Guillermo Diaz, who reviewed this article, says "do not give ibuprofen to children under 6 months old."
- How much acetaminophen should I give my child? As with ibuprofen, read the label and give your child the appropriate dosage. The packaging may suggest that you consult your doctor before dosing a child under the age of 12. St. Louis' Children's hospital has an informative chart that describes how much acetaminophen you should give a child (by weight), although you may still want to consult your child's doctor before dosing. When dosing, ensure that you're following the instructions exactly and not using a household spoon to take the measurements.
- Can I give my child "adult" acetaminophen? The Mayo Clinic recommends adult Tylenol not be given to children. When dosing recommendations are exceeded, acetaminophen is one of the most deadly drugs given to children. Parents need to take extreme care when giving a child any form of acetaminophen other than the type recommended by their physician, and must follow dosing information exactly.
- How often can I give my child acetaminophen? In general, acetaminophen may be given every four hours.
- Is it dangerous to give them Tylenol? There have been many deaths due to parents confusing infant Tylenol and children’s Tylenol dosing instructions (the infant Tylenol requires less volume because it is extremely concentrated, and children have died when parents give the infant Tylenol according to the children’s Tylenol dosage). Take extreme care not to exceed the recommended dosage of acetaminophen. Overdosing acetaminophen can lead to life-threatening liver problems. Make sure you know your child’s weight, use the measuring device that comes with the medication (do not use household spoons), and follow your physician’s advice for the type of acetaminophen and frequency of administration. Dr. Diaz notes that "underlying medical conditions like liver failure may affect whether your child can use acetaminophen."
- Alternating between the two: To control a difficult fever, the medications may be alternated. Ibuprofen will control a fever longer than acetaminophen. That said, Heather Finlay-Morreale, a pediatric doctor, recommends against "alternating [between] acetaminophen and ibuprofen. Having sick kids is stressful and parents are often more sleep deprived than their kids. It is so easy to make a mistake. The difference between a treatment dose and a toxic dose of acetaminophen is so close it’s not worth risking it. But if a fever is persistent and one medicine alone won’t work, it is best to keep a diary of what medicine is given, at what dose, and at what time."
- No aspirin: Aspirin should never be used in children under the age of 18 years. A condition called Reye's Syndrome may attack a child's liver and brain. This condition is linked to the use of aspirin during a viral illness.
What about Pedialyte?
Pedialyte is an electrolyte replacement solution often recommended for children who have a fever, are vomiting, or have diarrhea. Dr. Diaz added that "fever can lead to increased fluid loss and dehydration. Maintaining hydration during any illness is a good way to help children feel better and help the body in its fight to combat the illness and get back to normal." My son had severe, chronic ear infections as a child and often struggled with vomiting and fever as a result. He also had feeding problems, so getting him to take Pedialyte was especially challenging when he was sick. While I often kept powdered Pedialyte on hand in case of emergencies, he sometimes balked at the taste of this solution. He far preferred Pedialyte popsicles, which can be purchased premade or made at home using a plastic ice pop mold and electrolyte-replacement fluid. When he had the stomach flu, I really liked using PediaLyte Advanced Care, which contains pre-biotics to help with gut health.
Which Kind of Pedialyte Is Best?
Long shelf life, easy to travel with and compatible with plane travel.
Not as palatable as other versions of Pedialyte.
Pre-biotics to help with upset stomachs and diarrhea prevention.
Liquid form has a shorter shelf life and is more difficult to travel with.
The most palatable and preferred version by our child, helps cool body temperature while rehydrating.
Must be stored in the freezer, difficult to travel with.
Ice Pops Help Lower Fever
How Can I Naturally Reduce My Child's Fever?
- Sponge bath:Place the child in a tub of lukewarm water. Do not fill the tub with cold water, as this will be highly uncomfortable and will create chills. Do not cover the child with wet towels, as this will impede evaporation. This method works by allowing tepid water to evaporate from the child's skin. The evaporation process cools the child in a gentle manner. Dr. Diaz notes that "this is a temporary aid, and not clinically any more effective than antipyretics (acetaminophen/ibuprofen) alone; However, it can temporarily make them feel
a bit better. Although some children dislike it. Essentially this method not generally recommended as treatment because it is indicated to work in only very select circumstances, e.g. hyperthermia. Also, never use alcohol for this."
- Ice pops: Ice pops, like popsicles, hydrate the child and may help cool the child internally. This form of fluid may be preferred by a sick child. Some electrolyte replacement solution companies, like Pedialyte, now offer a frozen ice-pop product that may be tolerated better than the liquid version.
- Undressing: Dress the child in light clothing. Do not induce chills (if possible), but keep heavy blankets, coats, and thick pajamas away from the child. Use a thin sheet and lightweight pajamas to help keep them cool.
When Should I Take My Child to a Doctor for a Fever?
If a child's fever spikes at about 104°F (103°F axillary), they should be taken to the doctor immediately. If the doctor's office is not open, proceed to the nearest emergency department.
In particular, if a fever cannot be maintained below 102°F with fever-reducing medication, a visit to the doctor is in order. If a child has a high fever (above 102°F) with extreme lethargy, a stiff neck, or a rash that doesn't blanch when pressed, take the child to the nearest emergency room immediately. These are signs of meningitis, which is a medical emergency and must be treated with haste.
Dr. Diaz adds that "Any fever lasting more than three days, whose maximum temperature does not start to 'come down,' or which is steadily increasing, likely warrants medical evaluation, and the child should be brought in for evaluation.
If symptoms are localized to a certain body part (example: fever with ear pain, or only throat pain, or only joint pain, etc), then it warrants further evaluation.
If a parent ever feels their child is ill-appearing at any point, they should bring in their child for evaluation. A parent’s opinion and knowledge of their child goes a long way toward indicating how sick the child may be and whether something more serious may be going on."
Can a fever cause brain damage to my child?
It's unlikely. The child's temperature would have to be at 108°F for brain damage to occur. According to Seattle Children's Hospital, that rarely happens and generally requires environmental factors also increasing the child's temperature, such as being in a hot car. However, if your child's temperature is eking ever higher (say up to 104°F), it's better to go to the emergency room rather than risk your child's health.
What Fever Is Too High for a Child?
Head to the Emergency Room
Call the doctor. Use fever reduction strategies.
>102 with vomiting, stiff neck, or lethargy
Head to the Emergency Room immediately.
Fever with seizure
Fever with seizure
Head to the Emergency Room for the first febrile seizure.
What Do Febrile Seizures Have to Do With Fevers?
Who gets febrile seizures?
Most common in very young children (3 months - 5 years), febrile seizures occur in up to 5% of all children. When the body temperature changes rapidly, a child may have what is known as a tonic-clonic seizure, which is an overall classification of seizure (one that's not limited to children). This is an extremely frightening time for parents, and the child is usually rushed to the emergency room.
Most children who experience this phenomenon will "grow out" of the condition by the age of five or six years. A small percentage of children will continue to experience seizures after this time (approximately 2.5% of children who have febrile seizures as young children will develop epilepsy later on).
Are their siblings in danger of the same experience?
Children who have had one febrile seizure are more likely to have another. In addition, if one child in the family has febrile seizures, the siblings are at a higher risk of experiencing the same condition.
What should I do if my child is experiencing a seizure?
In general, febrile seizures are benign. The first time a child experiences a seizure with a high temperature, the parents should take the child to the nearest emergency department. The parents should:
- Note the time the seizure started.
- Place the child on his or her side until the seizure is finished.
- Note how long the seizure lasted.
- Call 911 or go to the nearest emergency room.
What does a febrile seizure look like?
Symptoms may include:
- staring blankly and/or looking dazed
- convulsing or shaking
- troubled breathing
- a bluish tint around the lips
- being unconscious or unresponsive
Are there different types of febrile seizures?
Yes, there are two classifications: simple and complex. Most febrile seizures are simple, resolve on their own, and—while frightening—aren't generally life-threatening. Let's look at the differences below.
What's the Difference Between a Simple and a Complex Febrile Seizure?
Brief, lasting less than 5 minutes
Prolonged, lasting more than 10 minutes (or have multiple short seizures in rapid succession)
Usually resolve on their own with no lasting effects
Happens in a localized part of the brain
Which Thermometer Is the Most Accurate for a Child?
Most physicians recommend a rectal temperature for infants under the age of three months. If a parent is uncomfortable with this procedure, take the baby in to a doctor's office as soon as possible to have the nursing staff obtain a good measurement. Any fever in a child younger than three months of age needs to be assessed and addressed immediately.
Ear thermometers are generally not accurate for children under the age of six months. If the ear canal is not large enough and pulled into a straight configuration, the reading will be inaccurate. Earwax will also interfere with this type of thermometer. It is best to use an alternative type of thermometer (under the arm or a temporal thermometer) in very young babies.
Temporal thermometers measure the heat in the temporal artery in the forehead. These thermometers are an excellent option for monitoring a child's temperature in the middle of the night. Be sure to follow the directions exactly to get an accurate reading. If any reading is in doubt, confirm with a digital thermometer under the arm.
Another type of thermometer is a pacifier thermometer. These wonderful little devices have been proven accurate for very young babies and offer a great alternative to monitoring a little one's temperature.
Many digital thermometers may be used under the tongue or under the armpit. Axillary (under the armpit) measurements are possible with very young children. If a child's temperature is taken under the arm, make sure to inform the child's doctor that it was an axillary measurement. The body temperature reading under a child's arm will be lower than when taken by mouth. All families should have at least one digital thermometer on hand for use with all members of the family.
There are several types of thermometers on the market today. Oral thermometers are traditionally placed under the tongue. These thermometers are not appropriate for very young children, as they cannot keep the tip of the thermometer in the right location to get an accurate reading. Dr. Diaz notes, "This can be affected by mouth breathing and by what the child has eaten or drunk prior to taking their temperature. Be sure to give a few minutes before checking the temperature if the child has just eaten or drank anything."
What Type of Thermometer Is Best for Which Age Group?
Type of Thermometer
Best Age Group
Ear (in combination with a second type of reading, such as an auxiliary)
Any (And tell your child's doctor how you took the temp; great backup measurement)
None (or old enough to follow directions)
Dr. Guillermo Diaz
- The article has been modified since this review was written.
“Fever is one of those things that pediatricians constantly deal with, but at the same time we need to be sure we're careful in messaging information so we balance the line to avoid being alarmist but not so lax as not to be clear on when a parent really should be alarmed. Overall, I think this is a great practical article for parents. I've reviewed the article, and my comments have been included.”