Temperature rising

A parent's guide to baby fever

He seems to be running a bit of a fever.” Uttered over a one-day-old baby, the midwife’s words caused even a third-time mother’s emotional temperature to surge temporarily.

This panicky parental response is so common doctors have coined a catchy name for it: fever phobia. But while an elevated temperature is a valuable clue to the state of your little one’s health, in most cases, it doesn’t warrant this kind of alarm. So what’s the significance of those numbers on the thermometer? And when should you be worried by the fact your toddler’s forehead feels hot? Here are the facts on fever:

“Fever per se isn’t an illness, it’s a symptom,” stresses Ottawa paediatrician William James. A higher-than-normal body temperature (see “When Does Your Child Have a Fever?”) is a little like the oil light on your car’s dashboard. Just as that red flicker can signal situations ranging from a faulty bulb to a defective oil gasket that could threaten the health of your engine, fever is simply a warning signal that reveals little about the underlying cause.

In the first few years of life, when a child’s immune system is still learning to fight off viruses and bacteria, these are the culprits most likely to be found lurking behind a fever. “Fever is produced by our immune system in order to defend us against potential threats,” explains Rodrick Lim, a paediatrician at the Children’s Hospital of Western Ontario. Nor is fever intrinsically harmful, he adds. In fact, turning up the thermostat a few degrees makes the invaders uncomfortable, and gives the body’s own fighting forces an edge.

But that doesn’t mean the degree of temperature is a measure of how severe or serious an illness is, or a need for antibiotics. Some of the highest fevers in children are caused by viruses, which these medications can’t kill. Many of the offenders, like roseola, are relatively harmless, and only need treatment with time and TLC.

That said, there are some situations in which fever alone is reason enough to seek immediate medical advice: if your baby is younger than six months — particularly if she is three months old or less — or has pre-existing health problems. In newborns, whose internal thermostats haven’t yet matured, a slightly elevated temperature may simply mean a baby is overdressed. Remember the little guy in the opening paragraph? The thermometer registered a reassuring number once his blanket, sleepers and hat were removed — it was July! But if stripping to the skivvies doesn’t work, call your doctor, public health nurse or paediatric warm line.
Why the extra vigilance with tiny babies? “Number one, their immune systems aren’t as well developed, so they could have a much more serious infection,” says Cynthia Cupido, an assistant professor of paediatrics at McMaster University in Hamilton. “Number two, they can’t tell us as well as an older child that something is wrong.” Because babies this young don’t always develop the same symptoms as older kids, it can also be tougher to tell whether they have infections. To be on the safe side, it’s best to have them seen by someone who’s experienced at making this kind of call.

With older babies and toddlers, when you’re trying to decide what to do about a fever, you can look for some of the same indicators a doctor would, and couple that with the intuition you’ve developed living with your child day to day.

Lim says, “The most important thing to take into context is how the child looks. I tell parents that a child who looks ill, who doesn’t have a fever, is much more concerning to me than a child who looks well, but has a temperature of 40.”

Hydration. “An important piece of data is how the illness is affecting the child’s ability to eat and drink,” Cupido explains. While it’s normal for a feverish one-year-old to push away cheese and crackers, if she’s refusing to drink, you need to keep an eye on whether she’s properly hydrated. Ditto for a younger baby who turns up his nose at the breast or bottle. (Obviously, when a temperature goes hand-in-hand with diarrhea, vomiting or both, making this distinction becomes doubly important.)

If your baby is producing a wet diaper every four to six hours (or one per feed), it’s probably OK to hold off on going to the doctor. On the other hand, if she’s showing danger signs of dehydration — a drop in urine output, not making tears, and dry-looking lips, tongue and eyes — seek medical attention immediately.

Activity Level. “If a child has no interest in interacting, his typical activity level has dropped off dramatically and that continues despite treatment,” says Cupido, “then that child should be seen.” It may be the illness, and not the fever, that’s responsible.

Distress. If your baby keeps crying inconsolably or otherwise seems to be in pain even after you’ve done your best to make him more comfortable, it’s best to bring in the experts. Check with your doctor, or bundle your baby up and head for the emergency department.

Treating a Fever

If your toddler is cranky (or even crying inconsolably), or a little listless, treating the fever may make her feel more comfortable. Even though a fever revs up the immune system, it’s OK to use an appropriate dose of acetaminophen or ibuprofen (follow the by-weight package directions) to turn down the temperature and relieve the chills and other miserable symptoms that accompany fever, says James, provided your baby is older than three months. (If your baby is younger, check with your doctor.) “If not using it speeds recovery by a half a day, I on’t think that’s as important as making the child comfortable.” Often this simple strategy will perk up your toddler’s energy level and make her more apt to keep drinking, which means she’ll also get better more quickly. You can also try old-fashioned comfort measures like cool cloths, books, stickers, freeze pops and a favourite juice. (Avoid alcohol rubs: it can be toxic when absorbed through the skin.)
If your child’s fever doesn’t respond to treatment, that doesn’t necessarily mean the illness is more worrisome. Unless the temperature is particularly high (39°C or above — in which case, check with a health professional) if your toddler seems otherwise happy, it’s probably OK to wait a day or even two before calling your doctor.

On the other hand, even if your child only has a slight temperature, and she just doesn’t seem right, go with your gut. “If a parent is concerned, I think that’s the most comprehensive warning,” says Lim. “That’s what we’re here for — to see children, and make sure they’re OK.”

When Does Your Child Have a Fever?
While a child’s temperature will normally fluctuate throughout the day (it’s usually a little cooler in the morning than the evening), your child has a fever if:
• the rectal temperature is 38.5°C (101.3°F) or higher;
• the oral, tympanic, or axillary temperature is 38°C (100.4°F) or higher.

Contact a physician if your child:
• is excessively fussy or irritable;
• is unresponsive or very lethargic;
• is under six months old and has a fever;
• has a fever greater than 39°C (102°F) that doesn’t respond to medication;
• has a fever plus a rash or other worrisome symptoms;
• is persistently wheezing or coughing.

Taking a Temperature

The kiss test is not a reliable tool for determining whether your baby has a fever. Use a thermometer to measure his temperature if he’s unwell, says Cynthia Cupido, a critical care physician at McMaster Children’s Hospital in Hamilton, Ont. What kind of thermometer should you choose? A rectal thermometer is a good option, since most types can also be used under the arm. No need to squint anymore — for easy-to-read results, you can’t beat the relatively inexpensive digital models. (The CPS now recommends using a non-mercury thermometer, since the metal does pose a small risk to kids if the instrument breaks.) Tympanic (ear) thermometers also offer the advantage of speed, which is particularly useful if your little one is crying or fidgety. On the down side, a good-quality tympanic thermometer is much more expensive than a reliable rectal model.

Febrile Seizures

No doubt about it — seizures are scary. And occasionally, in kids aged six months to about six years, a fever will trigger a seizure. (These are most common in kids who have a family history of febrile, or fever-related, seizures.) The important thing to keep in mind is that these seizures usually stop by themselves within a few minutes and, in most cases, don’t cause any damage, reassures London paediatrician Rodrick Lim. Just make sure your child is safe (protect her head, but don’t restrain her). If the seizure lasts longer than two or three minutes, call 911 — otherwise, as soon as the seizure stops, go to the emergency department to have your child checked over.

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