Your Sick Child – How to Treat a Fever

The Sick Child - Wikipedia

Our children had fevers again this week, and while DS1 did well with acetaminophen, fluids, and rest, DS2 had a much harder time.

For the first half of the day, I was able to regulate his fever quite well with children’s acetaminophen (active ingredient in tylenol, but we use generic ever since Tylenol has had recalls on their medications).  Halfway through the day, however, when it was time to give him another dose, his fever had risen to 103 degrees.  He was also shivering violently and moaning.  I gave him some more Tylenol and began sponging him down, but this made the shivering worse and made him scream.

All through this, he was perfectly coherent and spoke to me; he was simply miserable and wanted the shivering and aches to stop.

I broke out my “What to Expect the Toddler Years” book to see if there was something I was missing about fevers.  Usually, I am able to treat fevers quite easily, but DS2′s last two fevers have been more difficult than what I am used to, so I needed some advice.

To my surprise, according to the book, sponging with cold water isn’t recommended as it can raise the child’s temperature.  I hadn’t known this.  The book also stated that shivering will raise body temperature, so the shivering needs to be controlled.  While bundling isn’t recommended for a temperature, as it makes the fever worse, bundling your child in a thin blanket to make the shivering stop is recommended.

With this information in hand, I stopped the sponging treatment and laid a thin blanket on my son in his bed.  He seemed comfortable, and the shivering was beginning to subside, and so I went back downstairs to consult the book again and grab my phone to contact my husband.  I returned to his bedroom, and found him near sleep; the shivering had stopped. I removed the blanket and touched his skin…he had gotten hotter in that short period of time!  I took out the thermometer again.  104.5!!

I immediately started to sponge him down with luke warm water to bring down the fever.  It had been almost an hour, and the tylenol had done nothing to bring down his fever. He had only gotten hotter.  No seizures or unconsciousness, he was talking to me and telling me he felt sick. This was my only reassurance, as a fever that high can often bring febrile seizures and a lethargic child.  These signs mean an immediate trip to the Emergency Room.

I called and texted my husband frantically, telling him to come home immediately as I sponged our son and checked his temperature ever 15 minutes, begging the thermometer to read lower. Once I got it back down to 103, I called the doctor and awaited a call back, continuing to sponge him and have him take in fluids.

By the time I received a call back, my boy was smiling and asking to go back downstairs to watch a movie.  I had him lie on the floor, as the couch was making him hotter, gave him some juice and a sandwich. His appetite had returned! Great news!  By the time the doctor called, his temperature was at 102.7.  The fever had broken and started going down on its own after that, without the need for tylenol or sponging. By the time my husband was able to get home, the temperature was down to 101, and I fell onto the floor in complete and utter relief.

How to Treat a Fever

Most fevers are a good thing, and are actually the body’s response to fighting off a virus or infection.  Usually, if a fever is no more than 102 degrees, medications aren’t recommended unless the patient is in a lot of pain.  When reaching temperatures of 103, though, Tylenol is recommended.  If the medication isn’t working, sponging or the use of ibuprofen, in conjunction with acetaminophen, is used, or sponging with luke-warm (not cold) water is recommended at that point.

The best thing to do for a low-grade fever (between 99.4 and 103 degrees, depending on how the temperature is taken and what the patient’s baseline reading is when he/she isn’t ill) is to simply keep the patient cool, lightly dress (or naked), and up their fluid intake.  Also, it’s best to encourage as much eating as possible, as extra calories are burned during the course of a fever.

Do not bundle a feverish patient with heavy blankets! Despite what Grandma might tell you, treating a fever this way can lead to heatstroke.  Hot water sponging will do the same. The trick is to lower body temperature, not raise it.  Some even recommended sponging with rubbing alcohol. This isn’t a good idea either, as it can raise body temperature and pose a health risk if inhaled too much.

Needlessly Anxious : Mother Consulting Physician - Wikipedia

When do I call the doctor?

When in doubt, call the doctor. That’s rule number 1.  Sometimes, you just know that something is seriously wrong with your child, and it’s better to be safe than sorry.  However, here are some general tips for toddlers with fevers from “What to Expect the Toddler Years”.  My personal opinion is added in italics.

If the fever is:

• over 105 degrees, call your doctor immediately or go to the Emergency Room.
• 104-105, call the doctor within 24 hours.  Call doctor immediately.
• 102-103.9, call during regular office hours or immediately if on the higher end.
• under 102, call in a few days if the fever hasn’t gone away.

Exceptions:

There are many exceptions to the above “rules”, so many that they are too numerous to list here. However, if your child is unresponsive, lethargic, having convulsions or seizures, has a sudden rise in temperature due to being over-dressed or covered in blankets, and/or the fever isn’t coming down with the help of medications, or if the fever is accompanied by severe dehydration, it’s best to call your doctor immediately.  If convulsions are present, it’s probably best to call 911.

I highly recommend to all parents to pick up a copy of “What to Expect the Toddler Years” and “What to Expect the First Year” as there are numerous tips on dealing with fevers and other illnesses in children.  It’s a helpful resource if you face an illness you aren’t used to.

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