When you imagine your child’s milestones, you might think about their first tooth or first steps. You probably don’t think about their first fever, so when it happens, it can be a frightening experience.
“It’s hard to see your child feeling poorly, but parents can be especially scared of the fever itself,” says UNC Health pediatrician Katherine Jordan, MD. “The fever is actually the body’s way of protecting itself. By raising the temperature, it makes it harder for an infection to thrive in the body.”
When your baby or young child can’t talk to tell you how they feel, it’s easy to fear the worst about a fever. Dr. Jordan explains when to call a doctor if your child has a fever and how you can help them feel better at home.
Understanding Fevers in Children and Taking Their Temperature
The definition of a fever is a body temperature of 100.4 degrees Fahrenheit or higher, but if you’re the parent of an newborn, anything over 100 is a concern, Dr. Jordan says.
You may notice if your child feels warm or that they’re starting to act or look sick, but don’t rely on your hand on their forehead to determine if they have a fever.
“For little babies, parents should have a rectal thermometer, because it’s the most accurate,” Dr. Jordan says. “When you check the temperature rectally, you get the actual temperature from inside the body, called the core body temperature.”
If you have a baby, you can use a forehead thermometer as a first pass to check their temperature, but it’s important if there are concerns to double-check with a rectal thermometer, as it can affect your next steps (more on that in the next section).
An ear thermometer can be used on children age 6 months and older, and oral thermometers can be used once a child is 4. Forehead and armpit thermometers can be used at any age, but if your child has any underlying health conditions that make a fever more dangerous, you may need to continue using a rectal thermometer for its accuracy.
It can be especially frightening to take a child’s temperature and see a reading between 102 and 104, but a higher fever doesn’t necessarily mean your child is sicker or in more danger.
“It really depends on the situation,” Dr. Jordan says. “Sometimes bacterial infections or viruses just cause higher fevers than other illnesses. The fever itself is not dangerous, typically, unless there are other conditions that cause risk.”
If your child has other medical conditions such as cancer or sickle cell disease, or an incomplete vaccination history, you should talk with your doctor more urgently if your child has a fever.
When to See a Doctor About Your Child’s Fever
If your baby is younger than a month old, a fever is a medical emergency.
“Take the baby to the emergency room,” Dr. Jordan says. “They will need lab work and may need treatment right away.”
If your baby is between 1 and 3 months old, call their doctor to see if they can be seen urgently; they may also advise you to go to the emergency department.
These young babies are at particular risk for fevers because they don’t yet have some important vaccines. At 2 months old, babies should receive the first dose of the vaccines that protect them from the bacteria that cause pneumonia, meningitis and whooping cough, to name a few, meaning that they are now at lower risk for the complications from a fever, including sepsis.
“For babies older than 3 months who have had their 2-month vaccines and no underlying health conditions, a fever is not as urgent or dangerous, unless there are other health conditions that cause risk,” Dr. Jordan says.
If your baby did not receive recommended vaccinations at 2 months old, they are still at risk for infections and complications and should be seen urgently.
If there is any change in your child’s intake of fluid and output of urine—you notice they’re not producing wet diapers—call your doctor or seek urgent care. A baby or toddler can become dehydrated when they don’t feel well enough to eat because of their fever. Any time you see that your child is having trouble breathing—fever or not—call 911 or go to the emergency department.
You might still need to see your child’s doctor if it’s clear they have an infection that requires antibiotics, such as an ear infection or pneumonia, but as your child grows, the fever in and of itself is no longer as dangerous, as long as it responds to a fever reducer and is over in a few days.
“As long as everything else is OK—no change in urine, no underlying condition, no need for antibiotics—it’s fine to have a child home for three or four days with a fever,” Dr. Jordan says. “If a fever lasts longer than four days, the child should be evaluated for the cause.”
About 3 to 4 percent of children may experience a febrile seizure as a result of their fever. During a febrile seizure, the child becomes unresponsive, stiffens, then twitches or jerks. They occur most often in children between 12 and 18 months old, and they tend to run in families.
“If your child has a febrile seizure, they should be evaluated,” Dr. Jordan says. “The good news is, these are not typically dangerous to children, and they do well in the long-term.”
Treating Your Child’s Fever at Home
If your child has a fever and you determine it’s not an emergency, the next thing to focus on is keeping them hydrated. For babies, that means making sure they take breast milk or formula regularly; older babies, toddlers and children can drink Pedialyte or other fluids.
“If an older kid has a fever with a sore throat, something cold, like ice water or a popsicle, can help soothe their throat while keeping them hydrated,” Dr. Jordan says. Honey should not be given to infants younger than 12 months old.
You can give your child medication to reduce their fever. For babies younger than six months, only acetaminophen is recommended. For babies and children older than six months, you can use acetaminophen or ibuprofen. Talk to your child’s doctor or check the package to ensure you give your child the appropriate dose based on your child’s weight. Caregivers can check their child’s weight at home to make sure they are using the correct dose.
If your child’s fever doesn’t respond to a fever reducer, call your child’s doctor. Do not give aspirin to children younger than 16 years old because it can cause a rare but serious condition called Reye’s syndrome.
A cool washcloth applied to your child’s head can help them feel more comfortable, but don’t put a baby in a cold bath to try to reduce their fever.
If any symptom—a fever or something else—has you worried, reach out to your child’s doctor.
“Parents have the best insight into their children, so if something is not right to you, call their doctor,” Dr. Jordan says. “That’s what we’re here for. We’re always happy to see your child and talk through every concern.”
Concerned about your child’s health? Talk to their doctor. If you need a doctor, find one near you.