The baby feels warm! What should I do? Here are a few steps to follow if you feel your child has an elevated temperature.
Remember, fever is not an illness. It is a symptom (warning signal) that something is “ wrong”.
Fever is one of the body’s ways to help defend against a variety of infections or inflammations.
Only your doctor, on history, physical examination and, if necessary, laboratory investigations, can determine whether or not your child has a bacterial infection accompanied by fever requiring an antibiotic. Do not insist on an antibiotic. Let your doctor make the determination.
Most infants’ elevated temperatures are due to viral infections that do not require an antibiotic.
Far too many antibiotics are being prescribed to appease both the doctor and the parent. The doctor, unfortunately, may find it easier to prescribe an antibiotic for a child with a fever rather than explain why antibiotics are unnecessary at that time. Only with the documentation of a proven bacterial infection should antibiotics be prescribed and not “just in case”.
Remember, teething does not cause fever. Perhaps an increase of one half a degree but no higher.
High fevers should not be blamed on teething. Other reasons for the fever should be looked into.
It is extremely important to take your baby’s temperature. Do not rely on touch alone.
No matter how “temperature sensitive” your palm, fingers or lips are, no family should be without a thermometer or not know how to use it. Learn how to use your thermometer before you need to
Sites of Temperature Measurement
There are various areas on the body used to determine an elevated temperature. These include the ear, under the tongue, axillary (armpit) and rectal.
Ear temperature: The ear thermometer is the most recent advance in recording an infant’s temperature. The advantage of this method is that it is very quick. Also the child’s temperature can be taken without any discomfort, even while he is sleeping. It is quite accurate.
The disadvantages are that these devices are expensive and need replacing after a certain number of uses. It also requires practice using the proper technique to get an accurate reading.
It will give an accurate measurement even through substances like wax, but unfortunately, not through fluids such as pus or eardrops. I do not recommend the use of ear thermometers for infants under two years of age at its present level of technology.
Oral temperature: This method is quite accurate if the thermometer is held under the tongue for 2 minutes. The child must be old enough to be able to keep the lips closed around the thermometer to hold it in. A child under 4 years of age will most likely be unable to use an oral thermometer.
Axillary temperature: This method is painless and can be used on infants of all ages. It is accurate only if the thermometer is placed properly in the skin folds of the axilla at the mid-point in distance from the front to the back of the armpit. Often it is not put in far enough or is placed in too deeply, resulting in an inaccurate reading. Although convenient to use, I prefer the rectal route to give a more accurate reading.
Rectal temperature: A rectal thermometer is an excellent way of determining the temperature of an infant or child up to two years of age or older. The technique is safe, simple and accurate.
Being old-school, I trust this method as being the most accurate for infants and small children.
However, showing that I can change with the times, I am amenable to other readings, by other methods, as long as I am assured that they have been taken accurately.
Preferred Sites for Temperature Measurement
Less than two years of age: First choice, rectal Second choice, axillary
Two to four years: First choice, ear
Second choice, rectal
Third choice, axillary
Five years and older: First choice, ear
Second choice, oral
Note: Other methods of recording an elevated temperature, such as fever strips or the so-called thermometer pacifiers and others, may be helpful to tell if the temperature is elevated but may not give you an accurate reading.
Methods of Taking Temperatures
First, if using a mercury thermometer, clean it with an alcohol swab and shake the mercury down so that the mercury level is below the Normal line. Dip the tip of the glass mercury thermometer into a small amount of petroleum jelly. If you are using one of the mechanical digital read-out devices, cover the tip with a lubricated sleeve provided or put Vaseline on the tip. Turn on the thermometer.
For small infants under 18 months of age, lay them on their backs and grab both feet with one hand. Bend the legs at their knees so that their knees are near the tummy. This will expose the infant’s anal opening. With the other hand, insert the thermometer 1.5 to 2 cm. (3/4 to 1 inch) and hold for 1-1/2 to 2 minutes in the rectum or until the beep sounds in the mechanical readout
The older infant may be placed tummy or face down on your lap. Place one of your arms across the infant’s back to control movement. With the hand of that same arm, spread apart the buttock cheeks to expose the anal opening. Insert the thermometer tip with the other hand.
Calm reassurance and explanation during this procedure of temperature taking will usually relax the reluctant infant. Rectal temperatures are painless if you can get the infant to relax. You will not puncture the rectum, even if you insert the thermometer up to 3–4 cm inside.
When finished, wipe the petroleum jelly off the thermometer and read. Then clean with alcohol and store for further use. The disposable sleeves on the mechanical devices are to be discarded.
The only concern using mercury thermometers is that if the baby is struggling a lot, the thermometer could break while inside the rectum.
If your infant is a real fighter, use either one of the mechanical rectal digital read-out thermometers or choose another site.
Axillary (Armpit) Route:
Axillary temperatures should be taken in the mid-axilla region of the armpit with the arm against the child’s side. Leave the thermometer in place for 2 minutes.
Turn on the thermometer. Pull ear up and back. Place tip in ear to a point halfway between the ear and eye on the opposite side of head. Click and read.
Oral (Mouth) Route:
For oral temperatures it is best taken for children who can cooperate (over 4–5 years of age).
Make sure that the thermometer is kept under the tongue for 1–1/2 to 2 minutes. Lips should be closed around the thermometer.
Rectal – less than 38ºC or 100.4ºF
Oral – less than 37.5ºC or 99.5ºF
Axillary – less than 37.3ºC or 99.1ºF
Aural (Ear) – less than 38ºC or 100.4ºF
When to Seek Medical Advice with a Febrile Infant/Child
Using common sense is important. Only you can judge how ill your child is and when to seek medical advice. If your child is eating and is relatively playful, you can wait and see. A little crankiness is to be expected with an elevated temperature. Whether to seek medical advice in the middle of the night or not is difficult to answer. All symptoms always seems worse at night.
If the infant does not seem overly distressed, try to tide him/her over until the morning before calling to see your doctor. Certainly, if your baby appears more ill than you would expect from the temperature alone, seek medical advice at once.
Any infant under 3 months of age who has an elevated temperature should be assessed as soon as possible. As a general rule, with fever, the smaller the infant, the earlier you should seek advice. Any child having a temperature of greater than 40°C (104°F) should be seen that day.
Medical advice should also be sought if there is a fever accompanied by symptoms such as persistent sore throat, sore ear, pain on urination, persistent vomiting and/or diarrhea. Any cold
symptoms with persistent fever lasting over 48 hours should be assessed. Other symptoms of concern are the child with a fever who is lethargic, pale, refusing fluids or limp, or who has joint pain or a rash that looks like small bruises.
DO NOT USE MEDICAL WALK-IN CLINICS OR EMERGENCY DEPARTMENTS FOR CONVENIENCE.
Look at your child; if he is not extremely ill, wait to see your family doctor or pediatrician for assessment. Generally speaking, it is not so much the height of the fever to be concerned about but rather, the total picture of the child. If the temperature is very elevated and the child does not appear or act overly ill you can wait. If however, at a low temperature the child appears and acts ill he should be assessed.
Unexplained fevers (that is, those without any other symptoms) that persist in an infant or toddler are always a concern. One common cause of such fevers is roseola. This is a viral illness occurring in infants between 6 and 20 months of age. There is a high fever for about three or four days. The infant does not appear overly ill. The fever then breaks and a faint rash appears on the trunk area of the body. The rash fades in one or two days. Never do the rash and fever appear together. That is, the fever goes and then the rash appears. If this is what your baby
seems to have, do not fret. Your baby is not contagious. Let your child continue his/her normal
All too often, this child is placed on antibiotics when fever first presents. The question then arises as to whether or not the child had roseola or another viral rash, or if the rash is a result of the antibiotic (which he/she probably didn’t need in the first place)? Ninety-nine per cent of the time the rash is related to the viral infection and not to the antibiotic. No child should be labeled as having an antibiotic allergy unless the rash is seen by the doctor and determined to be allergic in origin. If there is doubt, allergy skin testing should be done.
A urinary tract infection is not an uncommon cause for an infant or toddler to have fever or fussiness (especially if the crying seems to indicate pain) lasting for two or three days without any other symptoms. When visiting the doctor with an unexplained fever (no other symptoms) of more than 48 to 72 hours, have the baby clean and dry in the diaper area. That is, no oils, powders or paste in this area. A urine-collecting bag may have to be applied to collect a urine specimen if the infant is not toilet trained. The sticky surface of the bag does not adhere unless it is applied directly to clean skin. Bring a bottle (milk, juice, water or a breast) with you to feed
the infant. This will encourage a urine sample after a short waiting period.
There are numerous illnesses that may present with a prolonged fever as the main and even only symptom. Illnesses such as juvenile rheumatoid arthritis or inflammatory bowel disease may present with intermittent fevers for months before the diagnosis can be made only after the onset of other symptoms such as a swollen joint or diarrhea.
Kawasaki’s disease or leukemia are always a concern in a child with fever and little else in symptomatology. Foreign travel illnesses such as malaria should be considered on an individual basis.
Fever control: With any elevated temperature, especially of high degree (over 39°C), the baby’s hands and feet may feel quite cool, lips appear purplish and, if old enough to talk, he may complain of cold feet. Shivering may be present. Do not be fooled and think from these observations that he is chilled and make the mistake of covering the child up. Leave the small infant in a diaper and undershirt with a light top only. When he sleeps, cover with a light blanket.
Remember, we want the heat to go out and not keep it in. Cool sponge baths or alcohol rubdowns are not necessary. If your baby is willing to eat, this is good, so encourage plenty of fluids, milk being acceptable. Acetaminophen or ibuprofen is available in drops, liquids and tablets.
Dose of Medications for Fever Control
• 15 mg per kg (7 mg per lb) of acetaminophen may be given every 4 hours for a total of 5 doses
in a 24-hour period.
• 8–10 mg per kg (4–5 mg per lb) of ibuprofen may be given every 6-8 hours.
Do not use any household teaspoons, which can differ in size, to measure medicine. Only use the dropper, measuring cup or measuring spoon supplied to ensure that the proper dosage of medicine is administered
Note: the fever may return before the next dose of medication is recommended. If this is the case you may wish to try alternating acetaminophen and ibuprofen. Alternate each every 4 hours. That is, acetaminophen, then 4 hours later ibuprofen, then 4 hours later acetaminophen and so on.
If the child refuses or vomits his fever medication, then acetaminophen is also available in suppositories.
The dosage is according to the infant’s weight rather than age. Acetaminophen may be repeated every four hours up to five doses per day. Ibuprofen may be repeated every eight hours up to 3-4 doses (every 6–8 hours) per day. Follow the dosage schedule listed on the bottle
according to weight. Acetaminophen suppositories may be used if the infant or child refuses to swallow the acetaminophen or ibuprofen.
Medication for fever control, whether it be acetaminophen or ibuprofen, may be continued for as long as the fever persists. There is no upper time limit.
If your infant or child vomits the medication within 20 minutes after it has been taken, it may be repeated. After this time, if vomiting occurs, wait for next dosage time.
With the first primary immunizations your infant receives, he may experience fever and irritability, as well as localized inflammation at the site of injection, for a period of 24 to 48 hours.
Acetaminophen or ibuprofen is not required before immunizations. They are administered only if symptoms of fever and irritability occur afterwards. You should inform the doctor if the infant has inconsolable crying, persistent fever of over 40°C when temperature is taken rectally, a febrile seizure or persistent lethargy and vomiting after any immunization.
Because an immunization may be given directly into the muscle that area may become tender, warm, red and swollen. Apply ice for five minutes at a time and repeat as often as necessary.
Acetaminophen or ibuprofen may be given for pain. Within a few days, the inflammation will resolve. Afterwards, a lump may be felt deep in the muscle. It may feel as big as a plum pit.
There may be a dimpling in the skin over the site of injection. In time, that is, a few months, it will resolve. It occurs because during the immunization the needle pierced one of the small blood vessels deep in the muscle. There is some bleeding into the muscle at that site. In time, the blood is replaced with fibrous tissue, which feels like a firm lump. The lump will slowly resolve.