Fever in children – When to call a doctor

by Aarti Kapur Singh

If you’re a parent, you’ve probably wrestled with this question. Here is what you must know about fever in children

Changing season is the trickiest time for babies. And for moms too. It is rather difficult to tell for parents when the increase in temperature in a baby is controllable and when should one get medical intervention without delay. If you’re a parent, you’ve probably wrestled with the question more than once when your kid got sick: Should I call the paed? All kids get a fever from time to time. Most usually don’t indicate anything serious. Fever itself causes no harm and can actually be a good thing — it’s often the body’s way of fighting infections. But when your child wakes in the middle of the night flushed, hot, and sweaty, it can be unsettling. Should you get out the thermometer? Call the doctor?

Read on to know when you should call a doctor if your child has fever…

Baby Fever:

First things first. Recognize the fever. Touch your baby’s forehead. If you think he feels hotter than normal, you’re probably right. A higher-than-normal body temperature is called a fever. Taking your baby’s temperature can confirm your suspicions and help you and your child’s doctor figure out the best way to get your baby back on the road to health.

Keep in mind that everyone’s temperature rises in the late afternoon and early evening and falls between midnight and early morning. This natural cycle of our internal thermostat explains why doctors get most of their phone calls about fever in the late afternoon and early evening.

A normal body temperature for a healthy baby is between 97 and 100.3 degrees Fahrenheit. If your baby’s rectal temperature is 100.4 degrees Fahrenheit or higher, he has a fever. If your baby seems sick and his temperature is lower than normal (less than 97 degrees F/36 degrees C), it is time to call a doctor. Very young babies sometimes become cold rather than hot when they’re ill.

These are the reasons your child could have fever:

1. Infection: Most fevers are caused by infection or other illness. A fever helps the body fight infections by stimulating natural defense mechanisms.

2. Overdressing: Infants, especially newborns, may get fevers if they’re overbundled or in a hot environment because they don’t regulate their body temperature as well as older kids. But because fevers in newborns can indicate a serious infection, even infants who are overdressed must be checked by a doctor if they have a fever.

3. Immunizations: Babies and kids sometimes get a low-grade fever after getting vaccinated.

4. Teething: Although teething may cause a slight rise in body temperature, it’s probably not the cause if a child’s temperature is higher than 100°F (37.8°C).

Symptoms of a serious fever:

A temperature reading isn’t the only indication of whether a fever is serious. 

1. Age is a factor: Fever is more serious in babies under 3 months. Older children with a cold usually don’t need to see the doctor. If your baby is 3 months or younger, though, you should call your paediatrician at the first sign of illness, since colds can quickly turn into something more serious, like bronchiolitis, croup, or pneumonia.

2. Behavior is another factor: A high fever that doesn’t stop your baby from playing and feeding normally may not be cause for alarm.

When to call the doctor: 

You’re the best judge of whether your baby is really ill – so do call if you’re worried, no matter what his temperature is. As a general rule, the younger your child, the sooner you will need to get him checked out.  Ask your baby’s doctor for more specific advice, but generally:

• Call the doctor if the baby is between 3 months and 6 months old and has a fever of 101 degrees F (38.3 degrees C) or higher, or is older than 6 months and has a temperature of 103 degrees F (39.4 degrees C) or higher – and has symptoms such as a loss of appetite, cough, signs of an earache, unusual fussiness or sleepiness, or vomiting or diarrhea.
• Call the doctor if your baby is noticeably pale or flushed, or has fewer wet diapers.
• If you notice an unexplained rash, which could indicate a more serious problem when coupled with a fever. Small, purple-red spots that don’t turn white or paler when you press on them, or large blotches, can mean serious bacterial infection. Do not waste time and call the doctor immediately.
• If your baby has difficulty breathing (working harder to breathe or breathing faster than usual), it could indicate pneumonia or bronchiolitis.

Here’s when we recommend you contact your child’s doctor, depending on his or her age:

• Under 3 months: Any fever of 100.4°F or higher, even if he shows no other symptoms of illness. If the fever develops after office hours or on a weekend, go to the emergency room. Young babies have a limited ability to fight illness because their immune system isn’t fully developed. If your baby is under 3 months old and has a temperature of 100.4 degrees F (38 degrees C) or higher, call the doctor immediately. A baby this young needs to be checked for serious infection or disease. Young babies can’t tell you if they are really sick and there are some serious bacterial infections that they are more prone to, like kidney infections, blood stream, and pneumonia. If your baby is under 3 months old, your doctor will probably ask you to bring him in to be examined. She may tell you not to give your baby any fever-reducing medicine until after she has taken an accurate temperature reading.
• 3 to 6 months: A fever of 101°F or higher. If your baby is 3 months old or older, the most important thing is how he looks and acts. If he appears well and is taking fluids, there’s no need to call the doctor unless the fever persists for more than 24 hours or is very high. Ask your doctor for additional guidance: For example, the doctor may suggest calling right away if your baby’s fever reaches 104 degrees, regardless of symptoms. If your baby is 3 months or older, is reasonably alert and taking fluids, and has no other symptoms that suggest a serious illness, the doctor may advise simply waiting 24 hours before bringing him in. Because fever is often the first symptom of an illness, a doctor may not find anything significant if your baby is examined too early.
• Over 6 months: A fever 103°F or higher.
•  A fever in any age child measuring between 104ºF (40.0ºC) and 105ºF (40.6ºC)
•  Fever in a child over three months of age without an obvious source (accompanied by common cold symptoms, diarrhoea, etc)

When your child is older than 3 months, call the pediatrician if:

• He’s having trouble breathing.
• He’s got a stuffy nose for more than 10 days or a cough that lasts more than a week.
• His ear hurts.

Other situations when you need to get in touch with the doctor, in case your child has fever, are:

• Fever more than 3 consecutive days with an obvious source of infection or any fever without an obvious source of infection
• Any fever and sore throat that lasts more than 24 to 48 hours
• You see signs of dehydration, such as a dry mouth, a sunken soft spot, or fewer wet diapers (less than one every 8 hours)
• Your child has a fever and pain when urinating
• Your child is lethargic, refuses to eat, has a rash, or is having difficulty breathing
• Your child has a febrile seizure
• Your child has a fever and has recently returned from a trip abroad
• If the child is still lethargic or listless even after taking fever-reducing medication
• A fever accompanied with a headache, stiff neck, or purplish patches or tiny red spots on the skin
• A fever and severe pain

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