Prather Pediatric and Allergy Center - Ask Doctor Brent

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Title: Fever in Children - What Is It and How To Treat It

Category: Child Care


Fever is a symptom of some underlying disease or inflammation. Most of the time in children, fever is caused by viral illnesses and is nothing to be really concerned about. Occasionally, however, fever is a symptom of a serious under- lying disease such as serious viral or bacterial infection and should not only be treated to help the child become more comfortable but the doctor should be called and the patient should be checked. This is a decision parents need to make each time the child has fever and certain characteristics should make the parents move quickly to call their doctor. These characteristics include a child who is under three months of age with any fever at all, a child of any age who has high fever and is "sick" looking. Finally, a fever which does not seem to respond to routine treatment with Tylenol and sponging and which persists over a long period of time such as several days should prompt a check with the doctor.

Children normally have a one to two degree change in their temperature (ranging anywhere from 97 to 100 degrees) every 24 hours. Because of that it is important to recognize that even a temperature of 99.9 or 100.0 rectally in a one year old baby may be perfectly normal and may not actually be a fever. It helps to check the temperature on more than one occasion to get an idea of whether or not the temperature is truly abnormal or is just the normal temperature swing found in all children.

In the past, Tylenol has been the mainstay of fever treatment and is still considered the first line drug to control fever in children because of its safety profile and ease of dosing and effectiveness. Because of Reyes Syndrome, aspirin is no longer used in children except in unique circumstances and, therefore, not available for treatment of fever in children as it was in years past. A new medicine recently approved for children under age 12 is ibuprophen. This is about as effective as aspirin and seems to be just about as safe as Tylenol. There have been no associations with Reyes syndrome to date with over 15 years of use in teenagers in this country and about 10 years of use in Europe in even smaller children. The trade name is Children's Advil and the other trade name is Pediaprophen. Dosing is similar to Tylenol and ranges from a half teaspoon to several teaspoons for a large child, every 4 to 6 hours. The actual milligram dose range is five to ten milligrams of ibuprophen per kilogram per dose. The effect on decreasing fever seems to last up to six and even eight hours in many cases. There is no hard proof that alternating doses of ibuprophen and Tylenol decreases fever better than a high dose of either medicine alone; however, this is commonly done and I think most pediatricians around the country feel comfortable doing it. Some of the reasons for using ibuprophen as a second line or even considering it as a first line medicine to treat fever in children are:

1. Good taste;

2. Ease of dosing and longer duration of action;

3. Relatively safe profile after several years of experience in teenagers and now a few years in young children;

4. Possible potential of helping the child feel better by alternating it with Tylenol.


This last item is especially important in the case of flu syndrome or high fever associated with severe ear or throat infection involving high fever and discomfort. Again, Tylenol is still considered by most pediatricians to be the safest and best choice for first line treatment for fever; however, we now have an option of giving children's Advil or Pediaprophen in addition to or in place of Tylenol to treat children's fevers. This is a welcome addition in light of the flu epidemic we had in our area last winter.