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Fever in Infants and Children

By

Deborah M. Consolini

, MD, Thomas Jefferson University Hospital

Medically Reviewed Nov 2022
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Topic Resources

Normal body temperature varies from person to person and throughout the day (it is typically highest in the afternoon). Normal body temperature is higher in preschool-aged children and highest at about 18 to 24 months of age. However, despite these variations, most doctors define fever as a temperature of 100.4° F (about 38° C) or higher when measured with a rectal thermometer (see How to Take A Child's Temperature How to Take a Child’s Temperature How to Take a Child’s Temperature ).

Although parents often worry about how high the temperature is, the height of the fever does not necessarily indicate how serious the cause is. Some minor illnesses cause a high fever, and some serious illnesses cause only a mild fever. Other symptoms (such as difficulty breathing, confusion, and not drinking) indicate the severity of illness much better than the temperature does. However, a temperature over 106° F (about 41° C), although quite rare, can itself be dangerous.

Fever can be useful in helping the body fight infection. Some experts think that reducing fever can prolong some disorders or possibly interfere with the immune system's response to infection. Thus, although a fever is uncomfortable, it does not always require treatment in otherwise healthy children. However, in children with a lung, heart, or brain disorder, fever may cause problems because it increases demands on the body (for example, by increasing the heart rate). So lowering the temperature in such children is important.

Infants with a fever are usually irritable and may not sleep or feed well. Older children lose their interest in play. Usually, the higher a fever gets, the more irritable and disinterested children become. However, sometimes children with a high fever look surprisingly well. Children may have seizures when their temperature rises or falls rapidly (called febrile seizures Febrile Seizures Febrile seizures are seizures triggered by a fever of at least 100.4° F (about 38° C). Most febrile seizures are harmless and caused by fever from a minor infection. Less often, a febrile seizure... read more ). Rarely, a fever gets so high that children become listless, drowsy, and unresponsive.

How to Take a Child’s Temperature

A child's temperature can be taken from the rectum, ear, mouth, forehead, or armpit. It can be taken with a digital thermometer. Digital thermometers are easier to use and give much quicker readings (and usually give a signal when they are ready). Glass thermometers containing mercury are no longer recommended because they can break and expose people to mercury.

Rectal temperatures are most accurate. That is, they come closest to the child's true internal body temperature. For a rectal temperature, the bulb of the thermometer should be coated with a lubricant. Then the thermometer is gently inserted about 1/2 to 1 inch (about 1 1/4 to 2 1/2 centimeters) into the rectum while the child is lying face down. The child should be kept from moving.

Oral temperatures are taken by placing a digital thermometer under the child's tongue. Oral temperatures provide reliable readings but are difficult to take in young children. Young children have difficulty keeping their mouth gently closed around the thermometer, which is necessary for an accurate reading. The age at which oral temperatures can be reliably taken varies from child to child but is typically after age 4.

Armpit temperatures are taken by placing a digital thermometer in the child's armpit, directly on the skin. Doctors rarely use this method because it is less accurate than others (readings are usually too low and vary greatly). However, if caretakers are uncomfortable taking a rectal temperature and do not have a device to measure ear or forehead temperature, measuring armpit temperature may be better than not measuring temperature at all.

Ear temperatures are taken with a digital device that measures infrared (heat) radiation from the eardrum. Ear thermometers are unreliable in infants under 3 months old. For an ear temperature, the thermometer probe is placed around the opening of the ear so that a seal is formed, then the start button is pressed. A digital readout provides the temperature.

Forehead temperatures (temporal artery temperatures) are taken with a digital device that measures infrared radiation from an artery in the forehead (the temporal artery). For a forehead temperature, the head of the thermometer is moved lightly across the forehead from hairline to hairline while pressing the scan button. A digital readout provides the temperature. Forehead temperatures are not as accurate as rectal temperatures, particularly in infants under 3 months old.

Causes of Fever in Infants and Children

Fever occurs in response to infection, injury, or inflammation and has many causes. Likely causes of fever depend on whether it has lasted 14 days or less (acute) or more than 14 days (chronic), as well as on the age of the child. Fevers are usually acute.

Acute fever

The most common causes of acute fever are

Newborns and young infants are at higher risk of certain serious infections because their immune system is not fully developed. Such infections may be acquired before birth or during birth and include sepsis Sepsis in Newborns Sepsis is a serious bodywide reaction to infection spread through the blood. Newborns with sepsis appear generally ill—they are listless, do not feed well, often have a gray color, and may have... read more (a serious infection of the blood), pneumonia (infection of the small air sacs of the lungs), and meningitis Meningitis in Children Bacterial meningitis is a serious infection of the layers of tissue covering the brain and spinal cord ( meninges). Bacterial meningitis in older infants and children usually results from bacteria... read more (infection of the tissues covering the brain).

Children under 3 years old who develop a fever (particularly if their temperature is 102.2° F [39° C] or higher) sometimes have bacteria in their bloodstream (bacteremia Bacteremia Bacteremia is the presence of bacteria in the bloodstream. Bacteremia may result from ordinary activities (such as vigorous toothbrushing), dental or medical procedures, or from infections ... read more ). Unlike older children, they sometimes have bacteremia with no symptoms besides fever (called occult bacteremia Occult Bacteremia Occult (hidden) bacteremia is the presence of bacteria in the bloodstream of a child who has a fever but who looks well and has no obvious source of infection. Most commonly, occult bacteremia... read more ). Routine vaccines Childhood Vaccination Schedule Most doctors follow the vaccination schedule recommended by the Centers for Disease Control and Prevention (CDC—see the schedule for infants and children and the schedule for older children... read more against the bacteria that usually cause occult bacteremia (Streptococcus pneumoniae Pneumococcal Vaccine Pneumococcal vaccines help protect against bacterial infections caused by Streptococcus pneumoniae (pneumococci). Pneumococcal infections include ear infections, sinusitis, pneumonia... read more and Haemophilus influenzae type b [Hib] Haemophilus influenzae Type b Vaccine The Haemophilus influenzae type b (Hib) vaccine helps protect against bacterial infections due to Hib, such as pneumonia and meningitis. These infections may be serious in children. Use... read more ) are now widely used in the United States and Europe. As a result, these vaccines have nearly eliminated occult bacteremia in children in this age group.

Less common causes of acute fever include side effects of vaccinations and of certain drugs, bacterial infections of the skin (cellulitis Cellulitis Cellulitis is a spreading bacterial infection of the skin and the tissues immediately beneath the skin. This infection is most often caused by streptococci or staphylococci. Redness, pain, and... read more Cellulitis ) or joints (septic arthritis Infectious Arthritis Infectious arthritis is infection in the fluid and tissues of a joint usually caused by bacteria but occasionally by viruses or fungi. Bacteria, viruses, or fungi may spread through the bloodstream... read more ), viral or bacterial infections of the brain (encephalitis Encephalitis Encephalitis is inflammation of the brain that occurs when a virus directly infects the brain or when a virus, vaccine, or something else triggers inflammation. The spinal cord may also be involved... read more ) or the tissues covering the brain (meningitis Meningitis in Children Bacterial meningitis is a serious infection of the layers of tissue covering the brain and spinal cord ( meninges). Bacterial meningitis in older infants and children usually results from bacteria... read more ), or disorders where different parts of the body become inflamed (Kawasaki disease Kawasaki Disease Kawasaki disease causes inflammation of blood vessels throughout the body. The cause of Kawasaki disease is unknown but may be associated with an infection. Children typically have fever, rash... read more Kawasaki Disease or multisystem inflammatory syndrome in children Complications COVID-19 is an acute respiratory illness that can be severe and is caused by the coronavirus named SARS-CoV-2. Symptoms of COVID-19 vary significantly. Two types of tests can be used to diagnose... read more [MIS-C]). Heatstroke Heatstroke Heatstroke is a life-threatening condition that results in very high body temperature and malfunction of many organ systems. (See also Overview of Heat Disorders.) Heatstroke can develop after... read more causes a very high body temperature.

Typically, a fever due to vaccination lasts a few hours to a day after the vaccine is given. However, some vaccinations can cause a fever even 1 or 2 weeks after the vaccine is given (as with measles vaccination Side Effects The measles, mumps, and rubella (MMR) vaccine is a combination vaccine that helps protect against these three serious viral infections. The vaccine contains live but weakened measles, mumps... read more ). Children who have a fever when they are scheduled to receive a vaccine can still receive the vaccine if the fever is low and they have no serious illness.

Chronic fever

Chronic fever most commonly results from

  • A prolonged viral illness

  • Back-to-back viral illnesses, especially in young children

Chronic fever can also be caused by many other infectious and noninfectious disorders.

Infectious causes of chronic fever include

Noninfectious causes of chronic fever include

Evaluation of Fever in Infants and Children

Detecting a fever is not difficult, but determining its cause can be.

Warning signs

Certain symptoms are cause for concern. They include

  • Any fever in infants less than 3 months old

  • Lethargy or listlessness

  • Ill appearance

  • Difficulty breathing

  • Bleeding in the skin, appearing as tiny reddish purple dots (petechiae) or splotches (purpura)

  • Continuous crying in an infant or toddler (inconsolability)

  • Headache, neck stiffness, confusion, or a combination in an older child

When to see a doctor

Children with fever should be evaluated by a doctor right away if they have any warning signs or are less than 3 months old.

Children without warning signs who are between 3 months and 3 years of age should be seen by the doctor if the fever is 102.2° F (39° C) or higher, if there is no obvious upper respiratory infection (that is, children are sneezing and/or have a runny nose and nasal congestion), or if the fever has continued more than 5 days.

For children without warning signs who are over 3 years of age, the need for and timing of a doctor's evaluation depend on the child's symptoms. Children who have upper respiratory symptoms but otherwise appear well may not need further evaluation. Children over 3 years of age with fever lasting more than 5 days should be seen by the doctor.

What the doctor does

Doctors first ask questions about the child's symptoms and medical history. Doctors then do a physical examination. A description of the child's symptoms and a thorough examination usually enable doctors to identify the fever’s cause ( see Table: Some Common Causes and Features of Fever in Children Some Common Causes and Features of Fever in Children Some Common Causes and Features of Fever in Children ).

Doctors take the child’s temperature. It is measured rectally in infants and young children for accuracy. The breathing rate is noted. If children appear ill, blood pressure is measured. If children have a cough or breathing problems, a sensor is clipped on a finger or an earlobe to measure the oxygen concentration in blood (pulse oximetry Pulse oximetry Both arterial blood gas testing and pulse oximetry measure the amount of oxygen in the blood, which helps determine how well the lungs are functioning. Arterial blood gas tests are invasive... read more ).

As doctors examine children, they look for warning signs (such as an ill appearance, lethargy, listlessness, and inconsolability), noting particularly how children respond to being examined—for example, whether children are listless and passive or extremely irritable.

Occasionally, the fever itself can cause children to have some of the warning signs including lethargy, listlessness, and ill appearance. Doctors may give children fever-reducing drugs (such as ibuprofen) and reevaluate them once the fever is reduced. It is reassuring when lethargic children become active and playful once the fever is reduced. On the other hand, it is worrisome when ill-appearing children remain ill-appearing despite a normal temperature.

Table

Testing

Testing for Acute Fever

For acute fever, doctors test for infectious causes according to the age of the child. They thoroughly evaluate children who are under 3 years of age, even those who do not look very ill and those who seem to have a source of infection (for example, an ear infection Acute Middle Ear Infection in Children Acute middle ear infection is a bacterial or viral infection of the middle ear, usually accompanying a cold. Bacteria and viruses can infect the middle ear. Children with ear infections may... read more Acute Middle Ear Infection in Children ). Doctors need to rule out a serious bacterial infection, such as meningitis Meningitis in Children Bacterial meningitis is a serious infection of the layers of tissue covering the brain and spinal cord ( meninges). Bacterial meningitis in older infants and children usually results from bacteria... read more , sepsis/bacteremia Occult Bacteremia Occult (hidden) bacteremia is the presence of bacteria in the bloodstream of a child who has a fever but who looks well and has no obvious source of infection. Most commonly, occult bacteremia... read more , or a urinary tract infection Urinary Tract Infection (UTI) in Children A urinary tract infection is a bacterial infection of the urinary bladder ( cystitis), the kidneys ( pyelonephritis), or both. Urinary tract infections are caused by bacteria. Infants and younger... read more . Testing is especially necessary in infants, because the source of their fever is difficult to determine and because their immature immune system puts them at high risk of serious infection.

Lab Tests for Fever in Children

Fever in infants under 1 month old

Children in this age group who have a fever are hospitalized for testing and treatment because their risk of having a serious infection is high. Testing typically includes blood and urine tests, a spinal tap Spinal Tap Diagnostic procedures may be needed to confirm a diagnosis suggested by the medical history and neurologic examination. Electroencephalography (EEG) is a simple, painless procedure in which... read more Spinal Tap (lumbar puncture), and sometimes a chest x-ray Chest Imaging Chest imaging studies include X-rays Computed tomography (CT) CT angiography Magnetic resonance imaging (MRI) read more . Stool tests are done in newborns who have diarrhea.

Fever in infants between 1 month and 3 months old

Children with fever in this age group who look ill (that is, who have an abnormal cry, lethargy, or other unusual behavior) or who have risk factors for a serious bacterial infection (that is, who have severe birth defects, were preterm, or are unvaccinated) should be hospitalized. These children undergo blood tests, urine tests, a chest x-ray, and a spinal tap to look for bacteremia, urinary tract infections, and meningitis.

Children with fever in this age group who look well also undergo blood and urine tests, but might not have a spinal tap. They are sometimes not admitted to the hospital.

Fever in children between 3 months and 3 years old

Children in this age group who have a fever but look well and can be watched closely may not need tests, especially if doctors find a source of the fever. If symptoms suggest a specific infection, doctors do the appropriate tests.

If children have no symptoms suggesting a specific disorder but look ill, have risk factors for a serious bacterial infection, or have a temperature of 102.2° F [39° C] or higher), blood and urine tests are usually done. Sometimes a spinal tap is done.

The need for hospitalization depends on how well or ill children look, the results of any tests done, and whether a follow-up examination can be done in a timely fashion.

Fever in children over 3 years old

Children in this age group do not typically undergo tests unless they have specific symptoms suggesting a serious disorder or if no source of the fever can be found.

Testing for Chronic Fever

For chronic fever, tests are often done. If doctors suspect a particular disorder, tests for that disorder are done. If the cause is unclear, screening tests are done. Screening tests include a complete blood cell count Complete blood count Doctors select tests to help diagnose blood disorders based on the person's symptoms and the results of the physical examination. Sometimes a blood disorder causes no symptoms but is discovered... read more , urinalysis and culture, and blood tests to check for inflammation. Tests for inflammation include the erythrocyte sedimentation rate (ESR) and measurement of C-reactive protein (CRP) levels. Other tests doctors sometimes do when there is no clear cause include stool tests, blood cultures or tests of antibody levels in the blood to detect bacteria or viruses, tuberculosis skin test or interferon-gamma release assay, chest x-rays, computed tomography (CT) of the sinuses, and bone scans.

Rarely, fevers persist, and doctors cannot identify the cause even after extensive testing. This type of fever is called fever of unknown origin Fever of unknown origin (FUO) Fever is an elevated body temperature that occurs when the body's thermostat (located in the hypothalamus in the brain) resets at a higher temperature, primarily in response to an infection... read more . Children with a fever of unknown origin may require additional testing and evaluation.

Treatment of Fever in Infants and Children

If the fever results from a disorder, that disorder is treated. Other fever treatment is focused on making children feel better.

General measures

Ways to help children with a fever feel better without using drugs include

Because shivering may actually raise the child’s temperature, methods that may cause shivering, such as undressing and cold baths, should not be used.

Rubbing the child down with alcohol or witch hazel must not be done because alcohol can be absorbed through the skin and cause harm. There are many other unhelpful folk remedies, ranging from the harmless (for example, putting onions or potatoes in the child's socks) to the uncomfortable and possibly harmful (for example, coining or cupping Cupping Cupping (a manipulative and body-based practice) is used in traditional Chinese medicine. Cupping is believed to increase blood flow to the area on which a cup is placed, thereby improving healing... read more ).

Drugs to lower fever

Fever in an otherwise healthy child does not necessarily require treatment. However, drugs called antipyretic (fever-lowering) drugs may make children feel better by lowering the temperature. These drugs do not have any effect on an infection or other disorder causing the fever. However, if children have certain chronic disorders or a history of seizures triggered by fever, using these drugs may be recommended by the doctor because they reduce the extra stress put on the body by fever.

Typically, the following drugs are used:

  • Acetaminophen, given by mouth or by suppository

  • Ibuprofen, given by mouth

Acetaminophen tends to be preferred. Ibuprofen, if used for a long time, can irritate the stomach’s lining. These drugs are available over the counter without a prescription. The recommended dosage is listed on the package or may be specified by the doctor. It is important to give the correct dose at the correct interval. The drugs do not work if too little drug is given or it is not given often enough. And although these drugs are relatively safe, giving too much of the drug or giving it too often can cause an overdose.

Rarely, acetaminophen or ibuprofen is given to prevent a fever, as when infants have just been vaccinated.

Key Points

  • Usually, fever is caused by a viral infection.

  • The likely causes of fever and need for testing depend on the age of the child.

  • Infants under 3 months of age with a temperature of 100.4° F or higher need to be evaluated promptly by a doctor.

  • Children age 3 months to 3 years with fever who have no symptoms suggesting a specific disorder but who look ill or have a temperature of 102.2° F (39° C) or higher need to be evaluated promptly by a doctor.

  • Teething does not cause significant fever.

  • Drugs that lower fever may make children feel better but do not affect the disorder causing the fever.

Drugs Mentioned In This Article

Generic Name Select Brand Names
Advil, Advil Children's, Advil Children's Fever, Advil Infants', Advil Junior Strength, Advil Migraine, Caldolor, Children's Ibuprofen, ElixSure IB, Genpril , Ibren , IBU, Midol, Midol Cramps and Body Aches, Motrin, Motrin Children's, Motrin IB, Motrin Infants', Motrin Junior Strength, Motrin Migraine Pain, PediaCare Children's Pain Reliever/Fever Reducer IB, PediaCare Infants' Pain Reliever/Fever Reducer IB, Samson-8
7T Gummy ES, Acephen, Aceta, Actamin, Adult Pain Relief, Anacin Aspirin Free, Apra, Children's Acetaminophen, Children's Pain & Fever , Comtrex Sore Throat Relief, ED-APAP, ElixSure Fever/Pain, Feverall, Genapap, Genebs, Goody's Back & Body Pain, Infantaire, Infants' Acetaminophen, LIQUID PAIN RELIEF, Little Fevers, Little Remedies Infant Fever + Pain Reliever, Mapap, Mapap Arthritis Pain, Mapap Infants, Mapap Junior, M-PAP, Nortemp, Ofirmev, Pain & Fever , Pain and Fever , PAIN RELIEF , PAIN RELIEF Extra Strength, Panadol, PediaCare Children's Fever Reducer/Pain Reliever, PediaCare Children's Smooth Metls Fever Reducer/Pain Reliever, PediaCare Infant's Fever Reducer/Pain Reliever, Pediaphen, PHARBETOL, Plus PHARMA, Q-Pap, Q-Pap Extra Strength, Silapap, Triaminic Fever Reducer and Pain Reliever, Triaminic Infant Fever Reducer and Pain Reliever, Tylenol, Tylenol 8 Hour, Tylenol 8 Hour Arthritis Pain, Tylenol 8 Hour Muscle Aches & Pain, Tylenol Arthritis Pain, Tylenol Children's, Tylenol Children's Pain+Fever, Tylenol CrushableTablet, Tylenol Extra Strength, Tylenol Infants', Tylenol Infants Pain + Fever, Tylenol Junior Strength, Tylenol Pain + Fever, Tylenol Regular Strength, Tylenol Sore Throat, XS No Aspirin, XS Pain Reliever
Anacin Adult Low Strength, Aspergum, Aspir-Low, Aspirtab , Aspir-Trin , Bayer Advanced Aspirin, Bayer Aspirin, Bayer Aspirin Extra Strength, Bayer Aspirin Plus, Bayer Aspirin Regimen, Bayer Children's Aspirin, Bayer Extra Strength, Bayer Extra Strength Plus, Bayer Genuine Aspirin, Bayer Low Dose Aspirin Regimen, Bayer Womens Aspirin , BeneHealth Aspirin, Bufferin, Bufferin Extra Strength, Bufferin Low Dose, DURLAZA, Easprin , Ecotrin, Ecotrin Low Strength, Genacote, Halfprin, MiniPrin, St. Joseph Adult Low Strength, St. Joseph Aspirin, VAZALORE, Zero Order Release Aspirin, ZORprin
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