How To Reduce A Fever In A Baby

What you need to know about babies and fevers.

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baby fever. Emma Innocenti/Getty Images

The week after Christmas, all four of my kids were hit by the flu. For the big kids, the flu hit hard, but the symptoms were manageable. They could tell me what hurt, they slept a lot, and they were able to drink a lot of water. With my five-month-old however, the flu really scared me. I had never had a baby so sick before at such a young age and even though I am a Registered Nurse and a mother of four, I felt like I had no idea what I was doing.

What is a fever? 

First things first, I realized that I needed a refresher course on what constitutes a fever in babies. A fever in infants is defined as anything over 100.4 degrees F rectally or over 99 degrees orally. I repeat, it's not a fever until it hits 100.4. This is hard for many of us to digest, but babies have naturally higher temperatures than adults, so keep this in mind before you panic.

How do you check your baby's temperature?

The American Academy of Pediatrics (AAP) recommends using a digital rectal thermometer for children from 0-3 years of age to get the most reliable reading. (Also, be sure to never re-use a rectal thermometer in the mouth)

What you need to know about babies and fevers

If you can, try to distinguish the cause of the fever. Acute fevers can be caused by a virus, while longer lasting fevers may be the result of an infection. Because so many symptoms of teething can mimic an ear infection, it can be helpful to keep in mind that teething usually doesn't cause a fever over 101 degrees F.

(Seriously, tuck that nugget of knowledge away for future use, parents.)

Age is also super important when it comes to fever in babies. If your baby is two months old or younger and develops a fever, it can be especially dangerous and may be due to a bacterial infection, so get him or her into the doctor's right away.

And lastly, it's important to understand that there are no clear recommendations from doctors that reducing fevers are medically necessary. According to the American Academy of Pediatrics (AAP), "there is no evidence that reducing fever reduces morbidity or mortality from a febrile illness." However, febrile seizures can occur, especially in infants over six months old and up to five years old.  And as parents, we want to make sure our children are as comfortable as possible. As an adult, I don't like having a fever and it always pains me to see my children suffer needlessly.

Treating the fever

If you do decide to treat your baby's fever and want to use medication to lower it, babies under six months of age will need dosing recommendations for medications from their doctor as the dose will vary based on the baby's age and weight. For babies over six months, acetaminophen and ibuprofen are commonly used to reduce fever, with dosing guidelines based on weight on the medications.

What's the best medication to use?

The jury is out on what's the best type of medication to lower a baby's fever.The APP reports that there is "significant concern" in overdosing with chronic doses of acetaminophen, commonly known as Tylenol, a situation that could occur if you were treating your baby with doses every four or six hours, as outlined on the label's instructions.

In fact, they explain that acetaminophen overdose is the #1 medication-related emergency room visit for infants.

The APP also notes that ibuprofen may be slightly more effective in reducing the fever and that no studies show any safety difference in ibuprofen versus acetaminophen for babies aged six to twelve months. And while alternating the two medications is a popular route, the APP does not recommend the practice, as it can be very easy to overdose using that method.

Give me the bottom line:

To treat fevers the APP recommends:

  • Treating the cause of the fever, not just the fever itself (and remember, antibiotics will NOT help a viral illness).
  • Keeping the baby comfortable and hydrated with comfort measures such as breastfeeding on demand and a lukewarm bath as appropriate.
  • Monitoring signs and symptoms very closely, watching for serious illness.
  • Using caution with medications. 
  • All infants two months old and younger with a fever should be evaluated as soon as possible by a health care provider. 

Sources

Janice E. Sullivan, MD, Henry C. Farrar, MD, the Section on Clinical Pharmacology and Therapeutics, Committee on Drugs. Fever and Antipyretic Use in Children. American Academy of Pediatrics Clinical Report. (2011). Accessed online: http://pediatrics.aappublications.org/content/127/3/580.full. 

Hannah F Smitherman, MD, et al. Evaluation and management of fever in the neonate and young infant (younger than three months of age). Up To Date. Accessed online: http://www.uptodate.com/contents/evaluation-and-management-of-fever-in-the-neonate-and-young-infant-younger-than-three-months-of-age

How to take a child's temperature. HealthyChildren.org. American Academy of Pediatrics. Accessed online: http://www.healthychildren.org/English/health-issues/conditions/fever/pages/How-to-Take-a-Childs-Temperature.aspx

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