When To Call Your Pediatrician for a Fever

Expert Q&A

A mother checking her daughter's forehead to see if she has a fever
Does your child have a fever? Should you call your pediatrician right away?. Image Source/Stockbyte/Getty Images

Q. My question is when is a fever in a toddler a concern? My son is 2 years old and used to have a normal temp around 98.7 when not ill. In the last 4 months, his temp is always in the 99.5-100.3 range with the exception of a few days here and there where it is 98.7 or so. I first noticed this because he feels hot to the touch when his temp is elevated and I knew that was not normal for him. He also has had occasional days with a fever of 102 or higher when not obviously ill. Is this something to be concerned about? Thank you. Alison, Novato, CA

A. A higher temperature than usual for so long should prompt a visit to your pediatrician.

Rules About Fever

In general, you should call your pediatrician or seek medical attention for a fever when:

  • a newborn or infant under two to three months old has a temp at or above 100.4°F (38.1°C)
  • an infant that is three to six months old has a temp at or above 101°F (38.3°C)
  • an infant six to twelve months old has a temp at or above 103°F (39.4°C)
  • a child over twelve months old has a temp at or above 103°F (39.4°C) and the fever does not improve with home remedies and a fever reducer or lasts more than 24 (under age 2 years) to 72 hours (2 years and over)
  • a child of any age repeatedly has a temperature above 104°F (40°C)

Except for seeking medical attention when a newborn or younger infant has a fever, there are not necessarily any real "rules" about fever for older infants and children, though.

When To Call Your Pediatrician About Fever

Remember that how high a fever reaches doesn't necessarily tell you how sick your child really is, so don't panic every time your child has a fever.

I often tell parents that a child can have a 105°F temp and be running around the room playing, while another with a 99°F temp can be deathly ill. Don't let the number on the thermometer fool you.

Whatever your child's temperature, even if your child doesn't have a fever, if your child is very irritable and doesn't have some playful moments, is breathing fast and hard, or is not eating and sleeping well, you should still call your pediatrician.

It is also important to keep in mind that children normally have higher temperatures than adults, so a rectal temperature under 100.4°F is often considered to be normal in a child under age 3 years.

Other Clues About Fever

Other things to consider about your child's fever and whether or not to call your pediatrician include:

  • Does your child have any chronic medical problems? It would be much more concerning if a child has a VP shunt, sickle cell disease, or had just received a dose of chemotherapy and has a fever, etc. A fever in these situations could be a medical emergency.
  • Does your child have a good reason to have a fever? A fever with a runny nose and cough, in a child who is playing, eating, and sleeping well, etc., is much less concerning (he likely has a cold virus) than a child with a fever and no other symptoms (what is the source of the fever?).
  • Does your child seem a lot better once his temperature goes down? While a high fever might not go down to normal, it should go down a few degrees with a fever reducer and your child should feel better. If not, that would be a good reason to call your pediatrician.
  • Is your child getting worse? A fever for a day or two with worsening symptoms would be a good reason to call your pediatrician or a fever after a week of cold symptoms, etc.
  • Does your child have a rash? A rash can be associated with many childhood infections, with some being very common, like roseola, but others that can be life threatening (meningococcemia).
  • How did you check your child's temperature? If he simply felt hot or you used an axillary (under the arm) thermometer, use a different method to confirm that your child really has a fever.

And most importantly, how worried are you about your child's fever? If you are concerned or worried, then call your pediatrician or seek medical attention.

Sources:

American Academy of Pediatrics. Your Baby's First Year.

Benito-Fernanndez J. Impact of rapid viral testing for influenza A and B viruses on management of febrile infants without signs of focal infection. Pediatr Infect Dis J. 01-DEC-2006; 25(12): 1153-7

Ishimine, P. Fever without source in children 0 to 36 months of age. Pediatr Clin North Am. 01-APR-2006; 53(2): 167-94

Sullivan, Janice E. Clinical Report. Fever and Antipyretic Use in Children. Pediatrics 2011;127:580–587.

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