Taking Temperatures and Treating Fevers with Medication

Published in Wellness, Pediatrics

Fevers cause parents to worry about their child. Once the number on the thermometer creeps up to more than the body’s core temperature, as parents you instinctively start to try to figure out what’s wrong.

How to Take Your Child’s Temperature

There are many ways to take a temperature; you can take it under the armpit, rectally, by scanning the forehead, and in the ears; but which way is the best way? All methods of taking temperatures are trying to do one thing, approximate the core temperature of the body. All methods are influenced, to a certain degree, by the environment so getting the correct reading can be difficult.

One of the easiest methods is under the armpit, but there are many things that can make the correct temperature fluctuate, especially if the child has been bundled up or running around. The two most accurate methods to take a temperature are rectally or by using a temporal scan. A rectal temperature is taken inside the body where it is closer to the correct core temperature and the temporal artery thermometer reads the temperature of the blood going across the forehead as it is heading to the brain.  If you are using the color-changing strip that you place on the forehead to take a temperature, throw them away because they just don’t work.

I often get asked if you have to add or subtract a degree depending on the method. The answer is no! When using methods other than rectal or temporal, the reading can be off an entire degree up or down and is just an approximation of temperature. Rectal and temporal readings are a much closer reading to the correct temperature.

Treating the Fever

As I said in my other article about fevers, they do have some benefits and that it is the body’s way of naturally fighting off infection. When treating fevers, remember to think about your child’s comfort level and if they are not tolerating the fever well, then it might be time to give medication. There are two common medications used to treat fevers, *Tylenol and Ibuprofen.

Infants: Do not give medication to infants under 2 months of age. If they are running a temperature of 100.4°F they should be seen immediately, even if it is the middle of the night.

Children under six months of age: Ibuprofen is not safe to use in children less than 6 months old, except in certain cases as recommended by your child’s pediatrician, so you are left to use Tylonol.

For children greater than six months of age you can use Tylenol, Ibuprofen or a combination of both. Remember that fever isn’t necessarily bad and that we are treating the level of discomfort associated with the fever. What I recommend to my parents is to use Ibuprofen. Ibuprofen can be given every 6 hours and for many kids it seems to work better because it lasts longer. If your child’s fever comes back up and it hasn’t been six hours, give a dose of Tylenol to get them through to that next dose of Ibuprofen. Giving Tylenol in this manner acts as a bridge to get them over the hump to help alleviate their discomfort. I do not recommend alternating Tylenol and Ibuprofen around the clock as data shows that this doesn’t necessarily do a better job of managing the fever and there is a greater risk of giving too much of one of the medications. Too much Tylenol can cause liver damage and too much Ibuprofen can cause kidney damage.

Febrile Seizures

If your child has a history of febrile seizures, your doctor may recommend a more aggressive treatment. It isn’t as much about how high the fever is, but how quickly the fever has developed.

Should I Give Medication before Shots?

You should not give Tylenol or Ibuprofen before your child gets their vaccinations unless they had a really prominent reaction during their last series of shots. Studies have shown that the medication can reduce the effectiveness of the vaccine. The American Academy of Pediatrics recommends that it’s best not to give them anything and to only give them Tylenol if they develop symptoms after the vacations and if they really need it.

Fevers can be a mystery because it isn’t always obvious what is causing it, but just remember the rule of thumb is to watch how your child is acting during the fever. If you have reason for concern, there is likely reason to medicate and if you have any questions, you should contact your child’s pediatrician.

Recently, some –but not all- manufacturers have changed the concentration of acetaminophen in the product they market as “Infant” fever reducer.  For this reason IT IS VERY IMPORTANT that you look very closely at the concentration listed on the packaging.  You should either see “160mg/5ml” or “80 mg/0.8ml” on the bottle.  The amount (volume) of medication you give your child will be very different between the two products.