Fever is a very common issue that pops up with our kids. When kids have fever they tend to be fussy, tend not to eat and drink well, and have a tendency to become dehydrated over time. As a parent, it can be scary but it is important for us to know how to effectively treat fever in order to help our kids feel better and avoid the complications of fever that can often times land us in the ER with our babies.
Patients will ask me all the time "how high should the fever get before I call you".....NOW....I am not a numbers person.....so dont fixate on a number..... For instance, if your child has a fever of 103 but they are playful, eating, drinking, making urine and are responding to the use of tylenol and motrin to bring the fever down, then I would probably get to your Pediatrician/Nurse Practitioner at your earliest convenience in the next 24 hours. Conversely, if your child has a fever of 101 but they are very fussy, are refusing to drink, are making less wet diapers or are not using the bathroom to urinate like they normally do, or are vomiting....then I would get to your provider as soon as possible. As the parent, look at the bigger picture not the number on the thermometer. Unlike adults, children can often experience very high fevers when they are ill. So keep your cool if you kids got a high fever but seek treatment anytime you feel like things are not right.
There is one MAJOR exception to the statement above: a newborn infant. From the day a baby is born until they get their first round of vaccines or typically 2 months of age (8 weeks), they are very susceptible to infection. If a baby younger then 2 months of age or unvaccinated gets a fever of 100.4 or greater when the temperature is taken rectally, the baby needs to be seen in the emergency room or by their health care provider immediately. In the event that your baby has a fever of 100.4 or more rectally they will likely undergo a batter of testing to ensure that there are no infections present. For example, a urine sample will probably be obtain by a catheter to test for a urinary tract infection, a chest xray will probably be obtained to check for a pneumonia, and a spinal tap might be done to check for meningitis.
No matter what, a baby this age needs to be seen as soon a humanly possible even if they are eating, drinking and urinating like normal. So that means in the middle of night....you take them to the ER!
TREATING A FEVER
There are two medications that you can use to treat fever: Acetaminophen (Tylenol) and Ibuprofen (Motrin). Both of these medications are weight based, so if you do not give the correct dose it will not work the way it is suppose to. Also, always give the medication based on weight not age....
Acetaminophen (Tylenol) can be given every 4 hours for fever. Below is the dosing chart used for Tylenol. Acetaminophen is the generic name and can be used in the same manner. (I always buy generic products because they are cheaper and work just as effectively as their more expensive counterparts.)
| Weight | Tylenol Milligram Dosage | Tylenol Infant drops 80mg/0.8ml | Tylenol Children’s liquid 160mg/5ml | Tylenol Chewables 80mg each | Tylenol Junior 160mg each |
|---|---|---|---|---|---|
| 6 - 8 lbs | 40 mg | ½ dropper (0.4 ml) | ¼ tsp (1.25 ml) | N/A | N/A |
| 9 – 11 lbs | 60 mg | ¾ dropper (0.6 ml) | ⅓ tsp (1.875 ml) | N/A | N/A |
| 12 – 17 lbs | 80 mg | 1 dropper (0.8 ml) | ½ tsp (2.5 ml) | N/A | N/A |
| 18 – 23 lbs | 120 mg | 1 ½ dropper (1.2 ml) | 3/4 tsp (3.75 ml) | N/A | N/A |
| 24 – 35 lbs | 160 mg | 2 droppers (1.6 ml) | 1 tsp (5 ml) | 2 tablets | 1 tablet |
| 36 – 47 lbs | 240 mg | 3 droppers (2.4 ml) | 1 ½ tsp (7.5 ml) | 3 tablets | 1 ½ tablet |
| 48 – 59 lbs | 320 mg | N/A | 2 tsp (10 ml) | 4 tablets | 2 tablets |
| 60 - 71 lbs | 400 mg | N/A | 2 ½ tsp (12.5 ml) | 5 tablets | 2 ½ tablets |
| 72 – 95 lbs | 500 mg | N/A | 3 tsp (15 ml) | 6 tablets | 3 tablets |
Ibuprofen (Motrin) can be given every 6-8 hours for fever. Ibuprofen (Motrin) is not recommended for children under the age of 6 months. Children who are younger than 6 months should only receive Acetaminophen (tylenol) if they are experiencing pain or fever.
| Weight (lbs) | Age (months) | Dose (mL) |
| Under 6 months | Ask a doctor | |
| 12-17 lbs | 6 to 11 months | 1.25 mL |
| 18-23 lbs | 12-23 months | 1.875 mL |
| Weight (lbs) | Age (years) | Dose (tsp or mL) |
| Under 24 lbs | Under 2 years | Ask a doctor |
| 24-47 lbs | 2 to 5 years | 1 tsp or 5 mL |
| 48-95 lbs | 6 to 11 years | 2 tsp or 10 mL |
ALTERNATING TYLENOL AND MOTRIN
Ever been told to alternate Tylenol and Motrin while your child has a fever? Here is why and how that works:
Even though Tylenol and Motrin essentially execute the same actions, they are very different medications. For example, Motrin is metabolized by the kidneys and Tylenol is metabolized by the liver, therefore they can be given safely simultaneously. You might find that you have given Tylenol to your child and their fever continues....then you want to give Motrin.
So here is how to do it....
Say you wake up in the middle of the night to a child who has a fever....(Always always always take your child's temperature....it is helpful to your health care provider to know how high the fever was and to you to know that the medications are working. I always recheck my daughter's temperature at her next diaper change after Tylenol or Motrin is given. It is the only way to measure the response of your intervention)....I would give Tylenol AND Motrin at the same time. Then I would start to alternate the medications every four hours starting with TYLENOL because Tylenol can be given every 4 hours whereas Motrin can be given every 6-8. Four hours after the dose of Tylenol I would give Motrin (which is now 8 hours after the original doses)....four hours later I would given Tylenol again and then Motrin four hours after that.....and so on and so on....
By alternating Tylenol and Motrin, you keep your child feeling better, less likely to dehydrate, and eating and drinking more than if their fever was high.
WHAT IF THEY HAVE A SEIZURE FROM FEVER?
Better known as a Febrile Seizure, a seizure in the presence of fever is most common in 6 months to 5 years of age. This is generally thought to be a result of a rise in body temperature, not how fast the temperature rises or how high the fever gets. A child can experience this phenomenon with a low fever, high fever, and even as the fever decreases with tylenol and Motrin. If this happens, place your child on the ground where he or she can be safe, do not place anything in their mouth, and roll them onto their side so that they do not block their airway with their tongue or saliva. Call 911 immediately, I would not attempt to drive the child to the ER. You need to monitor their breathing as much as possible and attempting to drive them on your own is unsafe and should be avoided.
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