Fever

Essential information to remember.The child has a fever if his rectal temperature (in the rectum) is 38.0°C (100.4°F) or higher.

Fever is an increase in body temperature above normal levels. It’s the body’s way of defending itself against infection.

Fever is very common in young children.

The temperature of children under 2 years of age can be taken in the rectum or the armpit (see How to take your child’s temperature, below).

Rectal temperature is the only reliable measurement for children age 2 and under.

When to take your child’s temperature

You don’t have to check the temperature of a child who is in good health. If your child looks ill, is hot, red, irritable or whiny, take his temperature. Record the temperature and the time you took it, so you can tell Info-Santé or your doctor, if need be.

What thermometer to use

The best choice is an unbreakable plastic digital thermometer without glass or mercury. Digital thermometers can be used to take temperature using the rectal (in the rectum), armpit (under the arm), and oral (in the mouth) method.

Mercury thermometers are not recommended because if they break the mercury can poison both you and the environment.

Essential information to remember.Rectal temperature is the only reliable measurement for children age 2 years and under.

Photo: Meggie Bérubé

 

How to take your child’s temperature

In the rectum

Rectal temperature is the only reliable measurement for children age 2 and under. Here’s how to take it:

  • Clean the thermometer in cool, soapy water, then rinse.
  • Cover the end of the thermometer in petroleum jelly (e.g., Vaseline).
  • Place your baby on his back, with his knees bent.
  • Gently insert the thermometer about 2 cm (¾ in.) into the rectum.
  • Keep the digital thermometer in place until it beeps.
  • Take it out and read the temperature.
  • Clean the thermometer

You can also cover the thermometer with a disposable plastic tip (probe cover) sold in drugstores. Follow the manufacturer’s directions for using and lubricating it.

Under the arm

Taking a child’s temperature using the armpit method is not as accurate as with the rectal method. The armpit method is convenient for checking if your baby has a fever. However, your child’s temperature must be confirmed using the rectal method if:

  • It is above 37.5°C (99.5°F).
  • It is equal to or less than 37.5°C (99.5°F), but your child is hot to the touch and seems sick.

Here’s how to take it:

  • Clean the thermometer in cool, soapy water and rinse.
  • Place the tip of the thermometer in the centre of the armpit against the skin.
  • Make sure that the child’s arm is held snugly against his body.
  • Keep the thermometer in place until it beeps.
  • Remove it and read the temperature.
  • Clean the thermometer.

In the ear

Taking a child’s temperature in the ear is very quick but is not recommended because it’s less accurate. In the mouth Taking a child’s temperature in the mouth is not recommended for children under five.

In the mouth

Taking a child’s temperature in the mouth is not recommended for children under five.

What to do if your child has a fever

Information to which you should
pay special attention.In some cases, you should promptly see a doctor or go to the emergency room if your child is feverish. See the red box below.

Baby under 3 months old – See a doctor promptly or take your child to the emergency room.

Baby 3 to 5 months old – Consult Info-Santé or a doctor. They will advise you.

Baby 6 months of age or older – Observe your baby: if she is feeding well and seems healthy to you, you can treat her at home. However, she should be examined by a doctor if her fever lasts more than 72 hours (3 days).

Make sure your child is dressed comfortably and is neither too cold nor too hot. Don’t undress him completely because he may get cold. To prevent him from becoming dehydrated, have him drink often.

Cool or lukewarm baths and alcohol rubs are not recommended. They are stressful for a feverish child and their effect doesn’t last.

If your child is unwell or irritable, medication may help (see Fever medication).

Has your child recently been vaccinated?

Your child may be feverish after being vaccinated. In this case, the fever does not necessarily mean he has an infection. It’s better to assess his general condition. Review the advice you were given when he was vaccinated. If necessary, consult a health professional or Info-Santé.

When to see a doctor

High fever does not always mean a serious illness. Keep a close eye on your child’s general condition, behavior, and other symptoms. It’s normal for a feverish child to need more cuddling and be less hungry than usual. Contact Info-Santé or your doctor in any of the following cases:

  • You’re worried about your child’s condition.
  • He has a fever and is less than 6 months old.
  • He’s had a fever for more than 72 hours, regardless of his age.

Information to which you should
pay special attention.See a doctor right away or take your child to emergency if he has a fever and has one or more of the following characteristics:

  • Is less than 3 months old
  • Has had a seizure
  • Is vomiting a lot
  • Cries constantly and won’t calm down
  • Is hard to wake or much sleepier than usual
  • Is pale or has abnormal color
  • Responds very little to others
  • Has difficulty breathing or is breathing rapidly
  • Has other symptoms that are worrying you

An Info-Santé nurse is always on hand to advise you on what to do: just dial 8-1-1.

Dial 9-1-1 if the situation seems serious and urgent enough that you need an ambulance.

Febrile seizures (convulsions caused by fever)

Information to which you should
pay special attention.Call 9-1-1 in one or more of the following situations:

  • Your child is under 6 months old
  • The seizure lasts more than 3 minutes
  • Your child’s condition worsens (e.g., trouble breathing, bluish skin)
  • Your child does not fully recover within a short period of time

From 2 to 5% of children age 6 months to 5 years are affected by febrile seizures, which are convulsions caused by fever. During a fever, their arms and legs twitch and jerk and they may faint.

Febrile seizures can be terrifying for parents, but they generally have no lasting effect on the child. Most of the time they last for a few seconds to a few minutes and stop by themselves. Afterwards, the child may appear to be asleep for a short period before recovering and returning to how she was before the seizure.

What to do?

Lay your child on her side, on a flat surface in a safe spot. Do not try to stop her movements. Do not put anything in her mouth.

After the seizure: In all cases, see a doctor quickly (within a few hours) or go to the emergency room. The doctor will check that your child is alright and does not have any other problems.

An Info-Santé nurse is always on hand to advise you on what to do: just dial 8-1-1.

Fever medication

Information to which you should
pay special attention.Never give aspirin to your child.

 

Essential information to remember.Keep medications in their containers, with a child-proof lid. Store medications and thermometers out of the reach of children in a cabinet with a lock or safety catch.

Medication is more useful for easing discomfort than for bringing down the fever. A feverish child who doesn’t look ill doesn’t necessarily need medication.

You can give him either acetaminophen or ibuprofen, unless your doctor makes a specific recommendation for your child. Don’t give both types of medication at the same time, unless your doctor advises it.

It’s a good idea to record the type of medication, the dose you give, and at what time.

You need to know your child’s weight in kilograms in order to give the right dose. If you don’t know his exact weight, use the last weight recorded on his vaccination record or check the age indicated on the medication packaging. Be sure to follow the manufacturer’s recommendations on the packaging. You can ask a pharmacist or Info-Santé what dose to give.

Measure the dose with the tool provided with the medication or with a graduated syringe you can get from your pharmacist. Kitchen teaspoons or soup spoons are not accurate enough.

First choice: acetaminophen

Acetaminophen (e.g., Tempra®, Tylenol®, or any generic brand for pediatric use) has been used for a long time and should be your first choice. Calculate 15 mg per kilogram. You can give one dose every 4 to 6 hours, but not more than five in any 24 hour period. Your pharmacist or Info-Santé can help you calculate the right dose.

Don’t give acetaminophen to a baby under 3 months old. Talk to your doctor first.

Second choice: ibuprofen

Ibuprofen (e.g., Advil®, Motrin®,or any generic brand for pediatric use) can also be used provided certain conditions are met. Calculate 10 mg per kilogram. As its effect lasts longer than that of acetaminophen, you can give it every 6 to 8 hours, but no more than 4 doses per 24 hours. Your pharmacist or Info-Santé can help you calculate the right dose.

Do not give ibuprofen in the following situations:

  • Your child is under 6 months old.
  • Your child is dehydrated due to severe gastroenteritis (stomach flu) or is not drinking.
  • Your child has chickenpox.
  • Immediately before or after an operation (unless a doctor recommends it).

Good to know...

Both these medications will usually make your child more comfortable and will bring down the fever within 30 to 60 minutes. After a few hours, the temperature may go up again and your child may once again seem unwell. You may have to give him another dose. But it’s important to avoid exceeding the recommended dose and frequency.

What to do if your child throws up the medication

If your child vomits within 30 minutes of taking the medication, don’t give him another dose. Wait an hour, and then take his temperature again. If he’s not feeling well and still has a fever, give him the same dose. If he throws up the medication again, do not repeat the dose. Consult your doctor.

If your child vomits more than 30 minutes after taking the medication, he has probably already absorbed the medication so you shouldn’t give him another dose right away.