Q&A: My child has a fever. What should I do?

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Q: My two year old has a fever of 102.3 rectally. He also has a runny nose, slight cough and seems a bit tired and cranky. Should I call his pediatrician right away or wait and see how it goes?

A: Among the zillion responsibilities you have as a parent, knowing what to do when your child gets a fever is among the most important and, therefore, the scariest. Let me break down the issues for you and help you figure out how to approach this common concern:


  1. Be certain there is indeed a fever. That usually means a rectal temp (the most accurate) in a young child. Generally any temperature above 100.4 is considered a fever.

  2. Fever = infection. It is not due to teething. It is not due to allergies. It is not due to stress. Your child's fever is almost certainly due to an infection.

  3. Therefore, once a fever has been established, the real question is: what kind of infection is it? A virus? A bacterial infection? Look for clues: are there any symptoms, like a rash, cough, vomiting or diarrhea?


  4. Most important, how sick does your child look? If s/he is happy and playful and living large, then a serious infection is unlikely, no matter what the degree of fever. If, on the other hand, she looks lethargic, unhappy, not alert, not hungry, etc, then a significant infection is more likely, no matter the level of the fever.


  5. Don't be fever-phobic. The fever is unlikely to cause any harm, except to make your child uncomfortable (for more on this see my blog post here.)


  6. For comfort you can give ibuprofen or acetaminophen in the prescribed doses, every four hours or so.

  7. Give plenty of fluids. Be sure s/he remains well hydrated throughout the illness.

  8. Involve your pedi! Only s/he will be able to diagnose what is going on should your little one need to be seen. Let him/her know what is going on from the beginning, especially if you have concerns.

The good news is that most infections are self-limited and kids come out of them fine. Odds are that is the case with this current infection. Your job (and mine), however, is to be a little paranoid that perhaps this time, just maybe it's something out of the ordinary, requiring immediate intervention.

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