When Does Fever in Children Require Medicine? A Doctor’s Advice

Please note: the recommendations in this article are intended for VACCINATED, healthy individuals. The advice included here is not intended to replace medical care. Always call your pediatrician or go to the emergency department for fever in a child under 6 weeks of age, for anyone with a fever who is immune compromised, if your child has a seizure with their fever, or if the fever is above 105 degrees Fahrenheit or has lasted for more than 5 days.

Are you anxious about your sick child, and run ragged from going from store to store to store to store only to find empty shelves where you hoped to find children’s acetaminophen (Tylenol) and ibuprofen (Motrin or Advil)? What is a parent with a sick child supposed to do?

When our kids are sick, we want to help them feel better. We worry about fever and the dangers of fever in children. And now we are stuck because of supply chain issues with the production of children’s and infant’s liquid preparations of the medications we use to treat fever.

mother's hand on feverish child's forehead while taking her temperatureFirst of all, take a deep breath. Fever, although often uncomfortable, is not dangerous in and of itself. Even very high fevers are generally well tolerated in children. Some young children may have febrile seizures (a convulsion caused by a fever) with rapid rise or fall in body temperature. While febrile seizures are terrifying for parents, they also are not dangerous and will resolve within a few minutes.

Read it again: fevers in children are uncomfortable but are generally not dangerous.

Normal body temperature in children is about 98.6 degrees Fahrenheit. A “normal” fever in children can range from 100.4- 105 degrees Fahrenheit. Less commonly fevers go to 106 (normal thermometers go to about 105 degrees Fahrenheit and then usually read “high”.)

Fevers serve the purpose of activating the body’s immune response. They also may make the body less hospitable to germs. What does this mean? It means that fevers serve a purpose. Fevers help kids get better.

So, if you can’t get medicine to treat your child’s fever, it’s ok! There are important things you can do to ease their discomfort and even help lower fever in children.

close up face of a feverish child with flushed cheeks

1. The most effective form of fever control is evaporative heat loss.

What this means is that the age-old act of putting a damp washcloth on your child’s forehead actually works, as long as you tweak it a little. The goal here is to expose as much skin as possible and repeatedly wipe ALL the exposed skin with a slightly cool (tepid) wet washcloth. Let the area dry, and wipe again. This helps the body cool by evaporation without causing shivering which actually increases body temperature. Do not leave a wet washcloth in one area (like the forehead) but rather keep wiping down your child’s whole body and allowing evaporation to cool your child.

Do not bundle your feverish child up because they are feeling chilled due to their fever. Bundling prevents heat loss and makes your child’s fever higher.

2. Have your child drink plenty of room temperature or cold liquid that does not contain caffeine.

Fever causes you to have increased fluid needs and makes you more prone to dehydration. Room temperature or cool liquids also help bring down the body’s temperature.

3. And, if you are desperate and your child can’t sleep, you can see if they weigh enough to chew a children’s chewable medication or if they are large enough (by weight) to take an adult dose.

Please reference the chart that is linked here or talk to your pediatrician about this option.

An adult (REGULAR STRENGTH)​​​ tablet can be crushed and put in pudding, yogurt, apple sauce, or ice cream if the child is unable to swallow a pill, but weighs enough to take one. Do not ever give over the weight-based dose of any medication, most especially acetaminophen (Tylenol) which is dangerous in overdose.

DO NOT GIVE ANY FORM OF ASPIRIN, EVEN CHEWABLE BABY ASPIRIN, to infants or children with a fever. It has been linked to a dangerous condition called Reye Syndrome.

I understand that it can be hard to see your sick, sweaty, feverish kid and not immediately offer medicine that can make them feel better pretty quickly. You’re probably even thinking, “What? Fever is not dangerous? What are you talking about?”

As an emergency physician, I’ve heard this worry from parents for decades. Because children generally have such good immune systems, they often mount very high fevers in response to infections.

The truth is that the height of the fever has nothing to do with the severity of the infection (that is, a 104-degree fever does not equal a more dangerous or worse infection than a 101-degree fever). In fact, our immune systems actually work better at higher temperatures which is why our bodies mount a fever response to begin with. Your body is better able to fight infection with a fever than without.

The only reason doctors worry about fever at all is because it means the body is fighting some sort of infection.

This could be a viral infection or, more rarely in healthy children, a bacterial infection.

Viral infections can not be treated with antibiotics. Treatment is mainly for comfort and symptom control. The infection will resolve on its own as long as the child doesn’t need respiratory support or intravenous hydration. Vaccination for COVID and flu as well as common childhood illness can decrease the likelihood that your child will have a serious infectious illness. But the common cold and RSV still have no vaccines and sadly, even your fully vaccinated child is likely to get sick with a fever during cold and flu season.

Bacterial infections do need to be treated with antibiotics and can be dangerous if not treated, but the danger is not from the fever. The danger is the infection. The fever is just a sign of the infection. Doctors are far more concerned with how your child looks and feels when their fever breaks than the height of the fever.

sick child lying in bedClearly, it would be wonderful if we were not having supply chain issues with medication, and we could give the medication we want to give, in the way we want to give it, when we need it. However, it appears we will be having supply chain issues for months to come, and during this cold and flu season, you may be unable to find your medication of choice.

If this happens, and you can’t find medicine to treat your child’s fever, don’t freak out. Attempt hydration and evaporative cooling, and if your child is acting ok and eating and drinking, the fever does not need further treatment. If your child is having difficulty breathing, lethargy, is unable to drink, the fever has lasted more than 5 days, or if there are other concerning symptoms please do seek medical care.


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