When and How to Treat a Fever: a Pediatrician’s Perspective

Last updated on August 9th, 2026 at 04:33 pm

I have posted in the past about fever and many of the myths surrounding it (Kids Will Get Sick: 5 Facts a Pediatrician Wants You To Know). In this post I would like to deal with the causes, nature of fever, benefits of fever, and some “treatments”. It is one of the most common reasons people bring their children to the Emergency room and probably among the least significant reasons for doing so.

Fever is a symptom of an illness such as cough, runny nose, headache, and many others and, except for the discomfort of the associated symptoms (chills, achiness, drowsiness, etc.) fever, in and of itself, does not need to be treated. As far as what is the definition of fever, it depends on the age of your child or infant. Just about any fever in an infant less than 3 months of age is considered to be significant for the purpose of evaluation. As your baby/child gets older the level of fever at which the concern rises does so with the height of the fever and the associated symptoms. Beyond the immediate newborn period (up to age 3 months) fever (or better termed higher than normal body temperature) is generally considered to be over 100.4 to 100.5 Fahrenheit.

Fever is part of the immune reaction that your body goes through to identify the offending agent and muster the resources to fight off that agent. Some studies have shown that the presence of fever helps your body fight off the disease in a more rapid and efficient way. As such, it is easy to see that in fighting off an illness, the reduction of that fever for its own sake is not necessarily the best thing to do. As I mentioned in my last post about fever, if your child is very uncomfortable due to the presence of fever, it certainly is reasonable to give a medicine such as Tylenol or Advil, but not just because the fever is there.

In an effort to reduce fever by worried parents many methods have been tried; such as placing a child in a cold bath or sponging with cold water, even to go as far as placing ice packs in supposedly strategic places. This would seem logical at first blush but in fact, human beings have a very good method of warming a cold body, and that is shivering, wherein the muscles go into a hypermetabolic state producing heat by metabolic processes. It is possible to place someone with a fever in a cold bath and have him or her come out with a higher temperature than before the bath. So the reasonable approach to comfortably lower a fever is to undress a child with fever but not enough to stimulate chills or shivering, place your child in a warm (skin temperature) bath of only a few inches of water and sponge off your child frequently allowing for natural evaporative processes to cool the skin. Offer your child plenty of cool fluids that will do some cooling from within as well as keeping him/her well hydrated- fever will cause extra fluid loss through sweating and the hypermetabolic state. Do not wrap your child in blankets just to “sweat the fever out” as doing this may also inadvertently raise fever, and increase fluid loss and discomfort- certainly covering the child enough to relieve chills and shivering is appropriate for comfort.

In trying to determine whether someone who runs a lower than “normal” natural body temperature is running a fever, just use the reading you get with the thermometer as the difference between a normal temperature and one that “runs low” is very small and would not be significant medically. Furthermore body temperatures vary throughout the 24 hour day in the same person- so when that “normally low” body temperature was taken becomes important.

So you can almost expect fever to accompany any illness of an infectious nature whether mild or severe. Keep calm, it is not the fever that is important, but the appearance, behavior and the presence of certain other symptoms that your Doctor with be most interested in when you call his office.

How to Help If Your Child Has a Seizure: Call EMS and Don’t Panic

Last updated on May 3rd, 2026 at 02:41 pm

Some children are prone to seizures and having met many of these parents and taken many of these children to the hospital, I know these parents are acutely aware of what to do and how to do it in the event of another seizure. It’s the children that have never had a seizure before and you the parents that have never had to deal with one before that we will focus on. The type of seizure most commonly encountered by children having their first seizure is the febrile seizure. The American College of Emergency Physicians published a number of great findings about febrile seizures and stated the following:

Simple fever-related (or febrile) seizures are common among children under age 5. Although these seizures can be frightening to parents and other caretakers, they are generally harmless. Annals of Emergency Medicine, the scientific journal of the American College of Emergency Physicians, published the following advice for parents and caretakers about simple febrile seizures.

Children at Risk

• Febrile seizures tend to run in families and are not preventable. Children of parents with a history of these seizures are about four- and one-half times more likely to experience a febrile seizure, and if both parents had febrile seizures as children, their child is 20 times more likely to experience one.
• About 30 percent of children who have a febrile seizure will have another one, usually within a year of the first seizure.
• Simple febrile seizures are common among children ages 6 months to 5 years.
• Febrile seizures have been associated with viral infections, Roseola, and Shigella, which is a bacteria that causes bloody diarrhea.
• There are no risk factors for febrile seizures related to geography, race, or ethnicity.

Signs and Symptoms

Here are the signs and symptoms associated with simple febrile seizures:

• Simple febrile seizures generally occur in the first few hours of a high fever or rapid rise in body temperature.
• These seizures generally occur only once in a 24-hour period and usually last less than a minute, but can last 15 minutes or longer.
• May cause loss of consciousness.
• May cause rhythmic muscle contractions.
• May cause child to clench teeth or bite cheek or tongue.
• Child may stare or become unresponsive.
• May cause face, arms, and legs to twitch, and arms or legs to jerk.
• Eyes may roll back.
• May cause difficulty breathing.
• May cause child to lose bladder or bowel control.

Advice to Parents

Parents should seek immediate medical attention for a child or infant experiencing a febrile seizure, even if the seizure does not appear life-threatening (e.g., child’s breathing is not constricted). Although the seizure may end before medical helps arrives or before the child reaches the emergency department, it is important to have a physician rule out other causes for a first-time seizure, especially meningitis. While the child is experiencing a seizure and until help arrives, parents should:

• Protect the child from injury.
• Lay the child face-up on the floor. If the child vomits, turn on the left side to prevent inhaling vomit or mucus into the lungs.
• Do not place anything, including your fingers, in the child’s mouth.

After a Seizure

• In the emergency department, a child who has had a seizure will be evaluated for serious diseases, such as pneumonia or meningitis. This may require diagnostic tests such as blood work, urinalysis, x-rays, or a lumbar puncture (spinal tap). Most children who experience a simple febrile seizure will not require admission to the hospital.
• Medicines generally are not given to prevent simple febrile seizures. In addition, medicines given for fevers, such as acetaminophen or ibuprofen, have not been shown to prevent febrile seizures, but are often recommended because they relieve body aches and fever.
• After a seizure, a child may be sleepy or experience memory loss, headache, or confusion.
• Febrile seizures can recur if the child has another fever.

The final thing I would like to add to this is that there is no reason to delay calling 911 if your child starts to have a seizure or you think they are having one please call and allow the professionals to help.

Good luck and Be Safe.

Kids and School – a “Germy” Combination

Last updated on November 24th, 2025 at 06:19 pm

Now, your children are in school and the initial trauma is over —for you. This is great; Mommy or Daddy’s day out every day, meetings at Starbuck’s, play a round of tennis, make dinner and await the arrival of your kids coming home. I’m sure things aren’t quite that way but you do have time to do things you did not have the time for before school, additionally you may very well still have a young one or two at home.

If your child is busy enjoying the challenges of his/her first encounter with a classroom setting, he/she is also busy adding to the petrie dish of viral and bacterial flora that decorate every nook and cranny of their little classroom. Not to worry parents, this petrie dish is actually world wide; doorknobs, telephone handles, handshaking, etc. This is not meant to worry you more but to help put your mind at ease. If, in fact, the entire tangible world is covered with a thin layer of “slime”, there are relatively very few people getting ill because of that contact. As a matter of fact, contact with these organisms can result in a certain amount of immunity while not actually imparting visible disease. Tough concept to understand but it is the same with your school age children and whether you worry about it or not, this contact will surely take place.

Add to that the possibility that your school aged child may then carry home the very “germs” you are worried about exposing your younger child to and it’s enough to pack up your entire family and seek shelter in the closest sealed balloon- like chamber.

Things are not as bad as all that. The coexistence of man and bacteria, mostly in a benign synergistic manner, has been well documented over time: we are better off because they are around and in turn they are better off because of our presence. There are far more harmless microorganisms in our environment than those causing disease, as a matter of fact some are even helping us come up with new and effective medications and products.

Certain bacteria can be coaxed into producing human-helpful by-products much easier and in far greater quantities than we can produce with our highly sophisticated technology. Bacteria and viruses are much “smarter” than you and me; whenever we come up with a defense, they find a way to get around our barriers with intricate defenses. Hence, the development of resistances to antibiotics, etc.

Sure it is reasonable to take practical precautions to protect your children, but their exposures are not necessarily a bad thing and no matter what you do some contact will be inevitable. Once entering a school setting a child can be expected to have 6-8 significant, although usually mild illnesses, per year for the first year or two, but guess what, after that time the illnesses become fewer and fewer.

So relax, do what you can reasonably do, but realize you can’t ever keep your child completely germ free. Get your child completely up to date with the recommended immunizations and vaccines before school entrance and keep him or her that way always.

Your Stay Healthy Guide for Common Kid Ailments

Last updated on May 3rd, 2025 at 06:01 pm

Your kids may come home from school one afternoon with something more worrisome than homework: sniffles, tummy bugs and even (ick!) lice. Now that students are cooped up in classrooms all day, schools can be breeding grounds for any number of ailments.

You probably can’t avoid sick days entirely; according to the American Academy of Pediatrics, the average schoolchild gets 5-6 colds and 1-2 cases of diarrhea in a year, and the Centers for Disease Control reports an estimated 6-12 million head-lice infestations per year among 3-11 year-olds. But there are steps you can take to minimize the risks and keep your whole family healthier, such as washing your hands often, eating right and staying up-to-date on vaccinations. And don’t give in when the kids beg to stay up a little longer: “Getting enough sleep helps your immune system fight off whatever might be coming your way,” advises Rebecca Jaffe, MD, of Wilmington, Delaware, a fellow of the American Academy of Family Physicians.

If you want to know about staying healthy, steering clear of the typical list of school yard sicknesses and the best way to treat them, here are the health facts about five common contagions:

Colds and flu

Cause: Viruses.

Symptoms: Stuffy nose, sneezing, mild sore throat and cough for colds; fever, aches, severe cough for flu.

Spread by: Droplets on hands or released into air by coughs or sneezes.

Prevention: Use a tissue to sneeze, cough or blow your nose; discard immediately and wash hands. Teach kids to sneeze into their elbow if there’s no tissue handy. Don’t share cups, water bottles or utensils.

Treatment: Rest and fluids. Give antihistamines and non-aspirin pain medications for colds; antiviral meds for flu if prescribed by your pediatrician. (Antibiotics are only effective against bacterial infections such as strep throat.)

Gastroenteritis (stomach flu)

Causes: Virus, bacteria or parasites.

Symptoms: Diarrhea, vomiting; may include fever, headache, chills.

Spread by: Contact with infected person or contaminated food or beverages.

Prevention: Frequent hand-washing. Disinfect surfaces your family touches often – doorknobs, keyboards, etc. – as well as the kitchen counter and other areas used for food preparation.

Treatment: Bed rest and an oral rehydration solution to prevent dehydration; gradually give bland foods such as toast, bananas and applesauce. See your pediatrician if your child runs a high fever or if vomiting and diarrhea continues for more than a day. Keep your child home until she’s been symptom-free for 24 hours.

Conjunctivitis (pinkeye)

Causes: Virus, bacteria, allergies.

Symptoms: Reddish eye and lower lid, itching, discharge and painful inflammation.

Spread by: Contact.

Prevention: Wash your child’s hands frequently and warn him not to rub or touch his eyes. Don’t share towels or washcloths.

Treatment: See your pediatrician for a prescription eye ointment.

Infectious skin rashes

Causes: Rashes can be caused by bacteria (impetigo), a virus (fifth disease) or mites (scabies).

Symptoms: Itchy, oozing blisters (impetigo); reddish rash on face and body (fifth); intensely itchy pimple-like rash (scabies).

Spread by: Impetigo and scabies can be spread by touching the infected area or handling the affected child’s towels or clothes; fifth disease is transmitted by saliva and mucus.

Prevention: Frequent hand-washing and use of tissues; avoid sharing towels.

Treatment: Varies by type. For impetigo, your doctor will prescribe antibiotics, antiseptic soap and bandages; for scabies, prescription creams; for fifth disease, acetaminophen or ibuprofen as needed.

Head lice

Cause: Red-brown insects about the size of a sesame seed that live and lay whitish eggs (nits) in human hair. Unpleasant as they are, lice don’t spread disease, and having them doesn’t indicate poor hygiene.

Symptoms: Itchy scalp, especially around the ears or nape of the neck.

Spread: Head-to-head contact.

Prevention: Discourage children from sharing hats, combs and other hair gear. Tie back long hair in braids or ponytails.

Treatment: Ask your doctor to recommend an anti-lice shampoo and follow instructions carefully. Use a fine-tooth louse comb daily for a week to remove any remaining bugs and nits. Wash clothes, hats, bedding and stuffed animals in hot water and dry on a high setting. Ask your school nurse when your child can return; some schools have a “no-nit” policy, but the AAP says there’s no need to keep children home if they have no active lice

Bronchiolitis or “Wheezy Bronchitis” and Kids

Last updated on March 29th, 2025 at 04:03 pm

One of the more common illnesses that is encountered during the winter months in infants and young children is a respiratory problem referred to as Bronchiolitis or “wheezy bronchitis”. This is a condition caused by a viral infection that attacks the respiratory tree, both upper (nose and throat) and lower (the smaller airways leading to the air sacks in the lungs). It is most commonly caused by RSV or Respiratory Syncitial Virus. It can also be caused by other winter time viral infections but the exact cause is relatively unimportant as the symptoms are nearly the same.

Your child will usually develop signs and symptoms of a regular cold with sneezing, runny nose, mild cough, and sometimes a low grade fever. At this stage it will be impossible to tell if this will progress to bronchiolitis, but most of the time this will remain a cold and your “cures” are limited as your doctor will tell you. In a certain number of infants and young children, after a few days of the cold, the cough might progress to a more significant stage and the infant or young child may show some signs of having difficulty breathing; more rapid breathing rate than normal will usually be the first of such signs, but fever alone can raise an infant’s rate of breathing, and if you are unsure call your baby’s Doctor and he/she will help you figure that out.

Because the primary problem with bronchiolitis is swelling in the respiratory passages (lower and upper), air might have to begin to squeeze through narrower passages in the lungs and similar to what we have presented about asthma in the past, this may lead to wheezing. Wheezing is a whistling (musical) type of noise when your child breathes out versus noisy breathing in noticed in those infants with the upper airway cold. Admittedly this may be difficult to see by non- medical parents, but you can ask your Doctor how to do this in a reliable and repeatable manner.

Most infants and young children will remain in this stage and, as long as he/she is feeding well , does not have fever over 103, and seems fairly cheerful with his/her usual skin color, you do not need to worry, and all the symptoms will resolve as the cold goes away.

Occasionally, the situation can worsen with more difficulty breathing, now showing itself by your child using more muscles of his/her body to help force the air through the small airways in the chest: those muscles might include the abdominal, neck and intercostals (muscles between the ribs). At this stage your child should certainly be under the care of a physician, who might, depending on the appearance of your child admit him/her to the hospital so that more intensive care can be used to help him/her breathe.

The illness is self limited in that between 3 and 7 days normal resolution will take place. The worsening progression that I outlined above will generally not happen very fast and you will have time to see that your child is getting worse. Anywhere along the way, should you have doubts about your ability to adequately monitor your child’s status you should be talking to his/her Doctor.

I would like to stress once again that most bronchiolitis illnesses in infants and young adults remains mild and in fact may be indistinguishable from a normal cold.

It’s Fall and My Child Won’t Stop Sneezing – Ask a Pediatrician

Last updated on October 23rd, 2024 at 05:50 pm

Just when you and your children have made it through the summer with all the allergic sneezing and coughing seen mostly at the beginning of the summer, Fall arrives and is ushered in by ragweed season. Here we go again: watery itchy eyes, sneezing, runny itchy nose, etc. Now throw in the contact between children of like ages occurring in school rooms across the country and what is a parent to think? Is this allergy, or might it be a cold? Good question, but in fact it makes very little difference if your child is otherwise healthy and feeling well.

While it is true you will begin to see infectious agents causing this situation, this is a child who need not be kept out of school and who need not necessarily be given any medicine to “cure the cold” (there are no existing medicines to cure a cold). There is a certain period of being contagious regardless of the effects of medicines on the symptoms for every infectious disease. In school aged children most of these illnesses are viral in nature and are very similar in their symptoms to allergic issues.

The contagious period often begins before the symptoms begin and are unaffected by the use of medications!

Regardless what many parents believe, I truly believe that “treatment” is only needed if the symptoms appear to be greatly influencing the life of the child; that is, interfering with appetite, sleeping, playing or school work. Unless that occurs, one is treating insignificant symptoms, such as cough, or fever and more to the advantage of the parents than the child. All medications have side effects and the over-the-counter cold preparations usually contain several medications of differing pharmaceutical classes; each designed to relieve a certain symptom, e.g. cough, runny nose, fever, etc. Most of the time your child does not need all features of these medications (but that’s the only way it comes) and side effects can occur.

Add to that the fact that even using the exactly correct medicine for the symptom, the over-the-counter medication is not liable to achieve the desired result. Also a good proportion of symptoms at this time of year may be allergy related and will respond even poorer to the over the counter cold medicines.

Other posts will deal with such issues as fever and use of antibiotics, but for now, you should be equally concerned about what goes into your child’s body whether that is foods or relatively useless medicines. Remember, as a parent, whether you sleep well at night or not is not as important as whether your child is perfectly comfortable even though there may be an annoying cough that you are listening to very intently all night.

You’re tired and yes you’re annoyed (it’s OK to be annoyed) but when you tentatively venture into your child’s room, most likely you’ll find he/she is sleeping, well, like a baby.

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