Fever: when is it an emergency?

It's easy to forget that fever is one of the body's natural ways of fighting illness and infection. When the number on the thermometer rises a degree or two, we often panic and start dialing the doctor, especially if the patient is a young child. You might even be tempted to grab your keys and head straight to the nearest ER. But is that wise?

Given the discomfort of leaving the house sick or with a sick child, the answer is not always yes. In fact, with an otherwise healthy person, the answer is most likely no. Here’s how to know when fever is an emergency.

Fever in Babies and Children

Relax, mom and dad. When children run a fever, it's usually the sign of a harmless viral or bacterial infection that will run its course with rest and home care. Often, the number on the thermometer is only part of the puzzle. You may need to look for additional clues when deciding whether medical care is necessary, especially in babies who are too young to speak. Some of these include if your child is:

• Behaving differently than normal; weak or constant crying and fussiness
• Not hungry or thirsty; having fewer wet diapers
• Unusually tired and lethargic; unresponsive or unable to be awakened
• Having trouble breathing
• Very pale with ashy, patchy, bluish skin or a reddish rash
• Experiencing muscle weakness, ear pain or a stiff neck

All of these are warning signs that something is wrong and you should seek immediate medical intervention. If you’re not sure, the expert pediatric and adult nurses at EIRMC’s Consult-A-Nurse line are available 24/7 to help you understand symptoms, manage chronic conditions and learn about treatment options over the phone. In medical emergencies, our pediatric ER is staffed with pediatric emergency medicine experts who can provide specialized care for infants and children of all ages.

Call Consult-A-Nurse^® at (208) 497-6167.

Here are some general fever guidelines from the Mayo Clinic:

Babies under 3 months – Call your pediatrician, even if there are no other signs or symptoms, if your infant’s temperature is 100.4ºF or higher (rectal) or 99ºF or higher (armpit).

Babies 3 to 6 months – A temperature above 102ºF taken rectally warrants a call to your doctor. Babies who appear unusually irritable, sleepy or uncomfortable should also see a doctor.

Babies 6 to 24 months – Children six months or older can be give acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). However, you should avoid giving aspirin to children this young. Call your pediatrician if your child’s fever is higher than 102ºF (taken rectally) and either doesn’t respond to medication or lasts longer than a day.

Children 2 to 17 years – Like the previous age group, kids in this age group can also take acetaminophen or ibuprofen and should avoid aspirin. If a fever above 102ºF (taken rectally for ages 2 to 3 and orally for children over 3) doesn’t respond to medication or lasts longer than three days, contact your doctor.

A note about fever-taking methods:

Be sure to tell your healthcare provide what method you used to determine that your child is running a fever. Some temperature-taking methods are considered more accurate than others.

• Temperatures taken rectally are generally considered more accurate in young children
• Plastic strip thermometers are generally not recommended for home use since they measure skin temperature, not body temperature
• Armpit temps tend to run one half to one degree lower than oral temps
• Ear and rectal temps tend to run one half to one degree higher than oral temps

Fever in Adults 18+

Below 102ºF – Rest and drink plenty of fluids. No treatment is needed unless the fever is accompanied by a severe headache, stiff neck, difficulty breathing, behavior change, severe pain or other unusual symptoms.

Above 102ºF – Be sure to seek treatment if the fever:

• Doesn't respond to medication
• Is consistently 104ºF or higher
• Lasts longer than three days
• Is accompanied by
  • Breathing problems
  • Vomiting or severe stomach pain
  • Headache and confusion
  • Severe back pain or stiff neck
• Occurs after surgery and you are worried about possible infection

Acetaminophen vs. Ibuprofen

According to the Cleveland Clinic, studies suggest ibuprofen is the champ at fighting fever, pain and inflammation while acetaminophen takes the prize for arthritis and headache relief. To maximize the effects of both and minimize the risks of taking too much of either, consider alternating between the two.

For most fevers, chicken soup and a little TLC is the right prescription. But if you do have a medical emergency, EIRMC’s Pediatric ER and adult ER are always here for you.