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What is a fever?

Fever refers to an elevation in body temperature. Technically, any body temperature


above the normal oral measurement of 98.6 F (37 C) or the normal rectal temperature of
99 F (37.2 C) is considered to be elevated. However, these are averages, and your normal
temperature may actually be 1 F (0.6 C) or more above or below the average of 98.6 F.
Body temperature can also vary up to 1 F (0.6 C) throughout the day.

Thus, fever is not considered medically significant until body temperature is above 100.4
F (38 C). Fever serves as one of the body's natural defenses against bacteria and viruses
which cannot live at a higher temperature. For that reason, low fevers should normally go
untreated, unless accompanied by troubling symptoms.

Also, the body's defense mechanisms seem to work more efficiently at a higher
temperature. Fever is just one part of an illness, many times no more important than the
presence of other symptoms such as cough, sore throat, etc.

Fevers of 104 F (40 C) or higher demand immediate home treatment and subsequent
medical attention, as they can result in delirium and convulsions, particularly in children.

How should I take a temperature for fever?

Digital thermometers can be used to measure rectal, oral, or axillary (under the armpit)
temperatures. The American Academy of Pediatrics does not recommend use of mercury
thermometers (glass), and they encourage parents to remove mercury thermometers from
their households to prevent accidental exposure to this toxin.

Measuring an axillary (under the armpit) temperature for fever:

Axillary temperatures are not as accurate as rectal or oral measurements, and these
generally measure one degree lower than a simultaneously obtained oral temperature.

• Place the tip of the digital thermometer in your child's armpit.

• Leave in place about one minute or until you hear a beep to check a digital
reading.

Measuring fever by eardrum temperature:

Tympanic (ear) thermometers must be placed correctly in your child's ear to be accurate.
Too much earwax can cause the reading to be incorrect.
Eardrum temperature measurements are not accurate in small children and should not be
used in children under 3 years (36 months) of age. This is especially true in infants below
3 months of age when obtaining an accurate temperature is very important.

Measuring fever by oral temperature:

Children 4 to 5 years old and adults can have their temperature taken with a digital
thermometer under the tongue with their mouth closed.

• Clean the thermometer with soapy water or rubbing alcohol and rinse.

• Turn the thermometer on and place the tip of the thermometer as far back under
the tongue as possible.

• The thermometer should remain in place for about one minute or until you hear
the beep. Check the digital reading.

Avoid hot or cold drinks within 15 minutes of oral temperature measurement to ensure
correct readings.

Measuring fever by rectal temperature:

The American Academy of Pediatrics recommends rectal temperature measurements for


children under 3 years, as this gives the most accurate reading of core temperature.

• Clean the thermometer with soapy water or rubbing alcohol and rinse with cool
water.

• Use a small amount of lubricant, such as petroleum jelly, on the end.

• Place the child prone (belly-side down) on a firm surface, or place your child face
up and bend his legs to his chest.

• After separating the buttocks, insert the thermometer approximately ½ to 1 inch


into the rectum. Do not inset it too far.
• Hold the thermometer in place, loosely keeping your hand cupped around your
child's bottom, and keep your fingers on the thermometer to avoid it accidently
sliding further into the rectum. Keep it there for about one minute, until you hear
the beep.

• Remove the thermometer, and check the digital reading.

• Label the rectal thermometer so it's not accidentally used in the mouth.

A rectal temperature will read approximately one degree higher than a simultaneously

How is fever treated?

Generally, if the fever does not cause discomfort, the fever itself need not be treated. It is
not necessary to awaken an adult or child to treat a fever unless instructed to do so by
your health-care practitioner.

The following medications may be used at home to treat a fever:

• Acetaminophen (Tylenol and others) can be used to lower a fever. The


recommended pediatric dose can be suggested by the child's health-care provider.
Adults without liver disease or other health problems can take 1000 mg (two
"extra strength" tablets) every four to six hours or as directed by your physician.

• Ibuprofen (Motrin/Advil) can also be used for fever in patients over 6 months of
age. Discuss the best dose with your doctor. For adults, 400-600 mg (two to three
200 mg tablets) can be used every six hours.

• Aspirin should not be used for fever in children or adolescents. Aspirin use in
children and adolescents during a viral illness (especially chickenpox and
influenza) has been associated with Reye syndrome. Reye syndrome is a
dangerous illness which causes prolonged vomiting, confusion, and even coma
and liver failure.
An individual with a fever should be kept comfortable and not overdressed. Overdressing
can cause the temperature to rise further. Tepid water (85 F [30 C]) baths may help bring
down a fever. Never immerse someone in ice water. This is a common misconception.
Never sponge a child or an adult with alcohol; the alcohol fumes may be inhaled, causing
many problems.

When should I seek medical care for a fever?

Any child below the age of 3 months who has a temperature of 100.4 F (38 C) should be
seen by a physician or other health-care worker. If a child or adult has a history of cancer,
AIDS, or other serious illness, such as heart disease or diabetes, medical care should be
sought.

Otherwise, observe the person with the fever. If they appear sick or have symptoms that
would suggest a major illness, such as meningitis (headache, stiff neck, confusion,
problems staying awake), urinary tract infection (shaking chills, burning with urination),
pneumonia (shortness of breath, cough), or any other signs of a serious illness, contact
your health-care provider.

On the other hand, if the fever accompanies a simple cold, you can treat the fever as
above and be assured that the fever is only a symptom of the illness. This is not to say
that you should ignore a fever. If there are other associated symptoms that are
bothersome, you should contact your health-care professional.

About 3% of all children between 18 months to 3 years of age will have a seizure
(convulsion) with a high fever. Of those with a history of febrile seizure, approximately
one-third will have another seizure associated with another febrile episode. Febrile
seizures, while frightening to the parents, are not associated with long-term nervous-
system side effects. Children used to be prescribed phenobarbital following a febrile
seizure as a preventive measure (prophylaxis). This has been shown to be unbeneficial
and possibly harmful, so it is not always recommended.

Aches, Pain, Fever At A Glance

• Although a fever could be considered any body temperature above the normal
98.6 F (37 C), medically, a person is not considered to have a significant fever
until the temperature is above 100.4 F (38.0 C).
• Most fever is beneficial, causes no problems, and helps the body fight off
infections. The main reason for treating a fever is to increase comfort.
• Children under 3 months old with a temperature of 100.4 F (38.0 C) or greater
should be seen by a health-care provider. They may be quite ill and not show any
signs or symptoms besides a fever. Infants less than 6 weeks old should be seen
immediately by their doctor.
• Acetaminophen (Tylenol and others) and ibuprofen (Advil, Motrin) can be used to
treat a fever. Aspirin should not be used in children or adolescents to control
fever.
Previous contributing author and editor:

Author: Dennis S. Phillips, MD


Editor: Dennis Lee, MD

Medically reviewed by James Gerace, MD, Board Certified American Board of Internal
Medicine with additional certification by the Subspecialty Board of Pulmonary Disease

References:

http://www.webmd.com/a-to-z-guides/body-temperature

http://www.aap.org/publiced/BR_Fever.htm

http://aappolicy.aappublications.org/cgi/content/full/pediatrics;103/6/e86

http://www.medscape.com/viewarticle/575603

Webster's New World Medical Dictionary, Third Edition


Fever

MedlinePlus Topics
Fever

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Thermometer temperature

Temperature measurement

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Avian influenza
Febrile seizures
Flu
H1N1 (swine) influenza
Heat emergencies
MRSA

Patient Instructions
Colds and the flu - what to ask your doctor - adult
Colds and the flu - what to ask your doctor - child
Febrile seizures - what to ask your doctor
Swine flu (H1N1) - what to ask your doctor - adult
Swine flu (H1N1) - what to ask your doctor - child
When your young child has swine flu

Fever is the temporary increase in the body's temperature, in response to some disease or
illness.

A child has a fever when their temperature is at or above one of these levels:

• 100.4 °F (38 °C) measured in the bottom (rectally)


• 99.5 °F(37.5 °C) measured in their mouth (orally)
• 99 °F (37.2 °C) measured under their arm (axillary)

An adult probably has a fever when their temperature is above 99 - 99.5 °F (37.2 - 37.5
°C), depending on what time of the day it is.

See also:
• Temperature measurement
• Heat emergencies

Considerations

Normal body temperature may change during any given day. It is usually highest in the
evening. Other factors that may affect body temperature are.

• In the second part of a woman's menstrual cycle, her temperature may go up by 1


degree or more.
• Physical activity, strong emotion, eating, heavy clothing, medications, high room
temperature, and high humidity can all increase your body temperature.

Fever is an important part of the body's defense against infection. Many infants and
children develop high fevers with minor viral illnesses. While a fever signals to us that a
battle might be going on in the body, the fever is fighting for the person, not against.

Most bacteria and viruses that cause infections in people thrive best at 98.6°F. Many
infants and children develop high fevers with minor viral illnesses. While a fever signals
to us that a battle might be going on in the body, the fever is fighting FOR the person,
not against.

Brain damage from a fever generally will not occur unless the fever is over 107.6 °F (42
°C). Untreated fevers caused by infection will seldom go over 105 °F unless the child is
overdressed or trapped in a hot place.

Febrile seizures do occur in some children. However, most febrile seizures are over
quickly, do not mean your child has epilepsy, and do not cause any permanent harm..

Unexplained fevers that continue for days or weeks are called fevers of undetermined
origin (FUO).

Causes

Almost any infection can cause a fever. Some common infections are

• Respiratory infections such as colds or flu -like illnesses, sore throats, ear
infections, sinus infections, infectious mononucleosis , and bronchitis
• Urinary tract infections
• Viral gastroenteritis and bacterial gastroenteritis
• More serious infections such as pneumonia, bone infections (osteomyelitis),
appendicitis, tuberculosis, skin infections or cellulitis, and meningitis

Children may have a low-grade fever for one or two days after some immunizations.

Teething may cause a slight increase in a child's temperature, but not higher than 100 °F.
Autoimmune or inflammatory disorders may also cause fevers. Some examples are:

• Arthritis or connective tissue illnesses such as rheumatoid arthritis, systemic lupus


erythematosus
• Ulcerative colitis and Crohn's disease
• Vasculitis or periarteritis nodosa

The first symptom of a cancer may be a fever. This is especially true of Hodgkin's
disease, non-Hodgkin's lymphoma, and leukemia.

Other possible causes of fever include

• Blood clots or thrombophlebitis


• Medications, such as some antibiotics, antihistamines, some seizure medicines

Home Care

A simple cold or other viral infection can sometimes cause a high fever (102 - 104 °F, or
38.9 - 40 °C). This does not usually mean you or your child have a serious problem.
Some serious infections may cause no fever or even a very low body temperature,
especially in infants.

If the fever is mild and have no other problems, you do not need treatment. Drink fluids
and rest.

The illness is probably not serious if your child:

• Is still interested in playing


• Is eating and drinking well
• Is alert and smiling at you
• Has a normal skin color
• Looks well when their temperature comes down

Take steps to lower a fever if you or your child are uncomfortable, vomiting, dried out
(dehydrated), or not sleeping well. Remember, the goal is to lower, not eliminate, the
fever.

When trying to lower a fever:

• Do NOT bundle up someone who has the chills.


• Remove excess clothing or blankets. The room should be comfortable, not too hot
or cool. Try one layer of lightweight clothing, and one lightweight blanket for
sleep. If the room is hot or stuffy, a fan may help.
• A lukewarm bath or sponge bath may help cool someone with a fever. This is
especially effective after medication is given -- otherwise the temperature might
bounce right back up.
• Do NOT use cold baths, ice, or alcohol rubs. These cool the skin, but often make
the situation worse by causing shivering, which raises the core body temperature.

Here are some guidelines for taking medicine to lower a fever:

• Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) help reduce fever in


children and adults. Sometimes doctors advise you to use both types of medicine.
• Take acetaminophen every 4 - 6 hours. It works by turning down the brain's
thermostat.
• Take ibuprofen every 6 - 8 hours. DO NOT use ibuprofen in children younger
than 6 months old.
• Aspirin is very effective for treating fever in adults. DO NOT give aspirin to a
child unless your child's doctor tells you to.
• Know how much you or your child weigh, and then always check the instructions
on the package.
• In children under 3 months of age, call your doctor first before giving medicines.

Eating and drinking with a fever

• Everyone, especially children, should drink plenty of fluids. Water, popsicles,


soup, gelatin are all good choices.
• Do not give too much fruit or apple juice and avoid sports drinks in younger
children.
• While eating foods with a fever is fine, foods should not be forced.

When to Contact a Medical Professional

Call a doctor right away if your child:

• Is younger than 3 months old and has a rectal temperature of 100.4 °F (38 °C) or
higher
• Is 3 -12 months old and has a fever of 102.2 °F (39 °C) or higher
• Is under age 2 years and has a fever that lasts longer than 24 - 48 hours
• Is older and has a fever for longer than 48 - 72 hours
• Has a fever over 105 °F (40.5 °C), unless it comes down readily with treatment
and the person is comfortable
• Has other symptoms that suggest an illness may need to be treated, such as a sore
throat, earache, or cough
• Has been having fevers come and go for up to a week or more, even if they are
not very high
• Has a serious medical illness, such as a heart problem, sickle cell anemia,
diabetes, or cystic fibrosis
• Recently had an immunization
• Has a new rash or bruises appear
• Has pain with urination
• Has trouble with their immune system (chronic steroid therapy, after a bone
marrow or organ transplant, their spleen previously has been removed, is HIV-
positive, or they're being treated for cancer)
• Has recently traveled to a third world country

Call 911 if you or your child has a fever and:

• Is crying and cannot be calmed down (children)


• Cannot be awakened easily or at all
• Seems confused
• Cannot walk
• Has difficulty breathing, even after their nose is cleared
• Has blue lips, tongue, or nails
• Has a very bad headache
• Has a stiff neck
• Refuses to move an arm or leg (children)
• Has a seizure

Call your doctor right away if you are an adult and you:

• Have a fever over 105 °F (40.5 °C), unless it comes down readily with treatment
and you are comfortable
• Have a fever that stays at or keeps on going above 103 °F
• Have a fever for longer than 48 - 72 hours
• Have had fevers come and go for up to a week or more, even if they are not very
high
• Have a serious medical illness, such as a heart problem, sickle cell anemia,
diabetes, cystic fibrosis, COPD, or other chronic lung problems
• Have a new rash or bruises appear
• Have pain with urination
• Have trouble with your immune system (chronic steroid therapy, after a bone
marrow or organ transplant, spleen was previously removed, HIV-positive, were
being treated for cancer)
• Have recently traveled to a third world country

What to Expect at Your Office Visit

Your doctor will perform a physical examination, which may include a detailed
examination of the skin, eyes, ears, nose, throat, neck, chest, and abdomen to look for the
cause of the fever.

Treatment depends on the duration and cause of the fever, and on other accompanying
symptoms.

The following diagnostic tests may be performed:


• Blood studies, such as a CBC or blood differential
• Urinalysis
• X-ray of the chest

Alternative Names

Elevated temperature; Hyperthermia; Pyrexia