My child has a FEVER of 104°F, what should I do? FEVER. It is such an anxiety provoking term in a parent’s vocabulary. Fever is considered a body temperature of 100.4°F (38.0°C) or above. A temperature of 99°F can be completely normal, especially if taken in the evening when body temperatures naturally rise. Fever itself is not actually dangerous at all*. Fever is part of your body’s response to fighting an infection. When fighting an infection, your body will not produce a temperature high enough to cause brain or organ damage. Yes, even a temperature of 104°F is safe, it may be miserable, but not dangerous. The body’s temperature needs to be above 108°F to cause brain damage. Your body typically does not cause fever above 104°F, and rarely slightly above 104°F in response to some infections (such as infection from the seasonal influenza virus, which often causes very high fevers).
The reason we treat a fever is only to make your child feel better. If your child has a temperature of 102°F, but is running around happily, there is no need to force fever medicine down your child. Alternatively, if your child has a temp of 100.4°F, but is miserable and tired, go ahead, a dose of fever medicine will help perk him or her up. Click HERE for our dosing calculator for acetaminophen and ibuprofen, and HERE if you would like to read more about these wonderful medications. Medicine will help the fever come down, but it will not treat the infection. Therefore, it is expected and completely normal to spike another fever once the medicine wears off, as your body is still fighting the infection. It is normal for fevers with viral infections to last 2-3 days, and sometimes longer. The height of the fever, or inability to “break” the fever, does not necessarily correlate with how serious the infection is; A temperature of 104°F may be caused by a mild virus that will resolve on its own, or it could be a more serious bacterial infection. How ill a child acts after treating the fever, along with how young the child is are more indicative of how serious the infection could be than the actual height of the fever. Children younger than 3 months old should always see their doctor if they have a fever to ensure it is not a serious bacterial infection.
You may have heard of seizures from fevers. This is true, some children have seizures with fevers. Although scary to see, these seizures are typically short lived lasting less than 5 minutes (usually much less), and do not cause any permanent damage. They do not cause brain damage, learning delays, or increase a child’s risk of developing a life-long seizure disorder. If you want to learn more about febrile seizures, read my Health-e Tips article specifically on this topic.
Hopefully now you feel a bit better about fevers. Fevers are on our team, they are the good guys! They help our body fight off infections, the bad guys. The reason for the fever, the infection, is typically viral or bacterial in children. Your doctor can help determine what condition is causing your child to have a fever, and can determine if antibiotics, or other treatments, are necessary.
*There are times your body has a fever due to medications or an extreme external temperature (trapped in a car in the hot desert, for example). These CAN be dangerous and are not self-generated by your body fighting an infection. These are not the type of fever we are talking about here in this article.
I’d like to tell you how the Coronavirus Vaccine is working in your body. Little things called ribosomes work hard all day in our body making proteins. Proteins are used in our body for many different things, and travel in our bloodstream to where they’re needed. Proteins can also be found on the outside of viruses.
Ribosomes use an instruction guide called messenger RNA (mRNA) to know how to make all the different proteins our body uses. Scientists were able to make mRNA instructions for a harmless protein on the outside of the coronavirus. Let’s call this little harmless protein Spike. The mRNA instructions for Spike are in the Moderna and Pfizer vaccine, and tell your ribosomes to make a whole bunch of harmless Spikes. When the ribosomes are done, the mRNA for Spike is destroyed.
Then Spike enters the bloodstream, and it looks a bit like coronavirus, but it is not the actual virus, and it is not dangerous. The immune cells in your blood see this protein that they do not recognize and label it as an intruder. Your immune system bans together to attack this coronavirus lookalike, forming antibodies to Spike. Some of your immune system has the ability to remember Spike for a long time.
This is all very hard work for your body, and can sometimes cause a fever and fatigue, just like when fighting a real virus. But all that hard work by your immune system pays off. Now, if the REAL coronavirus with the REAL Spike enters your body, your immune system recognizes it and is able to get right to action, fighting the Coronavirus before it is able to cause severe illness. And just like that you have immunity to COVID-19!
Acetaminophen and Ibuprofen are by far the two most advised medications in pediatrics, as they are both great for pain, as well as fever. I work in the pediatric emergency department, and often parents believe that we have “magic medications” in the ED that actually work for their child. I will let you in on our secret – we use the SAME medications, just at the appropriate dosages. The back of the package is often under-dosed and based on age. These meds both require weight-based dosing. If you are going to give a fever or pain medication, give the entire full dose to help your child feel better. It is better to give one full dose and get results, than numerous small doses that are ineffective. Below you’ll find a bit of useful information I like to educate all my patients on regarding these two helpful medications, as well as a calculator to determine your child’s dosing.
Ibuprofen is the generic for Motrin and Advil. They are all the same! Save your money and go generic. Ibuprofen is for children 6-months and older – little infant kidneys can’t quite handle ibuprofen yet. It lasts a bit longer in your body than acetaminophen, and usually wears off after about 6-8 hours, (which is why I like this one for right before bedtime – maximize your sleep!). It should not be given more frequently than every 6 hours. Ibuprofen is typically well tolerated, but it can be hard on a child’s stomach if taken religiously over the course of a couple of days. Ibuprofen can reduce fever, and it also can help with swelling and inflammation – that is why it is my go-to for pain control in children. It has actually been shown to be equal to, if not better than, opioids for children. Ibuprofen comes in an infant concentration as well as a children’s concentration. They are the exact same medication, but the infant’s version is more concentrated – meaning you don’t need to give as much liquid for the same amount of medication. It also comes with a syringe or dropper to make it easier to give to a baby. If you have your own syringe or dropper and your infant takes medication ok, I recommend the children’s ibuprofen to save you money. The infant formulation is over twice the price of the more diluted children’s formulation. (Tip for infant medication administration – plug your child’s nose, insert a small amount into the back of the cheek, let go of nose, repeat).
Acetaminophen is the generic for Tylenol, and also known around the world as Paracetamol. This medication is safe for babies to take. However, I always recommend talking to a doctor before giving medication to any infant under 3 months old. Acetaminophen is broken down in the liver and should not be dosed more often than every 4 hours. It is great for fever, and it can also be used for pain control for minor bumps and bruises, or teething.
I often recommend alternating between ibuprofen and acetaminophen if you need to give medication for a couple of days in a row. For example, let’s say your child spikes a fever at noon and you give a dose of ibuprofen. Ibuprofen typically lasts for 6-8 hours, but certainly fever can recur earlier than that. Now let’s say your child spikes a fever by 5pm. It is too early to give ibuprofen (not 6 hours yet between doses as noon to 5pm is only 5 hours). At 5pm, switch to a dose of acetaminophen. The two medications are safe to take together, just be sure there are 6 hours between ibuprofen doses, and 4 hours between acetaminophen doses. Be sure to remember, (or maybe even write down), which of the medications you gave last.
Check out our dosing calculator in the footer next time your child is in need of these magic medications!
RSV and Flu will soon be making their debut, joining COVID-19 this winter causing fevers and cold symptoms. These three respiratory viruses cause very similar symptoms in children, and it is difficult to distinguish between them. Let me give you a brief overview on these three winter culprits.
RSV is significantly worse in infants and toddlers than in older children and adults, as well as children with asthma. This virus causes coughing, wheezing, and fast, labored breathing in babies. Children do not necessarily have fevers with RSV. There is no treatment to kill the RSV virus. If a baby is having a difficult time breathing, sometimes the infant needs to be hospitalized to give oxygen and help him/her breathe easier. Inhalers for asthma, such as albuterol, do not help with wheezing from RSV unless there is an asthma component to the child’s breathing difficulties.
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