Fevers are rampant right now, and sometimes it’s tough to know when to head to the doctor when your child is sick with a fever. Here are some things to keep in mind as you try to decide.
Fever indicates that the body is fighting an infection. Both bacteria and viruses cause infections, so the presence of fever doesn’t usually help distinguish between them.
Fever can last up to 3-4 days even with a virus. If you’re child is feverish but seems more comfortable with ibuprofen and is able to eat a bit, drink a bit, and play a bit, chances are the illness your child has is viral. This is especially true if your child has a runny nose along with the fever. Since we can’t do much for viral illnesses, making a trip to the office for this constellation of symptoms may not be worth your time.
Although it’s true that bacterial illnesses are associated with higher fevers on average, many viruses give high temps too – even over 104 — so the degree of fever is rarely the determining factor in whether or not you need to seek care.
Fevers are highest in the afternoon and evenings for everyone, but if the pattern is one of near normal temps in the morning and higher temps in the afternoon, chances are the fever is from a viral illness. Bacterial illnesses tend to cause more consistent high temperatures, day and night.
If your child is running around and playing, even with a fever, chances are the illness is viral. Bacterial illnesses make you sicker overall and a child would be unlikely to be playing dress up or wanting to build with Legos if she had an underlying bacterial illness.
Children with fevers who are also very listless, not eating or drinking, very cranky and difficult to console need to be seen regardless of whether their fever is 100.4 or 104. Looking at how sick your child seems is a much better way to decide whether or not you need to make a trip to the office.
Any children who have had fevers over 100.4 for more than three days should be checked out. Most viruses give fever for just 2-3 days and after that, the chance that there’s a bacterial illness increases. Some viruses can cause fevers for longer, but by the fourth day of fever we want to be sure there’s nothing more going on.
Feverish children who have a sore throat but by day 2 or 3 haven’t gone on to develop a runny nose or cough should be seen to make sure that strep throat isn’t the cause. Don’t go in too early, though; the rapid strep test we do in the office may be falsely negative in the first 24 hours of fever. So give it a day or so to evolve.
Painful or frequent urination along with fever is a reason to head in sooner too, since a kidney or bladder infection could be the culprit.
Fever with neck stiffness or severe headache that doesn’t improve much with ibuprofen is a combo that requires medical attention pronto.
Children whose fever crops up after they’ve been sick for a several days should be seen, since there may be a secondary infection that needs treatment.
Fever with severe abdominal pain and vomiting, especially in the absence of diarrhea, is reason to be seen too.
Feverish children who are coughing so hard they’re vomiting consistently, who are grunting when breathing, who haven’t peed in 8-12 hours, or who have a purplish or bruise-like rash need to be seen right away.
I hope you can see that fever is rarely the determining factor in deciding whether or not your child needs to come to the office when he’s ill. The other symptoms he has and the overall sense of how sick he seems are much better guides for worried parents. Most fevers this time of year are caused by viral illness, but if your child is acting quite ill or has any of the worry signs described above she should be seen.