Fevers in Children: When to Worry and When to Remain Calm

One of the most common concerns parents have is when their child develops a fever. While fever can be alarming, it’s important to understand that a fever itself is not necessarily dangerous—it’s often a sign that the body is fighting an infection (most commonly a virus). However, knowing when to be concerned and when to remain calm can make all the difference in how you care for your child during these times.

What is a Fever?

A fever is defined as a body temperature that’s higher than normal. In children, a fever is typically considered to be a temperature of 100.4°F (38°C) or higher. The body naturally maintains a temperature around 98.6°F (37°C), and when an infection or illness is present, the body raises its temperature as part of the immune response to help slow down or stop the infection.

Fevers can be caused by many things, including viral or bacterial infections, inflammatory conditions, and even teething in infants. In most cases, fever is not harmful, but it’s important to monitor your child’s condition closely.

When to Remain Calm

1. Mild to Moderate Fevers
   If your child’s fever is relatively mild (between 100.4°F and 102°F), there is typically no need to worry. These types of fevers usually resolve on their own within a few days as the body works to combat the illness. Common causes include viral infections like the flu, cold, or ear infections.
   
   

2. Normal Behavior and Alertness
   If your child is still eating, drinking, playing, and is responsive, this is a good sign. Even with a fever, they are likely just dealing with the discomfort of the illness rather than a more serious condition. In these cases, you can manage the fever at home with fluids, fever-reducing medications (such as acetaminophen or ibuprofen), and light clothing to help keep them comfortable.
   
   

3. Managing Fever Comfortably
   For mild fevers, ensure your child stays hydrated and gets plenty of rest. You don’t always need to lower the fever immediately unless it’s causing discomfort. Fever medications, such as acetaminophen or ibuprofen, can be given according to age and weight guidelines. Avoid giving aspirin to children, as it has been linked to a rare but serious condition called Reye's syndrome.

How High Is Too High?

Many parents have heard or read that a fever that gets too high can be dangerous. While this is technically true, it’s not as worrisome as most parents think. In general, it’s best not to stress about the number but focus on your child’s comfort level.

While a fever above 106°F is considered hyperthermia and can be dangerous, the body has complex safety mechanisms in place that make going to a truly dangerous temperature very rare. Usually true hyperthermia only occurs in situations involving excessive and prolonged exposure to high outdoor heat.

Many children can run fevers as high as 104°F and 105°F and recover well, even if they feel somewhat miserable for a time. Remember, the body is just using its natural mechanisms to fight off an infection, but the temperature says nothing about what kind of infection it is. For example, viruses like RSV and adenovirus can cause really high fevers, but there is currently no medication to treat these viruses and the best treatment is to support them with fluids, fever medications, and other comfort measures.

When to Be Concerned

While most fevers are harmless, there are certain situations where you should seek medical attention. Consider contacting your pediatrician if:

1. ANY Fever in Infants Under 2 Months
   For newborns, a fever is a cause for immediate concern. Infants under two months of age should be evaluated by a doctor if they develop a fever, even if it’s low-grade. This age group is particularly vulnerable to serious infections that require urgent medical attention.
   
   

2. Difficulty Breathing
   Most children will breathe a little faster or have slightly altered breathing due to congestion during a viral illness. However, more severe trouble like wheezing, coughing fits, or seeing the ribs or sternum pulling inwards can be signs of more serious illness. If your child has some of these more serious signs, it’s important to get them medical attention as soon as possible.

1. Signs of Dehydration
   If your child is not drinking enough fluids and shows signs of dehydration (dry mouth, sunken eyes, far fewer wet diapers), it's important to consult a doctor. Illnesses that cause vomiting and diarrhea can accelerate the rate of dehydration, since the body is losing extra fluid. Dehydration can worsen the effects of fever and lead to more severe complications.
   
   

2. Fever Lasting More Than 3 Days
   A fever that persists for more than 72 hours without improvement should be evaluated by a healthcare provider. While some illnesses, like viral infections, can cause a prolonged fever, it’s essential to rule out other causes that do need more prompt treatment, such as a urinary tract infection or pneumonia.
   
   

3. Other Serious Symptoms

• Rash (especially if it's purple, or accompanied by fever)

• Severe headache, stiff neck, or sensitivity to light (potential signs of meningitis)

• Persistent vomiting or diarrhea

When to Seek Immediate Care

If your child has a fever and any of the following signs, seek emergency care right away:

• Seizures (febrile seizures are common in young children with high fever)

• Severe headache, stiff neck, or sensitivity to light

• Trouble breathing or rapid breathing

• Bluish skin, lips, or face

• Inability to wake or extreme confusion

Conclusion

Fever is one of the body's natural defenses against infection, and it’s often part of the healing process. Most of the time, a fever is not something to worry about, especially if your child is still alert and able to drink fluids. However, it’s important to trust your instincts as a parent—if something feels off or you’re unsure whether your child’s condition requires medical attention, don’t hesitate to contact your pediatrician.