Fever in Children

This webpage answers common questions about fevers in your baby or child, including what a fever is, what might cause it, what you can do about it, and when you should take your child to see a healthcare provider.

What is a fever?

A normal body temperature can change during the day but is usually between 97.9 and 100.2 degrees (36.6-37.9°C). The term fever means an increase in your child’s body temperature above 100.4 degrees (38°C) (Brower & Shah, 2020; Nield & Kamat, 2020; Pantell et al., 2021).

It’s important to use a thermometer to check your child’s temperature if you think they have a fever. They might feel warm when you touch them, but this isn’t the best way to see if they have a fever. Sometimes, they might not feel warm even if they do have a fever (Rosenbloom et al., 2020).

The easiest way to check your child’s temperature is with a forehead thermometer. These can find a fever in most children (Hurwitz, Brown, & Altmiller, 2015; Reynolds et al., 2014). Even though using a forehead thermometer is the easiest, the most reliable way to check a temperature in babies and young children is with a rectal (in the bottom) thermometer. Older children can have their temperature measured with an oral (in the mouth) thermometer if they can keep it under their tongue.
Checking a temperature with an axillary (armpit) thermometer is the least accurate, and might miss a fever (Reynolds et al., 2014).
The video below (WebMD, 2016) shows you how to use some of these methods in a toddler:

What might cause a fever?

There are many possible reasons your child might have a fever. The most common cause of fever is an infection. Some common infections that might cause fever include:

How do I treat a fever?

Do not use aspirin to treat your child’s fever.

If your child seems to be uncomfortable because of their fever, you can give them medicine to help bring the fever down (Green et al., 2021). Both acetaminophen (the medicine found in Children’s Tylenol®) and ibuprofen (the medicine found in Children’s Motrin® or Advil®) can be used safely to bring down your child’s fever (Tan et al., 2020). You can buy both of these medicines without a prescription.

You can choose to use one or both of these medicines. If you pick just one medicine, ibuprofen might work a little better than acetaminophen. The best way to treat a fever is to use a combination of acetaminophen and ibuprofen (Paul & Walson, 2021). The dose of each medicine is based on how much your child weighs, so carefully read and follow the dose listed on the medicine label.

If you decide to use both medicines, they can either be given together (table on the left side, below) or on an alternating schedule (table on the right side, below). Both of these methods work about the same to bring down your child’s fever (Paul et al., 2010; Paul & Walson, 2021).

Example of both medicines together:

12:00 – Acetaminophen & ibuprofen
1:00
2:00
3:00
4:00
5:00
6:00 – Acetaminophen & ibuprofen
7:00
8:00
9:00
10:00
11:00

Example of alternating medicines:

12:00 – Acetaminophen
1:00
2:00
3:00 – Ibuprofen
4:00
5:00
6:00 – Acetaminophen
7:00
8:00
9:00 – Ibuprofen
10:00
11:00

When should I see my child’s doctor or healthcare provider?

  • Babies less than 3 months old with a fever should always be seen by a healthcare provider, even if the fever gets better on its own or with medicine (Brower & Shah, 2020; Pantell et al., 2021; Ramgopal et al., 2019).
  • Older children should see a healthcare provider if they have any of the following with their fevers:
    • Ear ache or sore throat
    • Trouble breathing
    • Abdominal (belly) pain
    • Rash anywhere on the skin
    • Fevers over 102.2 degrees (39°C)
    • Fevers lasting more than 2 days (Aronson & Neuman, 2020)
  • When in doubt, you should call your child’s healthcare provider if you have any concerns about your child’s fever.

References

Aronson, P. L., & Neuman, M. I. (2020). Fever in the older child. In R. Kliegman, N. Blum, J. W. St. Geme, S. S. Shah, R. C. Tasker, & K. M. Wilson (Eds.), Nelson Textbook of Pediatrics (21st ed., pp. 1393–1396). Elsevier. 

Brower, L., & Shah, S. S. (2020). Fever without a focus in the neonate and young infant. In R. Kliegman, N. Blum, J. W. St. Geme, S. S. Shah, R. C. Tasker, & K. M. Wilson (Eds.), Nelson Textbook of Pediatrics (21st ed., pp. 1389–1392). Elsevier. 

Green, C., Krafft, H., Guyatt, G., & Martin, D. (2021). Symptomatic fever management in children: A systematic review of national and international guidelines. PLoS ONE, 16(6), Article e0245815. https://doi.org/10.1371/journal.pone.0245815

Hurwitz, B., Brown, J., & Altmiller, G. (2015). Improving pediatric temperature measurement in the ED. American Journal of Nursing, 115(9), 48–55. https://doi.org/10.1097/01.NAJ.0000471249.69068.73

Nield, L. S., & Kamat, D. (2020). Fever. In R. Kliegman, N. Blum, J. W. St. Geme, S. S. Shah, R. C. Tasker, & K. M. Wilson (Eds.), Nelson Textbook of Pediatrics (21st ed., pp. 1386–1388). Elsevier. 

Pantell, R. H., Roberts, K. B, Adams, W. G., Dreyer, B. P., Kuppermann, N., O’Leary, S. T., Okechukwu, K., Woods, C. R., Jr., & Subcommittee on Febrile Infants. (2021). Clinical practice guideline: Evaluation and management of well-appearing febrile infants 8 to 60 days old. Pediatrics, 148(2), Article e2021052228. https://doi.org/10.1542/peds.2021-052228

Paul, I. M., Sturgis, S. A., Yang, C., Engle, L., Watts, H., & Berlin, C. M., Jr. (2010). Efficacy of standard doses of ibuprofen alone, alternating, and combined with acetaminophen for the treatment of febrile children. Clinical Therapeutics, 32(14), 2433–2440. https://doi.org/10.1016/j.clinthera.2011.01.006

Paul, I. M., & Walson, P. D. (2021). Acetaminophen and ibuprofen in the treatment of pediatric fever: a narrative review. Current Medical Research and Opinion, 37(8), 1363–1375. https://doi.org/10.1080/03007995.2021.1928617

Ramgopal, S., Walker, L. W., Tavarez, M. M., Nowalk, A. J., & Vitale, M. A. (2019). Serious bacterial infections in neonates presenting afebrile with history of fever. Pediatrics, 144(2), Article e20183964. https://doi.org/10.1542/peds.2018-3964

Reynolds, M., Bonham, L., Gueck, M., Hammond, K., Lowery, J. Redel, C., Rodriguez, C., Smith, S., Stanton, A., Sukosd, S., & Craft, M. (2014). Are temporal artery temperatures accurate enough to replace rectal temperature measurement in pediatric ED patients? Journal of Emergency Nursing, 40(1), 46–50. https://doi.org/10.1016/j.jen.2012.07.007

Rosenbloom, E., Balis, C., Jacobson, D., Conway, M., Cheng, J., & Kozer, E. (2020). A cross-sectional study on subjective fever assessment in children by palpation: Are fathers as reliable as mothers? Emergency Medicine International, 2020, Article 3534267. https://doi.org/10.1155/2020/3534267

Tan, E., Braithwaite, I., McKinlay, C. J. D., & Dalziel, S. R. (2020). Comparison of acetaminophen (paracetamol) with ibuprofen for treatment of fever or pain in children younger than 2 years: A systematic review and meta-analysis. JAMA Network Open, 3(10), Article e2022398. https://doi.org/10.1001/jamanetworkopen.2020.22398

WebMD. (2016, September 23). How to take your toddler’s temperature [Video]. YouTube. https://youtu.be/2lLGr6wqqyg

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Page last updated 20 Feb 2022 by Jacob Miller