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The Red Hot Alert Get the facts on fevers Is it a fever? Body temperature is remarkably well-regulated, staying within 2 degrees Fahrenheit, above and below, the average of 98 F. This means the normal temperature is not a single number but a range between 96.5-100.4 F (35.84-38 degrees Centigrade or Celsius). Therefore, fever begins at a temperature of 100.5 F. Temperatures in the 99-100 F range are completely normal. A fever by itself is not dangerous A fever is the body's reaction to infection with virus or bacterial germs. "Fever by itself is not an illness," explains Marian Melish, M.D., pediatric infectious disease specialist. "It's a symptom of an underlying problem." Marian Melish, M.D. The germ or illness causing the fever may be mild or severe. The temperature does not necessarily correlate with the seriousness of the illness. Some very mild illnesses, such as roseola, or baby measles, can cause very high fevers (over 105 F), while some very serious illnesses may result in just a slight rise in temperature, such as to 101 F. Fever is not caused by teething or tantrums. Fevers can be a positive sign that the body is fighting an infection, because fever stimulates certain defenses, such as white blood cells, which attack and destroy invading bacteria. "Most fevers are caused by viral infection. Fever can be a sign of problems such as respiratory illnesses, pneumonia, ear infections, influenza and severe colds," says Dr. Melish. "It's important to be attuned to other symptoms your child is experiencing, such as changes in eating habits, vomiting or diarrhea, difficulty breathing, tugging or complaining about ears, or changes in skin color." "Fever due to infection rarely goes over 106.2 F, says Michael Sia, M.D., pediatrician and chairman of Kapi'olani's Department of Pediatrics. "I tell parents not to worry, as these high temperatures are not harmful. Also, seizures (convulsions) due to fever in children ages 4 months to 6 years, are most often associated with an abrupt rise in temperature, rather than an extremely high fever," explains Dr. Sia. Although seizures may be frightening for a parent to witness, those due to fever are usually short (less than five minutes), and are rarely harmful to the child's brain. "All children will be fussy and appear tired when the fever is high, but children with mild illnesses will be happy and playful when the fever is lower. In contrast, children who are really sick will remain tired and fussy even when their temperature is lower. So, if your child is running around happily, it's probably not anything serious," says Dr. Melish. When to call your child's doctor Michael Sia, M.D. Drs. Melish and Sia advise parents to watch for behavioral changes and consider the child's age and health history to determine if and when to call your doctor. "If the child is newborn to 6 weeks old, I want parents to call immediately, because any fever in a young infant is a major concern, since they may not show serious signs of infection until it's too late," says Dr. Sia. "Once a child is 2 years or older, parents begin to rely on their personal knowledge of the child and how she communicates how she is feeling," says Dr. Sia. If a child this age gets a fever for more than three days, call your child's doctor for follow-up. If your child looks ill despite taking medication, especially if there are complaints of sudden headache and mental changes, neck or back stiffness, or rashes, take your child to the emergency room right away. Taking your child's temperature The gold standard is to take a child's temperature with a digital thermometer, in the rectum (okole) in infants and toddlers, and by mouth in children from 3 years if she can hold the thermometer in a closed mouth for 2 to 3 minutes. Your doctor will appreciate if you take at least one accurate temperature reading before calling to report a fever. Once you know your child has a fever, ear thermometers, which are not as accurate but easier to use, can be used to "trend" the fever, or to determine if and by how much the temperature fluctuates after the initial reading. Treating a fever Never give children aspirin for a fever. Aspirin has been linked to Reye's syndrome, a condition that can be debilitating or even fatal in children. Acetaminophen and ibuprofen are the two medications that help fight fever. Follow the instructions or ask your doctor to be sure you give the appropriate dose. It is advisable to give one or the other, but usually not both. Don't worry if the fever stays up despite these anti-fever medicines, unless the child also appears ill. Bathing your child with lukewarm water will help bring down fever. This is rarely needed and may make your child feel worse. Never use cold water or alcohol to bathe your child because it may cause shivering and increase the temperature. Dress a child in light, comfortable clothing. Increase fluid intake but do not push solid foods. The body chemicals that cause fever decrease appetite. Don't worry about your child starving, she will eat again when the illness is over.