I hear a lot of concerns from families about fevers in children. Fortunately, most of these concerns are not based in fact and can easily be alleved with a little education. For example, fever does not make your child's brain melt and come out their ears. It does not cause deafness and rarely causes other neurologic problems. Children do not die from fever and fevers do not cause mental retardation. (However, infection can cause both death and mental retardation in exreme and rare cases. I don't want to dismiss these concerns, but I do want to try to put them in perspective).
Parents worry that certain infections are associated with high fevers. This is true. Fortunately, most high fevers are associated with harmless viral illnesses that are shortlived. Occasionally a high fever can be a sign of a more serious infection. Because of this, it is important to have your child see a physician for any fever lasting more than 3 days, or fever associated with other worrisome symptoms. So, what constitutes worrisome symptoms? How about a mucousy cough, shortness of breath, hallucinations, severe headache or unexplained pain. If your child has any other symptom that really worries you, contact your physician.
It is important to note that certain antibiotics, especially at high doses, can cause deafness. High fevers used to be routinely treated with high doses of antibiotics. These doses are no longer used, and some of these antibiotics are no longer even available. I mention this primarily for historical reasons. Some of you may have older relatives who know someone who experienced this during their childhood. Very young infants, such as those under 2 months of age, can still be susceptible to hearing loss. If you have a young infant under 2 months of age who is treated with several days of intravenous antibiotics, your physician may recommend testing for hearing loss.
Here are a few other things we know. Fever is one of your body's defense mechanisms. It helps fight infections. Therefore, when your child develops a fever, it is a sign that they have an infection or inflammation, usually infection. The fever is going to help fight infection, and should be allowed to do so. There is now evidence that shows that children get over an infection faster if we do not treat their fever. Therefore, as parents and health care providers, we should not be treating fevers with acetominophen or ibuprofen on a routine basis. We should reserve these medications for fevers that are over 103 degrees farenheit, or fevers that last more than a couple of days.
The exception to this is fever in a child with a history of febrile seizure. A febrile seizure is a specific type of seizure that is not part of a seizure disorder. It is not harmful. It is simply that child's way of bringing down their body temperature.
I receive many calls during the night about what dose of acetaminophen or ibuprofen to give a child. This is especially true for children under the age of 2. Why, you ask? Because the dose for older children is available on the bottle. Therefore, parents of children under 2 years of age have no guideline concerning dosage. A general rule of thumb is to give 1 tsp of children's strength ibuprofen or acetaminophen for every 10kg or 22lbs of body weight. (See below). Acetaminophen is to be given every 3-4 hours, while ibuprofen needs to be given only every 6-8 hours. Acetaminophen is still one of the leading causes of poisoning in children in this country. For that reason, I suggest that you not keep several types or concentrations around the house if you don't need them. Also, consider getting rid of the "Infant Concentrate" once your child can take medications from a spoon or medicine cup. When using an Infant Concentrate, always measure it with the dropper provided with that particular bottle and no other dropper.
If you are treating your child's fever, and it is not responding to either acetaminophen or ibuprofen, there are other measures you can take. Some people alternate the two medications. If you are going to do this, please speak with your physician first. You may also use a tepid, or lukewarm bath. Your child should be placed in this bath for 30-45 minutes. Placing the child in the bath for less than 30 minutes will bring down the temperature of the skin, but will not bring down their core temperature. Sponge baths are ineffective for the same reason.
If, despite these measures, your child continues to have a fever for 3 or more days, please contact your Personal Medicine provider. Call sooner if your child is having additional problems.
Dosing:
Never give any medication to children under 8 weeks of age without your doctor's permission.
0-6lbs: Contact your physician.
6-11lbs: 1/2 droppers of Acetaminophen Infant Drops or 1/3
dropper Ibuprofen Infant Drops.
11-17lbs: 1/2 tsp of Acetaminophen or Ibuprofen. 1 dropper Acetaminophen Infant Drops. 2/3 dropper
Ibuprofen Infant Drops.
17-22lbs: 3/4 tsp of Acetaminophen or Ibuprofen. 1 1/2 droppers of Acetaminophen Infant Drops. 1
dropper Ibuprofen Infant Drops.
22-33lbs: 1 tsp of either Acetaminophen or Ibuprofen. May also use 2 Acetaminophen 80mg tablet, one
160mg tablet, 2 Ibuprofen 50mg tablets or one 100mg tablet.
33-44lbs: 1 1/2 tsp of either Acetaminophen or Ibuprofen. May also use 3 80mg Acetaminophen or 3
50mg Ibuprofen.
44-55lbs: 2 tsp of Acetaminophen or Ibuprofen. May also use 4 Acetaminophen 80mg tablets, two 160mg
tablets, 4 Ibuprofen 50mg tablets or two 100mg tablets.
55-66lbs: 2 1/2 tsp of Acetaminophen or Ibuprofen. May also use 5 Acetaminophen 80mg tablets or
five 50mg Ibuprofen.
66-77lbs: 2 1/2 tsp of Acetaminophen or Ibuprofen. May also use 3 Acetaminophen 160mg tablets or 3
100mg tablets of Ibuprofen.
77-88lbs: 3 tsp of Acetaminophen or Ibuprofen. May also use 4 tablets of 100mg Ibuprofen, or two (adult)
200mg Ibuprofen.
88-100lbs: 3 1/2 tsp of Acetaminophen or Ibuprofen.
Over 100lbs: Use adult doses.
Please note these doses are only a guideline, and that your personal physician may recommend somewhat different doses. However, these guidelines should be helpful in those "middle of the night" instances when you may feel hesitant to call your physician.
Dr Nan N
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home.
http://FiresidePediatrics.com
http://PersonalMedicine.com
Great article! Another way I teach my medical students as frame of reference is that a 10 kg baby will get 1 tsp/dose of almost any medication. I.e. high dose amox comes in 400/5mL concentration. A 10 kg baby would need 1 tsp BID for ten days. The same is true for Tyl and ibuprofen.
ReplyDeleteFor parents I simply convert to pounds so that a 20 pound baby should get about 1 tsp per dose. Just as you mention above, these are guidelines, not hard and fast!
Great Article Dr. Nan! I am always so worried when my daughter has a fever. You just never know whether it's a big deal or not. And I never knew about how fever can be more effective in battling illness if left untreated! Great advice. Thanks for the telemedicine call the other day. :)
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