A Guide for Treating Fever in Babies and Toddlers

It can seem scary when your baby or toddler has a fever, but you shouldn't panic. We explain what to look for so you can stay calm—and help them feel better fast.

Animation by Sarina Finkelstein; Getty Images (1).

We've all been there: You're awakened in the middle of the night by the pained cries of your young child, and you notice that their forehead is hot to the touch. You take their temperature, and the reading sends your heart racing. Your first instinct is to speed-dial the doctor. But in most cases, here's what experts say you should do instead: Take a deep breath and relax.

Of course, that's easier said than done. If you're worried, certainly call the doctor. But it can help to know that fevers—even high fevers and fevers that cause hallucinations—are almost always not as scary or dangerous for kids as you think.

Many parents have "fever phobia," or a tendency to freak out when their child's body temperature spikes. Studies show that as many as 30% of pediatric acute-care visits are related to fever. "A lot of parents think a fever is really dangerous," says Robert W. Steele, M.D., a pediatrician at Children's Mercy Hospital in Kansas City. "But the vast majority of the time it's nothing serious."

Learn more about fevers in children, including how to treat them, what it means if your child has fever hallucinations, and when to see the doctor.

What Is a Fever?

Healthy body temperature can vary from person to person depending on their age, activity level, and even the time of day. According to Cleveland Clinic, the normal body temperature for children between birth and 10 years old ranges from 95.9 F to 99.5 F. So while the commonly cited 98.6 F figure falls in this range, it isn't necessarily an accurate limit when it comes to fevers.

Most pediatricians define a fever in young children as a body temperature above 100.4 F, according to the American Academy of Pediatrics (AAP).

In a way, a fever is a good thing. It means your child's immune system is doing its job by fighting an infection, says Michael Devon, M.D., a pediatrician in private practice near Philadelphia. The brain commands the body's temperature to rise, which in turn directs the white blood cells to attack and destroy invading viruses, bacteria, or other pathogens.

Amazingly, healthy kids of all ages usually can tolerate a fever of up to 105.8 F with no complications. Fevers above that can be very dangerous but are very rare. Chances are your child's temperature will never approach that scary number. But it's almost inevitable that sometime during a child's first three years their temperature will climb into the triple digits, says the AAP. Just know that if it's over 100.4 F by a few degrees, it's usually not harmful.

When to Call the Doctor About a Fever

Most of the bugs that cause a fever—such as cold, flu, or stomach viruses—aren't usually dangerous and can be treated at home. But as a parent, what you should do about a fever depends largely on your child's age, medical history, and temperature reading. If your child has a chronic medical condition or is not tolerating their illness or fever well, consult with their pediatrician. Otherwise, you can typically follow the below recommendations.

Less than 3 months old

For babies younger than 12 weeks old, anything above 100.4 F warrants a call to the doctor. Because an infant's immune system isn't fully developed, they're vulnerable to potentially life-threatening infections like bacterial meningitis and pneumonia, and an elevated body temperature is often the only symptom.

Between 3 and 6 months old

For babies between 3 and 6 months old, they should be examined by their pediatrician once their fever hits 101 F, says Steven Shelov, M.D., a pediatrician, Parents advisor, and the editor-in-chief of the American Academy of Pediatrics' Caring for Your Baby and Young Child.

Older than 6 months

For babies and toddlers older than 6 months, you can safely wait to contact your doctor until their temperature rises to 103 F, with one important exception. Phone right away if their fever hits 102 F or above and they have two or more of the following symptoms: a cough, a sore throat, a runny or stuffy nose, body aches, headaches, chills, fatigue, or diarrhea.

These classic H1N1 flu symptoms (which are strikingly similar to those for seasonal influenza or COVID-19) tend to occur within 24 hours of the onset of a fever, and your pediatrician might recommend that they take the antiviral drug Tamiflu to reduce the severity and duration of their symptoms.

Watch Your Child's Other Symptoms

Having a fever is a signal from the body that something is wrong. So, pay close attention to your child's other symptoms. If they have a runny nose and a low-grade fever (under 101 F), it usually means they've got a common cold, while vomiting and diarrhea probably point to a stomach virus. In both cases, the fever tends to come on gradually and disappear within a few days. But symptoms from flu or other viral infections often strike very suddenly.

"Flu hits your child like a ton of bricks," says Jason Homme, M.D., assistant professor of pediatrics at the Mayo Clinic in Rochester, Minnesota. One day they're fine, and then boom, the next they can't get out of bed, he describes.

For kids considered to be at higher risk (those under age 5 or with certain chronic medical conditions, such as asthma or diabetes), treatment may be needed, so your doctor might have them come in for a flu test. If your child is otherwise healthy their physician may simply assume (based on your description) that they have the flu. In that case, they'll need to stay home until they are fever-free for 24 hours without using a fever-reducing medication.

Fever Red Flags to Know

Let your doctor know right away if your child has a fever and complains of a sore throat, an earache, or pain while peeing since these ailments could signal strep throat, an ear infection, or a urinary tract infection, all of which may need to be treated with antibiotics. You should also check in with the doctor's office if your child shows symptoms of dehydration, including urinating less than usual, not producing any tears when they cry, or seeming less alert than usual.

Although rare, certain symptoms (which are often accompanied by fever) require immediate medical attention. Head straight for the E.R. if your child is extremely short of breath, cries inconsolably, has difficulty waking, or develops a rash that doesn’t blanch when you press it or has bruise-like purple spots (both could indicate meningococcemia, a potentially fatal infection of the bloodstream).

Call 911 if their tongue, lips, or nails are blue (a sign that they may not be getting enough oxygen), they have a stiff neck (a possible indicator of meningitis), or severe abdominal pain (which could mean appendicitis). Also, call your pediatrician if your child is under 2 and their fever lasts more than 24 hours.

For older kids with a fever, you can wait three days before calling unless they have symptoms suggestive of seasonal flu, COVID-19, or H1N1. Ask for an appointment if your child's fever disappears and then returns a few days later, since they may have developed a secondary infection.

Fever Hallucinations in Kids

When the body's temperature spikes, the mind can get disoriented or even make your child visualize, hear, or feel things that aren't there. These effects are called fever hallucinations. Scary as this delusional state can seem, fever hallucinations are not a red flag on their own. When the fever recedes, so will your child's confusion or hallucinations.

When to Treat a Fever in Babies and Toddlers

While it's a natural instinct to treat your child's fever so they feel better, keep in mind that medication will merely mask it, not cure it. "Once a fever reducer wears off, your child's temperature may soar back up because the underlying cause is still there," says Laura Jana, M.D., a pediatrician and co-author of American Academy of Pediatrics' Heading Home With Your Newborn.

As a general rule, you should focus on the way your child looks, feels, and acts rather than on what the thermometer says. "If you have to chase him around to give him medicine, he probably doesn't need it," says Dr. Jana. "Letting your child's fever run its course may actually help his body fight the underlying infection."

But if bringing down your little one's temperature makes them feel less achy or irritable, it's fine to do it. Also, if they are having trouble sleeping, treating the fever (and other symptoms) with medication can often help them get the rest they need.

How to Treat a Fever in Babies and Toddlers

For kids under 6 months, infant acetaminophen (such as Tylenol) is the only recommended fever reducer. Toddlers and kids can also take children's ibuprofen (such as Motrin or Advil), which is more effective at fighting fever but also somewhat more likely to cause stomach irritation. Never give aspirin to a child under 16 as it can cause Reye's syndrome, a potentially fatal liver condition.

If your child's fever is persistent, check if your doctor recommends treating them with alternating doses of acetaminophen and ibuprofen (spacing the two meds by at least two hours). But always be sure to follow the doctor's suggested dosing schedule and record the precise doses and times given to prevent the risk of an overdose.

Medication isn't the only treatment for a fever. In fact, for a low-grade fever, the pediatrician might recommend other home remedies such as a lukewarm bath or cool washcloth to temporarily cool your child off. Stay away from cold water and ice baths, though. "They'll make your child shiver, which can raise [their] temperature even higher afterward," Dr. Steele says. Also avoid alcohol rubs, a dangerous old-school remedy that can cause intoxication, seizures, or even coma.

Giving your child lots of fluids—including ice pops or Jell-O—will help their body battle the illness and keep them hydrated. If they're vomiting or have diarrhea, give them an oral-rehydration-therapy drink to help replace electrolytes and fluids. Keep your child in lightweight, breathable clothing; dressing them in layers is best because they may be sweaty one minute and shivering the next. And don't forget the most helpful home remedy of all: lots of TLC.

FAQs About Child and Toddler Fevers

Here are answers to common questions about fevers in toddlers and young children.

What type of thermometer should I use?

If your child is younger than 3 years old, a rectal thermometer gives the most accurate reading. You can use an oral thermometer for older children.

Can a high fever cause my child to have fever hallucinations?

Though adults are more likely to hallucinate from an elevated body temperature than kids are, it's possible your feverish child could start seeing things that aren't really there (such as a doll floating across their room or bugs crawling on them). High fevers—102 F or above—are more likely to cause fever hallucinations in children. While they may be frightening for your child (and for you), they're generally harmless and temporary.

Will my child have a febrile seizure?

While uncommon, it is possible for your child to have a febrile seizure. A febrile seizure is caused by a quick spike in temperature that disrupts the brain's normal electrical activity. Your child is more susceptible if febrile seizures run in your family or if they've had one within the past year. According to the AAP, between 3% and 4% of children have febrile seizures, which are most common in children between 12 and 18 months old.

Though the typical symptoms—rolling of the eyes, twitching, and even vomiting—are disturbing to watch, febrile seizures rarely harm a child and don't predispose them to epilepsy. If they have one, keep them on the floor and away from sharp objects. Turn their head sideways so that their tongue doesn't obstruct their breathing. Call 911 if the febrile seizure lasts longer than five minutes.

If my child's fever rises above 106 F, can it cause brain damage?

Yes, a fever higher than 105.8 F can cause permanent injury, but a temperature this high is very rare. Plus, complications from the fever are almost never the result of illness alone. Brain damage from a high fever is most likely to occur if your child has heatstroke.

Key Takeaways

While a fever can make your child cranky or lethargic, having an above-normal temperature—or even fever hallucinations—is typically not dangerous for kids. In fact, having a fever is one way the body fights infection. Most kids can tolerate a fever of up to 105.8 F. However, it's recommended to check in with their doctor if their fever creeps up to or above 100.4 F for newborns, 101 F for babies 3 to 6 months, and 103 F for kids 6 months six months or older. If your child has a mild fever but shows other signs of distress like listlessness or trouble breathing, seek medical care right away.

Updated by Nicole Harris
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Sources
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  1. Beliefs, Practices, and Healthcare-Seeking Behavior of Parents Regarding Fever in Children. Medicinia (Kaunas). 2019.

  2. Fever in children: overview. Informed Health. 2022.

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