Ask Your Family Doctor

Developed by the College of Family Physicians of Canada

What is a normal temperature?

A normal temperature is about 37oC (98oF) when taken orally (by mouth). Temperatures taken rectally (by rectum) usually run 0.5oC higher than those taken orally. So a normal temperature is about 37.5oC (99.5oF) when taken rectally. But temperatures may vary during the day, even in healthy children. Many doctors define a fever as an oral temperature above 37.8oC (100oF) or a rectal temperature above 38.0oC (101oF) or an axillary (by ear) temperature above 37.2oC (99oF) (ear temperatures are not accurate in children under 6 months of age and often not recommended in children less than 1 to 2 years of age).

What's the best way to take my child's temperature?

You may think you can tell if your child has a fever by touching his or her forehead. It may alert you to a fever, but this isn't an accurate way to tell. Fever strips, which are placed on the child's forehead, are also not accurate.

The best ways to take your child's temperature are orally, rectally, by placing the bulb of the thermometer under the arm (axillary temperature) or using an ear thermometer. For children under 2, you can check by doing an axillary temperature and do a rectal temperature if there is a fever, in order to get an accurate measurement.

Here are some tips on taking your child's temperature:

	If you are using a mercury thermometer, the mercury of the thermometer should be below 35oC (95oF) before taking a temperature. You can run cool water over the thermometer to lower the reading. Some thermometers must be shaken to lower the reading.
	Don't bundle your baby or child up too tightly before taking the temperature.
	Never leave your child alone while taking the temperature.
	Be sure you use the right thermometer. Rectal thermometers are thicker than oral thermometers (the bulb is fatter). Digital thermometers are usually used in the mouth or under the arm.
	If you're taking your child's temperature orally, place the end of the thermometer under the tongue and leave it there for two minutes. Don't let your child bite on the thermometer. The child must be old enough to cooperate and often this method is used in children over 4 to 5 years of age. Digital thermometers may beep when they are ready to be read.
	If you're taking your child's temperature rectally, coat the tip of the thermometer with petroleum jelly (Vaseline) and insert it half an inch into the rectum. Hold the thermometer still for two minutes. Never let go of the thermometer. This method often works best with infants. Some doctors prefer the axillary method for safety reasons.
	Axillary temperatures are not always accurate but this is a safe way to take the temperature of toddlers and children under 4 years of age. Place the bulb of a glass thermometer in the child's armpit and hold the arm against the child's body so that the bulb is covered. Keep the bulb in place for at least 3 minutes.
	Ear temperatures - Uses a special thermometer that quickly takes the temperature from the eardrum (tympanic membrane). These are not accurate in infants and the machines can be expensive.
	After you're done using the thermometer, wash it in cool, soapy water or according to the manufacturer's directions.

When should I try to lower my child's fever?

In older children, fevers are more frightening than they are harmful. They're usually just a sign that the body is fighting an infection. The main reason to treat your child is to make him or her feel better. When your child is achy and fussy, you may want to give him or her some medicine to bring down the fever.
Fevers often run from 38o to 40oC and usually are a result of viral illnesses lasting just a couple of days.

How much medicine is needed to lower a fever?

Acetaminophen and ibuprofen are medicines that relieve pain and lower fever. (Some examples are Tylenol, Tempra, Panadol and Advil and Motrin BI). In small children, ibuprofen may have more side effects.

How much medicine children need depends on their weight and age. When the age and weight categories in the chart don't match, use the weight of you child as the main guide in figuring out how much acetaminophen or ibuprofen to give.

These doses may be a little higher than what is on the medicine package. If you have any questions about the right dose, ask your family doctor. Usually (Tylenol) acetaminophen is recommended using a chart for dosing:

There is no benefit of using both acetaminophen and ibuprofen or of alternating these drugs.

Tips on giving medicine

	Don't give more than five doses in one day.
	Don't give a baby younger than four months old any medicine unless your family doctor tells you to.
	Read labels carefully. Acetaminophen comes in different forms: drops, liquid elixir, chewable tablets and caplets. Each form is a different strength.
	Don't replace the drops with elixir because the drops are stronger.
	Fill the dropper to the line when using drops.
	For liquid elixir, use a liquid measuring device to make sure you give the right dose. Get one at your drug store or ask your pharmacist.

Why not use aspirin to lower my child's fever?

Aspirin can cause Reye's syndrome in children who have the flu or the chickenpox. Reye's syndrome is a serious illness that can lead to death. Because it may be hard to tell if your child has one of these infections, it's best not to use aspirin unless your family doctor says it's okay. Acetaminophen and ibuprofen are safer choices to use in children with a fever.

Are there other ways to help my child feel better?

Yes. Here are a few:

	Give your child plenty to drink to prevent dehydration (not enough fluid in the body) and help the body cool itself.
	Keep your child quiet. Moving around can raise the temperature even more.
	Keep the room temperature at about 21oC (70 oF) to 23 oC (74 oF).
	Dress your child in light cotton pajamas so that body heat can escape. Don't over bundle your child.
	If your child is chilled, put on an extra blanket but remove it when the chills stop.

Will a bath help lower my child's fever?

Used together, acetaminophen or ibuprofen and a lukewarm bath may help lower a fever. Give the medicine before the bath. If the bath is given alone, your child may start shivering as his or her body tries to raise its temperature again. This may make your child feel worse.

Your doctor may suggest giving your baby a sponge bath after giving acetaminophen if the fever reaches 39oC (103oF) or if your baby or child has ever had a seizure during a fever. In a few children, seizures can be caused by a fast rise in temperature.

Don't use alcohol for baths because it can be absorbed through the skin. Also, don't use cold water because it can cause shivering.

When should I call the doctor?

A saying doctors use is, "Don't treat the thermometer, treat the child". This means that your child's behaviour is more important than the number on the thermometer. You can follow the guidelines below to help decide when to call your doctor, but it's important to call your doctor whenever you feel that your child needs help or if you have any questions.

	Under one month old. Call your family doctor right away if your baby's temperature goes over 38.5oC (101.3oF) rectally, even if he or she doesn't seem sick. Your doctor may want to see your baby and may want to put him or her in the hospital to find out what's causing the fever. Babies this young can get very sick, very quickly. Also call your doctor if your baby has any of the warning signs listed below, even if he or she isn't running a fever.
	One to three months old. Call your doctor if your baby has a temperature of 38.5oC (101.4oF) even if your baby doesn't seem sick, or a temperature of 38oC (100.4oF) that has lasted more than 24 hours. Also, call if your baby has any of the warning signs listed below.
	Three months to two years. If your child has a fever of 38.6oC (101.4oF), watch how he or she acts. Call the doctor if the fever rises or lasts for more than three days, or if your child has any of the warning signs listed below. If the temperature is 39oC (103oF), call your doctor even if your child seems to feel fine.
	Over two years old. If your child has a fever of 38.6oC (101.4oF), watch how he or she acts. Call the doctor if the fever rises or lasts more than three days, or if your child has any of the warning signs listed below.

Call your doctor if your child has any of these warning signs:

	Changes in behaviour
	Severe headache
	Constant vomiting or diarrhea
	Skin rashvDry mouth
	Sore throat that doesn't improve
	Earache that doesn't improve
	Stiff neck
	Fever comes and goes over several days
	Stomach pain
	High-pitched crying
	Swelling on the soft spot on the head
	Irritable
	Unresponsive or limp
	Not hungry
	Wheezing or problems breathing
	Pale
	Whimpering

What about immunization?

Immunization is your best prevention. H. Influenza vaccine has helped to lower serious bacterial infections in children. Pneumococcal vaccine is now also available for infants, which will help to lessen even more the risk of serious bacterial infections in young children.

Revised 2007 The College of Family Physicians of Canada

This information provides a general overview on this topic and may not apply to everyone. To find out if this information applies to you and to get more information on this subject, talk to your family doctor. This health education material has been favorably reviewed by the Patient Education Review Committee of the College of Family Physicians of Canada: Dr Cathy MacLean, Halifax, NS (Scientific Editor) Dr C. Richard Fischer, Pickering, ON Dr Patrice Laplante, Fleurimont, QC Dr Richard Moffatt, Red Deer, AB Dr David Nunn, Kentville, NS Dr Cornelius Woelk, Winkler, MB The College of Family Physicians of Canada, one of the nation's largest medical groups, is committed to promoting and maintaining high standards for family physicians - the doctors who provide ongoing, comprehensive care for people of all ages. This patient education information was developed by The College of Family Physicians of Canada in cooperation with the American Academy of Family Physicians.

Support for this program has been provided by an educational grant to the Research and Education Foundation by Scotiabank.