Fever
(Excerpts from “Pediatrics” and “AAP News”)
Fever in a child is one of the most common symptoms managed by pediatricians and is a frequent cause of parental concern. Fever accounts for one-third of all presenting conditions in children. Fever, however, is not the primary illness, but is a physiological mechanism that has beneficial effects in fighting infection. Fever slows the growth and reproduction of viruses and bacteria, and enhances the body’s immune response. Most fevers are of short duration, are benign and may actually be protective. Fever, in and of itself, is not known to endanger a generally healthy child; in contrast, fever actually may be of benefit. Some studies have shown that fever actually helps the body recover more quickly from viral infections. The degree of fever does not always correlate with the severity of illness. In addition, there is no evidence that fever worsens the course of an illness or that it causes long-term neurological complications.
A normal temperature range is 97-100.4 degrees. Many parents give fever medications (Acetaminophen or Ibuprofen) even when there is minimal or no fever because they are concerned that the child must maintain a “normal” temperature. Approximately 50% of parents consider a temperature of less than 100.4 to be a fever and 25% of parent s would give medication for a temperature less than 100. The primary goal of treating a child with a fever should be to improve the child’s comfort rather than focusing on the normalization of the body temperature. The desire to improve the overall comfort of the febrile child should be balanced against the desire to simply lower the body temperature. Parents should focus on monitoring activity, observing for signs of serious illness and maintaining appropriate fluid intake to maintain hydration. Many physicians continue to encourage the use of antipyretics, believing that most benefits result from improved comfort and the accompanying improvements in activity and feeding, less irritability, and a more reliable sense of the child’s overall clinical condition. Sleeping children should not be awakened to take a temperature or to give fever medications. Treating with fever medication does not prevent febrile seizures.
Acetaminophen and ibuprofen, when used in appropriate doses, generally are regarded as safe and effective agents in most clinical situations. However, as with all drugs, they should be used judiciously to minimize the risk of adverse drug effects and toxicity. Studies provide some evidence that combination therapy may be more effective at lowering temperature. However, questions remain regarding the safety of this practice as well as the effectiveness at improving discomfort, the primary treatment endpoint. The possibility that parents will not receive or not understand dosing instructions, combined with the wide array of formulations that contain these drugs, increases the potential for inaccurate or overdosing.
There will soon be a change in the dosing of Acetaminophen to reduce the risk of dosing errors. There will no longer be an infant concentrated drop formulation. All of the Acetaminophen liquid will be 160mg per teaspoon.
Acetaminophen Dosing
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Children's Liquid |
160mg/teaspoon
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(e.g. Tylenol) |
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Weight (lb) |
9-11 lb |
12-17 lb |
18-22 lb |
22-28 lb |
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Dosage - every 4-6 hours as needed |
1.25ml |
2.5ml (1/2 tsp) |
3.75ml |
5ml (1tsp) |
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Weight (lb) |
29--34 lb |
35-40 lb |
41-46 lb |
47 lb |
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Dosage - every 4-6 hours as needed |
1.25 tsp |
1.5 tsp |
1.75 tsp |
2 tsp |
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Infant Drops
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50mg/1.25ml |
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(e.g. Motrin or Advil) |
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Weight (lb) |
12-17 lb |
18-22 lb |
22-28 lb |
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Dosage - every 6-8 hours as needed |
1.25ml |
1.875ml |
2.5ml |
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Children's Liquid
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100mg/5ml |
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(e.g. Motrin or Advil) |
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Weight (lb) |
22-28 lb |
29-33 lb |
34-38 lb |
39-43 lb |
44 lb |
Dosage - every 6-8 hours as needed |
1 tsp |
1.25 tsp |
1.5 tsp |
1.75 tsp |
2 tsp |
