High fevers in kids seem scarier than they usually are

The call came in around midnight. A 5-year-old had a 102 degree fever, and the father wanted to know whether he needed to rush his son to the nearest emergency department. I knew from the panic in the dad's voice that the little boy was experiencing his first significant fever.

Parents with older kids have already dealt with a wide variety of childhood infections and, as a group, tend to be a little more laid-back when it comes to fevers. These moms and dads show up three or four days into an illness, explaining, "Well, he's had a 103 fever, but he's been looking pretty good, and I figured he'd get over it on his own."

Fevers can make kids and parents uncomfortable, but they are merely symptoms of infection, not diseases in and of themselves. While a high temperature can signal the presence of a significant illness, other factors help distinguish true disease severity.

When a parent calls to report that a child has a fever, it's also helpful to know how long it's lasted and whether the fever is increasing or decreasing. Other important information includes how alert the child is, whether he's eating or drinking, if the illness includes vomiting or diarrhea, or whether the child has a rash. Illnesses among family members or classmates can also give clues to what a sick child has been exposed to.

When your child comes down with a fever, start jotting down a few notes on a sheet of paper. If you don't and the illness lasts a few days, you'll find that the details quickly blur together. Tracking temperatures as well as the timing of fever reducers helps keep you from inadvertently overdosing your child and keeps your thoughts organized in case you need to seek medical care.

For children younger than 3, the American Academy of Pediatrics generally advises taking temperatures rectally to get a more accurate reading. Older children are unlikely to cooperate with rectal temperature taking, so using a thermometer in the mouth or under the arm are acceptable alternatives.

Ear thermometers can be used in these older kids, but results are very dependent on factors such as the presence of earwax and proper positioning of the device in the child's ear. Remember that these days, mercury thermometers should not even be in the household as mercury is considered an environmental toxin.

Though high fevers can be scary, experts at the National Institutes of Health stress that they actually serve a function in combating illness. A rise in body temperature helps kick a child's immune system into high gear to help fight off infection. Don't get hung up on the notion that a high temperature must be driven all the way down to normal. The real goal is to lower a child's temperature to keep him comfortable while he's sick.

That being said, if your child has a fever and you don't like the way the illness is progressing, put in a call to the doctor. Even when your sick child looks reasonably good, contact the pediatrician if you have an infant less than 3 months old with a rectal temperature of 100.2 or higher, or if you have a child of any age with a fever higher than 105 degrees.

As fevers are signs of infectious illness, children with rectal temperatures over 100.5 are considered contagious to others and should not attend school. A good rule of thumb is that a child should be fever-free for 24 hours before returning to the classroom. (And, no, it doesn't count if he's fever-free with the help of Tylenol or Motrin!)