When is a fever cause for concern?

Fevers most common reason for ER visits

FORT LAUDERDALE, Fla. - As director of the pediatric emergency department at Broward General Medical Center, Dr. Francis Amador said the most common concern he sees among parents is a child with a fever.

"The most important thing to know is that the fever is a reaction to something; what is that something?" he said.

Amador said deciding whether to bring a child to the emergency room depends on a number of factors.

"First, we look at the age of the child," he said.

Infants 2 months old or younger with a rectal temperature of 100.5 should be taken to the hospital for a full evaluation.

"We will have to admit the child to run a battery of tests that can take up to three days," said Amador. "Ninety percent of the time, we don't find anything."

With infants and children over 6 months of age, heading to the ER depends on the presence of other symptoms.

"If the fever is accompanied by head and neck pain, it could be a sign of meningitis.  If there is abdominal pain with a fever, that could be an indication of appendicitis," said Amador.

If the child is becoming dehydrated, has difficulty breathing, has a headache that won't go away or develops a red or purple rash, Amador said parents should seek medical attention.

The best way to take a temperature is with a digital thermometer.  Doctors recommend this be done rectally for infants and young children.

"The tympanic thermometer, which is used in the ear, is not considered reliable outside the clinic setting.  Glass thermometers are also not optimum because they may break and can take several minutes to get a reading.  The digital thermometer gives an accurate reading in seconds," said Amador.

Children's doses of acetaminophen and ibuprofen can be used to reduce a mild fever, but doctors caution against using aspirin, even child doses.

Aspirin use in children under the age of 19 has been linked to liver and even brain damage.

Liver damage has also been reported with high doses of acetaminophen.  The makers of this medication recently reduced the infant and children's dose from highly concentrated to a less concentrated version. 

The newer medications have an oral syringe instead of a dropper to provide the correct dose.

Doctors also caution against the popular folk remedy of applying rubbing alcohol to the skin to reduce a fever.

"Alcohol can be dangerous to children," said Amador.

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