UMEM Educational Pearls

Title: Pediatric Fever

Posted: 12/1/2018 by Rose Chasm, MD (Updated: 11/13/2024)
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As we enter cold and flu season, expect to see rising visits for pediatric patients with fever. There is much evidence based literature regarding pediatric fever, but wives tales and misinformation persist.

No matter what the school nurse says, only a temperature >/= 100.4 F or 38 C is a fever.
Routine use of rectal and oral routes to measure temperature are not required to document a fever in children.
Use of electronic thermometers in the axilla is acceptable even in children under 5 years
Forehead chemical thermometers are unreliable.
Reported parental perception of fever should be considered valid and taken seriously.
Measure heart rate, respiratory rate, and capillary refill as part of the assessment of a child with fever.
Heart rate typically increases by 10, and respiratory rate increases by 7 for each 1 C temperature increase.
If the heart rate or capillary refill is abnormal in a child with fever, measure blood pressure.
Do not use height of temperature to identify serious illness.
Do not use duration of fever to predict serious illness.
Tepid sponging/bathing, underessing, and over-wrapping are not recommended in fever.
Do not give acetaminophen and ibuprofen simultaneously.

References

Davies, P., and I. Maconochie. “The relationship between body temperature, heart rate and respiratory rate in children.” Emergency Medicine Journal 26.9 (2009): 641-643.

Daymont, Carrie, Christopher P. Bonafide, and Patrick W. Brady. “Heart Rates in Hospitalized Children by Age and Body Temperature.” Pediatrics 135.5 (2015): e1173-e1181.d

The National Institute for Health and Care Excellence. Pediatric Fever Guidelines, 2007 and 2013