UMEM Educational Pearls

Category: Pediatrics

Title: Pediatric Fever

Posted: 12/1/2018 by Rose Chasm, MD (Updated: 6/17/2024)
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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.


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