Is My Kid’s Fever Normal? How to Know if a Fever is Okay or the Sign of a Bigger Problem

metro health fevers in children sick girl

Use This Guide From a Pediatrician When You’re Trying to Decipher a Fever

Just the mention of the word “fever” has people on high alert these days. With fever being a main symptom of COVID-19, many of us are paying close attention to how we feel and regularly checking our temperatures. 

Doctors are finding that more parents are concerned about mild illnesses associated with fever because they’re worried it could be the coronavirus. 

A COVID-19 test creates a ripple effect of consequences: the child has to stay home from daycare, a parent has to stay home from work, siblings have to cancel activities and the entire family has to quarantine until test results come in.

But before we panic about fevers, Metro Health – University of Michigan Health pediatrician Caitlin Mlynarek, DO, has helpful advice. 

Having a fever isn’t necessarily a bad thing,” shares Dr. Mlynarek. “Fever is an integral part of the body’s inflammatory response and, as such, may have a role in fighting infection. Fever can stop the growth and reproduction of some bacteria and viruses and enhance immunologic function.”

I’ve told my kids this so many times. If the thermometer says “red” they begin to panic (raising their temperature even more!) and I have to reassure them that this means that their body is strong and it’s fighting off the bad guys. 

But while children don’t need to worry about their fever, caregivers need to know when to seek medical attention for a raging fever. 


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Signs Your Fever is “Normal”


Most of us have heard that a normal adult body temperature is considered to be 98.6°F. But what you might not know is that infants and young children generally have higher temperatures than older children and adults. 

“This is related to the greater surface-area-to-body-weight ratio and the higher metabolic rate of infants and small children,” Dr. Mlynarek explains.

After having my third baby, I finally realized that a fever doesn’t mean the same thing for every child. Now I know that a fever accompanied by other symptoms is usually the sign of trouble. 

My oldest actually gets cooler when she’s really sick while my middle kid runs a temp nearly every day for no major reason. It’s helpful to have a baseline temperature when considering each child’s health, though. 

Dr. Mlynarek’s helpful guide for what is considered a true fever in children of all ages:

  • Rectal temperature greater than or equal to 100.4°
  • Oral or pacifier temperature of 100° or higher
  • Axillary (armpit) temperature of 99° or higher

The best ways to check body temperature for different age groups, according to Dr. Mlynarek is as follows:

  • Neonates and infants 0-3 months: rectal temperature
  • Older infants and children up until age 4: ear or armpit temperature
  • Children older than 5: oral temperature

Dr. Mlynarek says if your child has a fever, but doesn’t show signs of dehydration, respiratory distress, neck stiffness or altered mental status, it can be easily managed at home and isn’t cause for concern.  

“Acetaminophen and ibuprofen can be used as fever-reducing medications if the child appears uncomfortable and has decreased activity level,” Dr. Mlynarek recommends.

 “Acetaminophen can be used in children older than three months and ibuprofen in children older than six months. Other management options include a cool bath or cool washcloth on the child’s forehead.”

My middle kid regularly runs a high temperature is she’s having anxiety or mild allergies, but since there are no other symptoms, if her temp stays below 101, we care for her at home.  I used to freak out every time this happened, which became exhausting: there was nothing I could ever do about it, and it always resolved itself on its own. 


Signs Your Fever Could be Indicating Danger  


There are certainly situations when a fever is signaling a serious problem. In these cases, parents should take action. 

“If your child has a fever and is limp, weak, unresponsive, has severe difficulty breathing or has a rash with purple or blue-colored spots or dots, call 911 immediately,” Dr. Mlynarek stresses. 

She strongly suggests newborns less than four weeks old who have a rectal temperature of 100.4 or higher should be taken to the emergency department. Parents should also go to the emergency room if their child is less than a year old with a combination of fever and sickle cell disease, confusion, altered mental status, seizure or weakened immune system.

There is a whole host of additional symptoms associated with fever that warrant a conversation with your child’s pediatrician.

  • Child cries when they are touched
  • Shaking/chills
  • Sustained/frequent crying
  • Won’t move an arm or leg
  • Difficulty breathing/nasal congestion
  • Tugging at ears
  • Pain with urination
  • Signs of dehydration
  • Fever for more than three days
  • Barky cough
  • Productive cough
  • Sore throat
  • Abdominal pain


A Fever of 104+ Doesn’t Mean Brain Damage

Dr. Mlynarek says many parents believe that a fever of 104°F or more is life threatening or can lead to long-term brain damage. 

“There is no evidence to suggest that a fever like that is associated with increased risk of an adverse outcome, although this belief is held by many caregivers and clinicians.”

I admit that I have this notion stuck in my brain, so when my three year old started registering 104 and 105 on the thermometer, I became alarmed. “Shouldn’t I be taking her to the hospital??” I wondered. Thankfully, it was 1 AM and I opted to lie in bed with her and wait till morning if her symptoms didn’t worsen. Her fever broke a few hours later and there were no long term effects of that illness.

Fevers Don’t Automatically Require Antibiotics

Another misconception is that when a child has a fever, they must have an infection that requires antibiotics. But many times, fevers in children are the result of viral infections, not bacterial.

Fever in a Normal Acting Child is not Immediate Cause for Alarm

Additionally, Dr. Mlynarek says the fever questions parents ask the most center around fever management and concerns that if their child’s fever isn’t going down, there must be a problem. 

“The biggest thing I tell parents is that a fever is a normal, healthy immune response and the fever only needs to be treated if the child is uncomfortable and isn’t able to stay hydrated. You do not need to wake your child up to give them medication if they are sleeping comfortably. I usually recommend alternating between acetaminophen and ibuprofen to provide consistent fever control throughout the day.” 

 “If you ever have questions about your child’s health, don’t be afraid to reach out to his or her pediatrician,” Dr. Mlynarek concludes. 

“Fevers can affect children in different ways for various reasons. For a normal, healthy child, a fever may have little or no consequences. But for children with pulmonary or cardiac abnormalities, the increased demands fever puts on the body can be detrimental and offset any immunologic benefit. 

“It’s best to consult your child’s doctor to find out what’s normal or potentially harmful to them.”

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