Fever over 3 months

Fever Over 3 Months 


**If patient has additional symptoms with fever use protocol that addresses other symptoms** 

Reassurance and Education 

    - Having a fever means your child has a new infection. 

    - It's most likely caused by a virus. 

    - Most fevers are good for sick children. They help the body fight infection. 

    - The goal of fever therapy is to bring the fever down to a comfortable level. 


Expected Course of Fever 

    - Most fevers associated with viral illnesses fluctuate between 101 - 104 F (38.3 - 40 C). 

    - They last for 2 or 3 days. 


Fever Level and What It Means 

    - 100-102F (37.8- 39C) Low grade fevers: Beneficial, desirable range. Don't treat. 

    - 102-104F (39- 40C) Moderate fevers: Still beneficial. Treat if causes discomfort. 

    - 104-105F (40- 40.6C) High fevers: Always treat. Some patients need to be seen. 

    - Over 105F (40.6C) Less than 1% of fevers go above 105F (40.6C). All these patients need to be examined because of 20% risk for bacterial infections as the cause. 


Fever Medicine 

    - Fevers only need to be treated if they cause discomfort. That usually means fevers over 102 or 103 F (39 or 39.4 C). 

    - Give acetaminophen (e.g., Tylenol) every 4 hours or ibuprofen (e.g., Advil) every 6 hours as needed  

    - Remember, fever medicine usually lowers fever 2-3 degrees F (1- 1 1/2 degrees C). It takes 1 to 2 hours to see the effect. 


* Sponging with Lukewarm Water 

Note to Triager: discuss only if caller brings up this topic. 

    - An option for fevers above 104 F (40 C) but rarely needed. 

    - Indication: [1] Fever above 104 F (40 C) AND [2] doesn't come down with acetaminophen or ibuprofen AND [3] causes discomfort. 

    - Always give the fever medicine at least 1 hour to work before sponging. 

    - How to sponge: Use lukewarm water (85-90 F). Sponge for 20-30 minutes. 

    - Caution: Do not use rubbing alcohol (Reason: prolonged exposure can cause confusion or coma) 

    - If your child shivers or becomes cold, stop sponging or increase the temperature of the water. 




  • Tactile Fevers (also called "subjective" fevers): Tactile fever means the child "feels hot" and the temperature hasn't been measured. This is the least reliable way to detect fever. 

  • If a thermometer is not available and the child is 3 months or older, accept a tactile fever as evidence for the presence of fever. About 80% of children with tactile fever have an actual fever when measured (Graneto, 1996). 

  • If the presence of fever is the only indication for being seen (such as lasting over 3 days), strongly encourage the caller to measure the temperature and call back. 

  • Caution: If another symptom is present, see that guideline (e.g., cough, runny nose, sore throat, earache, abdominal pain, diarrhea, vomiting) (Exception: Crying as only other symptom) 

  • Not Due to Teething. Teething does not cause fevers. 



  • Although high fevers can cause small increases in RR, there is no reliable conversion factor. 

  • RR Assessment: RR is difficult to assess over the phone. Caller reports of "fast breathing" are also unreliable unless measured. 

  • Nurse judgment exception: If the fever is above 103 F (39.5 C) and the RR is slightly increased above abnormal (and not associated with any increased work of breathing or trouble feeding), a nurse may elect to provide a follow-up call in 1 hour. During that time, the caller will be instructed on how to lower the fever and how to better count the RR. Again, if in doubt or if time-consuming, refer the patient in for an exam and pulse oxygen saturation check. 


The following RR are abnormally fast: 

  • 2 months or younger: > 60 breaths per minute 

  • 2 to 12 months: > 50 breaths per minute 

  • 1 to 5 years: > 40 breaths per minute 

  • 6 to 11 years: > 30 breaths per minute 

  • 12 years or older: > 20 breaths per minute 



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