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.
ADDITIONAL THINGS TO KNOW ABOUT FEVERS:
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.
INCREASED RESPIRATIONS AND 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
