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“You give me fever”! While it might have been a good song, fever can make anyone feel horrible. There are so many medications out on the market and in so many different forms; it can be very confusing and dangerous. Each year, overdoses of acetaminophen (sold as Tylenol and other brands) account for more than 56,000 emergency room visits and an estimated 458 deaths from acute liver failure, reports the March issue of the Harvard Women’s Health Watch. And according to a new study from the U.S. Acute Liver Failure Study Group, acetaminophen-related liver failure appears to be on the rise. With that being said, I use Tylenol as needed, I recommend it to my patients, and I give it to my children. Safety is the key. Correct dosing based on weight will be discussed later in this blog.

What Is Fever?

Fever, or pyrexia or controlled hyperthermia is when the human’s body temperature goes above the normal range of 36-37C (98-100F) – it is a common medical sign. As the individual’s body temperature goes up, there may be a sensation of cold until the temperature plateaus (stops rising).

An elevated body temperature (fever) is one of the ways our immune system attempts combat an infection. Fevers are even considered a good thing, as it is a sign that the immune system is working appropriately. Usually the rise in body temperature helps the individual resolve an infection. However, sometimes it may rise too high, in which case the fever can be serious and lead to seizures and other complications.

What Do I Do If Me or My Child Have Fever?

So should you treat a fever or let the fever run its course? Here’s help making the call.

Age

Temperature

What to do

Infants
Birth to 3 months 100.4 F (38 C) or higher taken rectally Call the PCP, even if your child doesn’t have any other signs or symptoms.
3 months to 23 months Up to 102 F (38.9 C) taken orally Encourage your child to rest and drink plenty of fluids. Medication isn’t needed. Call the PCP if your child seems unusually irritable, lethargic or uncomfortable.
3 months to 23 months Above 102 F (38.9 C) taken orally Give your child acetaminophen (Tylenol, others). If your child is age 6 months or older, ibuprofen (Advil, Motrin, others) is OK, too. Read the label carefully for proper dosage. Don’t give aspirin to anyone age 18 or younger. Call the PCP if the fever doesn’t respond to the medication or lasts longer than one day.
Children
2 years to 18 years Up to 102 F (38.9 C) taken orally Encourage your child to rest and drink plenty of fluids. Medication isn’t needed. Call the PCP if your child seems unusually irritable or lethargic or complains of significant discomfort.
2 years through 18 years Above 102 F (38.9 C) taken orally Give your child acetaminophen or ibuprofen. Read the label carefully for proper dosage. Don’t give aspirin to anyone age 18 or younger. Call the PCP if the fever doesn’t respond to the medication or lasts longer than three days.
Adults
Older than 18 years Up through 102 F (38.9 C) taken orally Rest and drink plenty of fluids. Medication isn’t needed. Call the PCP if the fever is accompanied by a severe headache, stiff neck, shortness of breath, or other unusual signs or symptoms.
Older than 18 years Above 102 F (38.9 C) taken orally If you’re uncomfortable, take acetaminophen, ibuprofen or aspirin. Read the label carefully for proper dosage. Call the PCP if the fever doesn’t respond to the medication, is consistently 103 F (39.4 C) or higher, or lasts longer than three days.

Temperature readings are different from different parts of the body (rectum, ear, mouth). Your child has a fever if her temperature is above:

  • Rectal 100.4° F (38.0° C)
  • Oral 99.5° F (37.5° C)
  • Axillary (armpit) 98.6° F (37.0° C)
  • Tympanic (ear) 100.0° F (37.8° C)

How Much Tylenol Do I Give or Take?

Do not give Tylenol for any infant less than 3 months. If your child develops fever under 3 months, take them to your nearest ER. Fever at this age requires lab work and usually a spinal tap. DO NOT try to treat this age!

For Children: If you give your child acetaminophen, read the product label carefully to determine the correct dose based on your child’s weight. If you don’t know your child’s current weight, you can use your child’s age to determine the dose.

Generally, doses can be repeated every four hours, but shouldn’t be given more than five times in 24 hours.

To reduce the risk of medication errors, manufacturers are in the process of changing the concentration of infant drops to match that of children’s liquid. As a result, the dosing directions for infant drops will change. Be aware that there might be a time when both the current and new concentrations of infant drops are available.

For Adults: For adults and children 12 years of age and older, the recommended dose of acetaminophen is 650 to 1000 mg every 4 to 6 hours as needed, not to exceed 4000 mg in 24 hours. For extended-release acetaminophen, the dose is 1300 mg every 8 hours as needed, not to exceed 3900 mg in 24 hours.

How Much Ibuprofen Can I Give or Take?

For Children: If you give your child ibuprofen, read the product label carefully to determine the correct dose based on your child’s weight. If you don’t know your child’s current weight, you can use your child’s age to determine the dose.

Generally, doses can be repeated every six to eight hours, but shouldn’t be given more than four times in 24 hours.

For Adults: The maximum amount of ibuprofen for adults is 800 milligrams per dose or 2400 mg per day (3 maximum doses). Use only the smallest amount of ibuprofen needed to get relief from your pain, swelling, or fever. Take ibuprofen with food or milk to lessen stomach upset.

It is often recommended to alternate Tylenol and Ibuprofen when your child is running fever. These two medications in combination do work well. Alternate each drug every 4 hours. That means if you give Tylenol at 1pm, then give Ibuprofen at 5pm, then give Tylenol at 9pm – DO NOT use either medication any sooner, even if the fever begins to rise again.

Natural Ways to Treat a Fever:

Tepid Baths – Lukewarm baths are a good way to bring down the fever. Do not allow the water to be too cool, which induces shivering. This can be very comforting.

Light Clothing and Blankets – You may want to cover up, but that may only make the fever rise more. Light clothing and light blankets will allow the fever to decrease naturally.

Encourage Fluids – Water is a good thing for children above the age of 1. Hydration is the key. Taking sips of water every few minutes will decrease the chance of dehydration that can occur with fever.

Rest – This may be easier said than done. But, when you are sick and running fever that is your body telling you to STOP. This is your chance to rest, so do it? You will feel better quicker, if you will simply rest.

When Is Fever An Emergency?

Call 911 if the person has any of the following symptoms:

  • Unresponsiveness
  • Wheezing or difficulty breathing
  • Lips turning blue
  • Fever combined with stiff neck and headache
  • Temperature above 105º F
  • Convulsions or seizures
  • Confusion or altered speech
  • Sudden onset of rash

Fever can be a very common signal of illness. If you are concerned about the fever contact your health care provider. That is what your health care provider is for.

Coming up next: Do I Need an Antibiotic? The age old question!

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