My Child Has a Fever: When Should I Worry?

Taking a child's temperature

In the times of COVID-19, it’s easy to forget that fevers are a normal part of childhood. If your child has a fever, remember these four words to help you know when to seek medical care: LOOK, LISTEN, ASK and HYDRATE.

LOOK: Does Your Child Appear Stressed When Breathing?

Is your child having trouble breathing? All kids will breathe a little bit faster than their typical baseline when they have a high fever. You want to see how much effort they are putting into breathing. Comfortable, slightly faster breathing is OK and your child can be observed at home. Very rapid (over 50 breaths per minute that persists) breathing, or persistent expanding of their chest or belly in an exaggerated way for more than a minute or two, is concerning. It’s about how stressed your child looks while breathing. 

LISTEN To Your Child’s Breathing

Is your child making any consistent noises or gasping sounds when they inhale or exhale? Is their cry nice and strong, or weaker and more hoarse than usual? Noisy breathing, or a change in their cry, is concerning in the context of increased breathing effort. Persisting respiratory distress is a reason to call your physician.

ASK a Question to Gauge Lethargy

Ask older kids a question. If they can answer it appropriately, they are alert. In younger, pre-verbal kids, try to have them engage in a toy or book that they like. If they respond appropriately, they are alert. They may appear fatigued and have low energy, but are not at a concerning level of true lethargy until they struggle to wake up and cannot maintain any coherent conversation or response because they are falling back to sleep. True lethargy is a reason to call your physician right away.

HYDRATE: The Most Important Way to Get Through Illness with Fever

Giving your child water is the most important way to help them through an illness with fever. Your child will feel better overall if well-hydrated. Babies younger than six months should be hydrated only with formula or breastmilk, never with pure water. An inability to maintain hydration and a decrease in urine output are reasons to contact your doctor for evaluation.

You’ll notice that medicating a fever is not on the list. A fever does not need to be treated. We often treat fevers not to protect the body from the heat, but to make the child feel a bit better and thereby be more willing to drink water and stay hydrated. The aim during a fever is hydration and comfort for your child. 

All fevers lasting five consecutive days should be evaluated by a physician in the office and will likely require additional testing.

author name

Joan B. Thode, MD

Joan B. Thode, MD, FAAP, is a pediatrician with LG Health Physicians Roseville Pediatrics.

Education: Undergraduate–Franklin & Marshall College; Medical School–George Washington University School of Medicine and Health Sciences, Residency–NYU Langone Medical Center.

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The LG Health Hub features breaking medical news and straightforward advice to help individuals of all ages make healthy choices and reach their wellness goals. The blog puts articles by trusted Lancaster General Health clinical experts, good 'n healthy recipes, videos, patient stories, and health risk assessments at your fingertips.


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