My Kid is Sick! Now What? A Parent’s Guide to Fevers & Other Illnesses

My kid is sick! Now, what? We have all asked ourselves this very question. But do you really know what to do? We all worry about whether or not we are doing the right thing for our kids in general. This worry is likely multiplied times a hundred when they are under the weather. But does EVERY.SINGLE. sniffle, sneeze, and cough deserve a missed day of school (a.k.a. another missed day of work or schedule rearrangement)? Or better yet, does it warrant a trip to the doctor’s office?

The question is “when does sick really mean SICK?” Inquiring minds (those sleepless mommy and daddy minds) want need to know!

The start of the new school year is well under way with plenty of germs to spare. We are all hoping and praying that our kids will dodge that dreaded first illness. If luck is not on your side, it is important for us [parents] to know what to do for our children, others and ourselves (for our own sanity) to ensure that our kids get well and that we do not spread the more germs.

So I polled my fellow JMB moms asking what questions, worries, and concerns they may have when their kiddos are sick. With the help of Dr. Tracy Tyson of Orange Park Pediatrics and Wolfson Children’s Hospital, I have some answers to share! A “what to do when” reference guide for when our littles are affected by fever, respiratory symptoms, and/or dehydration.

Here is what Dr. Tyson advises:

Fever

What temperature is considered a fever?
Fever is defined as a temperature above 100.4 degrees Fahrenheit (F).

What is the best method of taking a temperature? Oral, ear, rectal, forehead, etc.
In infants less than two years, rectal temperature is the most accurate. Over two years of age, temporal artery measurement has been shown to be the most accurate, although oral and tympanic membrane (ear) can be accurate as well. 

My daughter Avery, having her temperature taken like a big girl.
My daughter, Avery, having her temperature taken like a big girl.

At what age can you safely and effectively switch to taking a temperature in the ear?
Over two years of age.

Other than medications, what other methods can be used to safely reduce fever?
Removing all clothing and blankets can decrease temperature, a warm bath can decrease a few degrees (cold bath is not necessary and can decrease body temperature too quickly). Cold compresses to groin, forehead and axilla (underarms) can decrease temperature a few degrees as well.

When should a fever reducer be administered?
Fever is the body’s natural defense against infection and should be treated only when the child appears uncomfortable, is above 101.5 degrees F, or to keep the child hydrated.

What medication is best to reduce fever?
Ibuprofen works best, as well as acetaminophen. Aspirin should not be given to children under 12 with a fever due to the risk of a lethal liver disease called Reye Syndrome.

At what temperature do I need to be worried?
Under two months of age, any temperature over 100.4 F should be evaluated immediately.

In older infants and children, the absolute number is not the most important factor. It is more important to know how the child appears and what other symptoms they may have. If the temperature is 104 F but reduces with Ibuprofen and the child is playing and well hydrated, and then it is less concerning than a child with 100.5 F who isn’t drinking, playing and is sleeping all day.

At what temperature do I call the doctor?
This depends on the age of a child.

Less than two months, any fever (100.4 F or greater), call your doctor immediately.

Between 2-6 months, any temperature greater than 100.4 F should be seen by your doctor within 24 hours but temperature greater than 101.5 F, you should call your doctor.

Over six months, typically if any temperature is greater than 102.5 F for more than 4 hours, call your doctor. There isn’t a magic number to immediately call at this age, more again how the child acts and if the temperature comes down with treatment. Immunizations have made higher temperatures less concerning over the last 15 years.

How long do I let a fever continue before calling the doctor?
4 hours

When is it safe to return to daycare, school, etc. after fever/illness? Is there a length of time to follow when child is considered not to be contagious?
24 hours after a fever has resolved; the contagiousness is significantly reduced. Most children are still slightly contagious for several days, but it depends on the illness. 24 hours is ok in most cases.

My sweet girl is not feeling well.
Being sick is not fun!

Respiratory Symptoms

What respiratory symptoms should I keep my child home for?
School age children should be kept home for a significant cough that disrupts the classroom or makes it difficult for the child to concentrate, or profuse green or yellow colored nasal congestion. Daycare or preschool age children should ideally be kept home for milder nasal congestion and cough to help prevent the spread of the virus through the school.

What symptoms warrant a doctor call or visit?
Any persistent cold symptoms greater than a week should be evaluated. Most viruses will resolve in 5-7 days so if the symptoms are not improving or if worsening, then see your doctor.
A barking, repetitive cough with any noisy breathing should be evaluated as well.
Cough followed by vomiting.
Difficulty breathing during any activities or at rest.

When is it ok to send my child to school, daycare, etc. when they are exhibiting respiratory symptoms such as cough, sniffles, runny nose, sneezing, wheezing, especially when they are otherwise feeling good?
It is always technically best, to prevent the spread of infection, to keep a child home during any times they might be contagious to others. This helps prevent the spread of infection throughout the school. This is, however, not practical for school age children. In a child over five who is otherwise feeling good, without fever or significant symptoms, sending to school is okay in most cases.

Dehydration

What are the signs and symptoms of dehydration?
Decreased urination, dry mouth, no tears and decreased activity are the easiest to notice.

Can it be treated safely at home? If yes, what are the recommendations?
Mild dehydration can be treated at home in most cases. If the child can keep fluids down, then give small amounts 15 ml or 3 teaspoons of electrolyte solution (Pedialyte, Gatorade or Powerade) every 20 minutes for 2-6 hours. If the child is not vomiting and begins to improve, you can continue at home.

When should we call the doctor?
If the child is not able to keep fluids down for more than 6 hours, hasn’t urinated in 12 hours, or is not playful and active then call your doctor. Younger infants are easier to get dehydrated, so we usually get concerned earlier.

A special thank you to Dr. Tracy Tyson for taking the time to answer our questions.  Please remember this is only meant to be used as a reference guide.  If you have any concerns, go with your gut and refer to your doctor.

Paula
Paula Brunt, who has spent the majority of her life in North Central Florida, found comfort with her husband Stefan and their two children, Avery (4 years) and Evan (9 months) here in Jacksonville. Paula’s career as a Pediatric Oncology Nurse at Nemours Children’s Clinic has recently been put on hold to enjoy the pleasures and embrace the challenges of being a stay at home mom. Raising her two toe-heads consists of plenty of excitement daily, but Paula still makes it a priority to begin her mornings with the ladies of Jacksonville Stroller Strength, where she is a student as well as an instructor. Aside from doing her best to live an active and healthy lifestyle, she enjoys time with friends rooting for the Gators, and “relaxing” at the beach with her family in tow. Family, friends, and good food bring a smile to Paula’s face, and she loves nothing more than bringing them all together!

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