When Does a Child's Fever Warrant a Doctor's Attention?

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Excellent child parenting can be difficult, especially when you are trying to make a decision about whether or not to take your kid to the pediatrician. As any parent knows, all kids get child fevers (typically the body's response to infection), but sometimes it's tough to know whether your child's fever requires you to visit a pediatrician. To help you make a well-informed decision to help you with your kid parenting skills, here are some invaluable pointers to consider.

You should take your child to the doctor or the emergency room if:

• He or she is less than 8 weeks old and has a temperature higher than 100.4 F.
• Your child is less than 3 months old and is not behaving as usual, is eating less, is more irritable, or has developed a skin rash or other concerning symptoms.
• Your child is between the ages of 3 months and 36 months and has a fever greater than 102.2 F. Doctors particularly worry about high temperatures in kids within this very young age range.

What to Expect
Once you get to the doctor, or the emergency room, what should you expect? There are no pat rules that doctors follow to evaluate and treat fevers, but here are some of the common procedures that routinely occur.

• For starters, when monitoring a fever, most physicians prefer using the rectal temperature as it most accurately reflects a child's core temperature. Armpit and oral temperature can be inaccurate.
• Blood and urine will be checked in a child younger than 4 weeks old. Often the doctor will order an X-ray and even a spinal tap to rule out the source of infection. After an emergency-room evaluation, the child will be admitted to the hospital for observation.
• Blood counts in children 4 weeks old to 3 months old will be checked to evaluate response to infection. The child then may be admitted to the hospital depending on whether he or she appears ill. Otherwise, a follow-up visit to the child's pediatrician is in order.
• If your child is older than 3 months, the doctor may suggest some tests to determine what's causing the fever. Some sources are fairly easy to pinpoint, including ear infections, throat/tonsil infections and even pneumonia.

When the source of the fever is unclear, the doctor will:

• Order a blood count to understand the extent of the infection.
• Evaluate urine in girls under the age of 1 (because they are more prone than boys to urine infections).
• Consider a chest X-ray to look for pneumonia, especially if the child is breathing fast or has low-oxygen saturation.
• Order a spinal tap to rule out infection around the brain.

It's important to remember that all children get fevers, but that most fevers are not dangerous. Most are viral infections that your child will recover from. As a parent, your best line of defense is to know your child, have a healthy level of concern and maintain good communication with your pediatrician.

Neal Sikka, M.D. is an emergency physician at George Washington University in Washington, D.C. He attended medical school at Washington University School of Medicine in St. Louis.