From the Guidelines
A low-grade fever in a child is typically considered to be a temperature between 99.5°F (37.5°C) and 100.9°F (38.3°C) and can be managed at home with hydration, rest, and acetaminophen or ibuprofen if necessary, as long as the child is not showing any concerning symptoms, according to the most recent guidelines 1.
Key Considerations
- The definition of fever varies, but a rectal temperature of greater than or equal to 38.0 C (100.4 F) is commonly used 1.
- The risk of serious bacterial infections (SBIs) in febrile children has decreased since the introduction of vaccines against Streptococcus pneumoniae and Haemophilus influenzae type b, but urinary tract infections are now the most common SBI in febrile infants younger than 24 months 1.
- The American Academy of Pediatrics recommends that febrile infants and young children (2–24 months of age) with no obvious neurologic or anatomic abnormalities be evaluated for urinary tract infections, which can be diagnosed with a urine culture obtained through urethral catheterization or suprapubic aspiration 1.
Management
- Ensure the child stays hydrated with plenty of fluids and gets adequate rest.
- If the child is uncomfortable, acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) can be given according to the package instructions based on the child's weight.
- Never give aspirin to children due to the risk of Reye's syndrome.
- Dress the child in light clothing and keep the room at a comfortable temperature.
When to Seek Medical Attention
- If the fever persists beyond 3 days.
- If the fever rises above 102.2°F (39°C).
- If the child shows signs of dehydration, extreme irritability, lethargy, or other concerning symptoms. It is essential to note that while the risk of SBIs has decreased, it is still crucial to monitor the child's condition and seek medical attention if any concerning symptoms develop.
From the Research
Definition of Low-Grade Fever
- Low-grade fever in children is typically defined as a temperature ranging from 38°C to 39°C (100.4°F to 102.2°F) 2
Treatment Options
- Alternating acetaminophen and ibuprofen may reduce the proportion of children with refractory fever, but its efficacy in reducing febrile distress is uncertain 3
- Combined paracetamol and ibuprofen therapy can result in a lower mean temperature at 1 hour after treatment compared to monotherapy alone 4, 5
- Alternating therapy may also result in a lower mean temperature at 1 hour after the second dose and fewer children remaining or becoming febrile for up to 3 hours after treatment 4, 5
Efficacy and Safety
- Dual therapy (alternating or combined) may be superior to single therapies for treating fever in children, with no significant differences in adverse events 6
- However, the evidence for improvements in measures of child discomfort remains inconclusive, and future research is needed to assess the safety and efficacy of combined and alternating antipyretic therapies 4, 6, 5
Guidelines and Recommendations
- Clinical practice guidelines for the symptomatic management of fever in children vary widely, and the level of evidence for most recommendations is low or indeterminable 2
- There is no recommendation on which all guidelines agree, and many are inconsistent with the evidence, highlighting the need for further research and standardized guidelines 2