Fever—Child Care and Schools

What is fever?

Fever is an elevation of the normal body temperature. Fever is most commonly caused by the body's response to a viral or bacterial infection, but it can have causes other than infection, such as an inflammatory disorder, a reaction to a vaccine or medication, or cancer.

What is considered a fever?

For infants and children, a body temperature of 100.4 ?F (38.0 ?C) or higher that is measured at any site (axillary, oral, temporal/forehead, or rectal) is considered elevated. In infants and children 4 months of age and older, such temperature elevations do not always indicate a serious health problem. However, in infants younger than 4 months, a temperature above 100.4 ?F (38.0 ?C) may signal a potentially more serious underlying illness.

Devices to measure body temperatures include thermometers intended for use in the mouth, armpit, ear canal, rectum, or skin that overlies an artery next to the outside corner of the eye. To read more about how to take a child's temperature and the special issues associated with each method, go to www.healthychildren.org/English/health-issues/conditions/fever/Pages/How-to-Take-a-Childs-Temperature.aspx (available in English and Spanish). Note: Do not adjust the reading for the location in which the temperature was taken. Simply record the temperature and the location where it was taken.

Does fever mean a child is contagious?

• Children with fever are not always contagious. Noncontagious causes of fever include urinary tract infections, some skin infections, and causes unrelated to infections.

• The most common cause of fever is a viral upper respiratory infection (common cold), which is contagious but not particularly harmful to others. Some children may have only a fever without developing other symptoms, and the fever may resolve on its own.

• Many infections make children contagious before a fever develops or after it resolves, and other infections may not cause fever but still spread germs.

Is fever harmful to the child?

• No. Most (virtually all) fevers from infections are not harmful. However, very high body temperatures from heatstroke are harmful. Children should never be left unattended in a car because the temperature can rise quickly and cause heatstroke (hot, dry, red skin with lethargy), which can cause death. Exercising in excessively hot weather or in overheated indoor rooms can also be harmful.

• Children with fever are usually less active.

• Children with fever need to drink more fluid to avoid dehydration, as fever depletes body fluids.

• Some young children (younger than 6 years old) with fever may have a febrile seizure, which is a brief seizure (less than 15 minutes) that is not harmful, although it is frightening to witness. A child who has experienced their first seizure with fever should be evaluated by a pediatric health professional. Referral to a pediatric health professional is not needed only if the seizure fits a known pattern of a previously identified febrile seizure disorder for that child and the program staff members have been trained by a health professional about its management for that child.

• Fever is one way the body may respond to an infection. When fever develops, all the infection-fighting mechanisms tend to speed up and can help the body fight the infection. Children may have high elevations in body temperature and appear relatively well. Therefore, fever alone is not a reliable measure of the severity of illness; behavior is a better indicator. Children who appear to be moderately ill with a fever should be evaluated by a health professional.

What are the roles of the educator and the family?

• Measure a temperature only if a child is acting ill (ie, has a behavior change or new respiratory symptoms).

• If a child who is acting ill has a fever, notify the staff member designated by the early childhood education program or school for decision-making and action related to care of ill children and staff members. That person, in turn, should alert the parents/guardians to pick up the child.

• Treating the fever is not necessary unless the child is uncomfortable. Evidence suggests fever helps the body fight infection. Generally, there is no rush to reduce a child's temperature. Acetaminophen (eg, Tylenol) or ibuprofen (eg, Advil, Motrin) may be considered for comfort if the child feels ill; ibuprofen should be used only in children over 6 months of age. Aspirin should never be administered to children with fever because of the potential risk of Reye syndrome. Reye syndrome is a serious complication associated with the use of aspirin in someone infected with a viral illness.

• Any child receiving a medication should have a note from the child's health professional. The medication bottle should have the child's name and clear dosing instructions on it. If a child has a fever and behavior change and the requirement for a note and clearly labeled medication is met, the program can administer fever-reducing medication while waiting for parents/legal guardians to come pick up the child.

• There is no need to cool the child to try to bring down an elevated body temperature. A known exception is if the child's elevated temperature is not a fever due to infection but the result of exposure to extreme heat, often associated with vigorous exercise or an excessively hot environment (heat exhaustion or heatstroke); such instances are medical emergencies that require immediate first aid and urgent care by a health professional.

• Infants younger than 4 months with an unexplained fever should be evaluated by a pediatric health professional. Any infant younger than 2 months with a temperature of 100.4 ?F (38.0 ?C) or greater should get medical attention immediately—within an hour if possible. The fever is not harmful; however, the illness causing it may be serious in infants younger than 2 months.

Exclude from educational setting?

Only if

• Fever is noted in an infant younger than 2 months (60 days).

• Unexplained fever occurs in an infant who is younger than 4 months.

• Fever is associated with respiratory symptoms (cough, runny nose, sore throat).

• Fever is associated with behavior change or other signs of illness or conditions that require exclusion (see Conditions Requiring Temporary Exclusion in Chapter 4 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition).

• The child is unable to participate and staff members determine they cannot care for the child without compromising their ability to care for the health and safety of the other children in the group.

Note: Children excluded for fever do not need to see a pediatric health professional unless there are specific concerns as defined in the Signs and Symptoms Chart in Chapter 5 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition or in the Quick Reference Sheets in Chapter 6 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition.

Readmit to educational setting?

Yes, when all the following criteria are met:

• When exclusion criteria are resolved, the child is able to participate, and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group.

• Children with a respiratory illness who had fever may return when fever-free for 24 hours without fever-reducing medications and respiratory symptoms are improving.

• A visit to a pediatric health professional is not required after exclusion for fever.