Medications
Such as acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®) are often used to treat baby and infant fever. These medications can reduce the child’s discomfort and lower the child’s temperature by 2 to 3ºF (1 to 1.5º C). Aspirin is not recommended for children under age 18 years due to concerns that it can cause a rare but often lethal illness known as Reye syndrome.
Acetaminophen may be given every four to six hours as needed. If the temperature remains elevated despite acetaminophen and the child is greater than 6 months of age, ibuprofen may be given every six hours in place of acetaminophen. The dose of acetaminophen or ibuprofen should be calculated based upon the child’s weight.
Despite widespread use, neither acetaminophen nor ibuprofen is 100% safe. Combinations of acetaminophen and ibuprofen are even less safe than using either drug alone.
Acetaminophen can cause liver damage at larger than recommended doses (1). Acetaminophen is found in 300 products alone or in combination with other drugs, making inadvertent exposure to higher than recommended dose possible (2). Unsafe dose of acetaminophen is not too far off the safe dose. Children younger than10 years of age and especially small children, around the age of 2 are more likely to get unintentionally large doses of acetaminophen (2,3) for fever. In some cases unintentional acetaminophen induced liver damage can be sever enough to cause death, or require liver transplantation (3).
Ibuprofen is known to cause severe kidney toxicity even at regular doses (4,5). However, a single dose of ibuprofen can cause kidney failure, requiring dialysis (use of artificial kidney) (6). Ibuprofen can often cause in children serious gastrointestinal complications, including stomach bleeding, inflammation of the duodenum, ulcers of the stomach and esophagus (7). Stomach bleeding may occur even when children take regular doses of ibuprofen (8). Children taking ibuprofen have increased risk of developing potentially lethal type A streptococcal infection (flesh eating disease) (9).
Increase fluids
Fever can increase a child’s risk of becoming dehydrated. To reduce this risk, parents should encourage their child to drink adequate amount of fluids. Children with fever may not feel hungry and it is not necessary to force them to eat. However, fluids such as milk, formula, and water should be offered frequently. Older children may eat flavored gelatin, soup, or frozen popsicles. If the child is unwilling or unable to drink fluids for more than a few hours, the parent should consult the child’s healthcare provider.
Rest
Fever causes most children to feel tired and achy. During this time, parents should encourage their child to rest as much as the child wants. It is not necessary to force the child to sleep or rest if he or she begins to feel better. Children may return to school or other activities when the temperature has been normal for 24 hours.
Physical cooling
This therapy usually involves sponging, using a damp washcloth to apply comfortably warm (75-85ºF or 25-30ºC) water to the entire child’s body. Cooling occurs as water evaporates from the skin surface. Therefore, the child should not be wrapped in wet towels or submerged in water when this method of cooling is used. Comparing to adults, children have higher body surface area in relation to their body mass. This makes sponging in children much more effective than in adults. In fact, sponging in children can be as effective in fever reduction as anti-fever medications (10). Sponging can be combined with anti-fever medications for cumulative effect (11). Sponging children with diluted or undiluted rubbing (isopropyl) alcohol is contraindicated because rubbing alcohol may get absorbed through the child’s skin or lungs and cause serious toxicity. However application of diluted ethyl (drinking, or grain) alcohol to the skin is not know to cause the same problems.