A runny nose or mild cough probably doesn't worry you much — as a parent, minor cold symptoms can be common. But a sick baby or toddler with a fever will probably kick your concern up by at least a few notches.
Fever is one of the most common reasons why parents of babies or toddlers reach out to their pediatricians. But take heart: Even though fevers can make your little one uncomfortable, they aren't usually harmful and don't make an illness worse.
Better still? A fever is likely a sign that your child's body is hard at work fighting off the infection that's ailing her. And since fevers are most often triggered by viruses, they'll usually run their course all on their own.
In the meantime, your job is to help your child feel comfortable and watch for a temperature or other symptoms that warrant a call to the doctor. Here's what to do when your baby or toddler has a fever, what counts as high fever in babies and when to seek medical attention.
What causes fever in babies and toddlers?
A number of different things can trigger your baby or toddler's temperature, and not all of them are related to illness. The most common causes of infant fever include:
- A cold, flu or ear infection
- Vaccinations, which can sometimes trigger fever as a side effect
- Teething, which can cause a slight rise in body temperature, but not usually above 100 degrees Fahrenheit
- A more serious infection, like COVID-19, pneumonia or scarlet fever
While any of these conditions can be worrisome to a parent, keep in mind that the fever itself indicates that your child's immune system is working to keep her healthy.
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According to the American Academy of Pediatrics (AAP), most fevers are relatively brief and harmless. They're usually a positive sign that she's fighting an infection.
What's more, the severity of a fever doesn't always correlate with the severity of the cause, so it's important to try to determine that underlying cause while managing any discomfort.
What is considered a fever for a baby?
Though your fever alarm might go off as soon as your little one's temperature hits 98.7 degrees Fahrenheit, from a pediatrician's perspective, a child has a fever if a rectal reading is 100.4 degrees F or higher, or if an oral reading is 99 degrees F or higher.
Under normal circumstances, you don't need to call the doctor right away about a fever, though these days, your pediatrician will probably want to test your child for COVID-19 just to rule it out.
Keep in mind that these guidelines are only appropriate for children who are up-to-date on their vaccinations. Babies and toddlers who have fevers and are not vaccinated are more susceptible to certain illnesses, and would therefore need to be seen by their pediatrician more urgently.
When should you seek help for a baby or toddler's fever?
Usually a fever is nothing to worry about, especially if your child only has a mild fever: under 100.4 degrees F in infants under 3 months old or under 101.5 degrees F in older babies. That said, your pediatrician will probably recommend that you get your child tested for COVID-19 at any age if she has a temp of 100.4 or higher.
Also be on the lookout for any additional signs of physical pain or distress accompanied by fever that could indicate a more serious condition. You should pay attention, too, to a fever that doesn't seem to be easing up.
Unless otherwise specified, temperatures given here are for rectal readings.
Call 911 if:
- Your child has trouble breathing, is breathing rapidly or is wheezing.
- Your child's lips, tongue or nails are blue.
- Your child is limp or unresponsive.
- Your child is drooling excessively and has trouble breathing or swallowing.
- Your child breaks out in purple, bruise-like spots.
- Your child is having a seizure.
Call the doctor right away if:
- Your baby under 3 months old is running a fever of 100.4 degrees F or higher. (Go to the ER if your baby is less than 30 days old and has a fever of 100.4 or greater.)
- Your child is fussing or crying inconsolably.
- Your child is unusually drowsy.
- Your child shows any signs of dehydration, including fewer wet diapers, not taking in or keeping down liquids, a dry mouth, crying without tears or a sunken soft spot (in babies).
- Your child has other severe symptoms like a stiff neck, painful sore throat, ear pain, a rash, severe belly pain, vomiting or diarrhea.
- Your child has blood in her urine, stool or phlegm, or blood is leaking from her ears.
- Your child has a fever and an underlying health condition. (The doctor may have told you to call right away with fevers.)
- You suspect there is something wrong that isn't on any checklist. A parent's intuition is often right in these cases.
Call the doctor within 24 hours if:
- It seems like your child is getting worse instead of better.
- Your child is still acting sick or unusual (she's crankier, sleepier or less interested in eating) even after her fever drops.
- Your child has any other symptoms that you feel warrant a call — like a cough that's disrupting her sleep
- Your child still seems weak or lethargic even after the temperature has gone down.
Because girls have a higher risk of contracting urinary tract infections (UTIs), you should also call the doctor if your daughter has a fever for more than 72 hours if there are no other obvious cold symptoms. Boys can get UTIs as well, so get your son's prolonged fever evaluated too.
You can talk with the pediatrician about your child's other symptoms, along with her overall behavior and energy level, to figure out if you're dealing with a minor illness or if she needs to come in for a visit.
How to take your baby or toddler's temperature
You can probably sense whether your sweetie has a fever just by putting your hand on her forehead or seeing the flush on her face.
But the only way to get a reliable reading — and determine whether the fever alone warrants a call to the doctor — is by taking her temperature with a thermometer.
Rectal readings with a digital thermometer are the most accurate option for babies and toddlers. There are ways to make it more comfortable for your baby, like lubricating the tip with petroleum jelly.
As for non-rectal readings? Forehead can be another accurate option for babies over 3 months. Ear thermometers can be useful for babies over 6 months, but they can be harder to insert when you're dealing with a wiggly baby, and earwax buildup could affect the reading.
You won't be able to get an accurate temperature orally until your child can keep the thermometer under her tongue with her lips closed, a milestone she'll likely reach between ages 3 and 5. Under-the-arm readings are considered the least reliable of all.
Because forehead and ear thermometers can be inconsistent, you may want to take two or three readings.
What are the symptoms of a fever in babies?
A rectal temperature above 100.4 degrees F is generally accepted as a sign or symptom of fever in children.[1] Oral temps over 99 degrees F are also considered a fever, but they're generally unreliable in kids under 3 to 5, who are too young to hold a thermometer under their tongue.
Fevers are often accompanied by a flushed face, sweaty skin and excess thirst, as well as symptoms of whatever is causing the fever. For example, if your little one spiked a fever and is pulling on her ear, chances are she's fighting an ear infection.
How can you bring down your baby’s fever at home?
Start by taking measures to keep your little one comfortable and hydrated. You don't necessarily have to give medicine at the first sign of a fever (and you should never give fever-reducing meds to babies under 3 months old).
Some tried-and-true tips that help bring down your baby's fever:
- Offer plenty of fluids. Feverish babies and kids sweat, losing lots of water. Make sure your little one stays well hydrated by offering extra feedings to infants. For toddlers, water, diluted juice, soup, ice pops and store-bought electrolyte solutions (such as Pedialyte) are all good choices.
- Keep her cool. If your little one is running hot, chances are she's sweaty, red and feeling cranky. Dress her lightly and, if she's still warm, turn on a fan or air conditioner to make her more comfortable.[2]
- Slow it down. Even if your feverish baby or child wants to play, activity can make her feel even warmer. Encourage her to slow down to keep her body temperature in check.
- Feed the fever. It's an old cliché, but it's true: Fevers amp up your metabolism, so your baby or child may need more calories. Don't force feed your child if she doesn't have an appetite, however.
- Dab with lukewarm water. Sponging your child with tepid water (85 to 90 degrees F) can help bring her temperature down by one or two degrees. (Don't use cold water — it can trigger shivering and actually make the fever worse.) Fill the tub with an inch or two of water and use a clean washcloth or sponge to spread water over her body. As long as she's comfortable and content, continue sponging her until her temperature starts to drop, which could take 30 to 45 minutes. If she's uncomfortable or would rather get out of the tub, don't force her to stay in.
- Offer meds as needed. Acetaminophen (Tylenol or Feverall) can be given to a feverish baby who is 3 months or older, and ibuprofen (Motrin or Advil) can be given at 6 months or older. Be sure to follow the dosing instructions on the label, and never give medication to babies under 12 weeks old without consulting your pediatrician first.[3]
Worrying that your child's fever could potentially lead to more serious symptoms can be unsettling. But remember, most of the time a fever isn't a major cause for concern.
If your little one is still interested in playing, is eating and drinking well, is alert and happy and has a normal skin color, her fever probably isn't coming from something serious. In that case, once you confirm that her fever isn't caused by COVID-19, it's fine to simply keep an eye on her symptoms. But if at any point you feel like you should call the doctor again — even just for your own reassurance — don't hesitate to do so.
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