When children develop a fever in the middle of the night, parents want to make them feel better.  There are lots of useful ways to do this.

The first thing, of course, is to ensure that the fever doesn’t represent something dangerous.  Meningitis or dehydration come to mind; parents should use their best judgement about when to call the doctor or run to the emergency room.  (Click here to see my guidelines.)

On the other hand, fever is not dangerous.  It makes kids feel lousy, and it’s worth treating for that reason, but the fever itself does not hurt otherwise healthy kids, despite “folk tales” that you might have heard.  (Read here for more information.)

Most kids with fever can be helped to feel better at home for a couple of days.  Tepid baths can be given as frequently as desired.  Fluids are really important, no matter what else is wrong; a couple of ounces every hour while awake is usually enough.  Any kind of fluid is fine; milk, tea (avoid caffeine), soup, jello … anything!  If the child’s urine is dark yellow, he needs more to drink.

Fever reducers (such as acetaminophen or ibuprofen) certainly help febrile kids feel better.  Some people feel that fever shouldn’t be treated with fever reducers, because the fever might “help the immune system fight the infection.”  Actually, this idea comes from studies that were performed in infected iguanas!  They got better faster if they were allowed to increase their temperature by crawling into into warmer areas.  But I am not convinced by this; there’s no such data confirming that infected humans get better faster if their fever is untreated.

So I do recommend fever reducers.  Acetaminophen (7 mg per pound) can be given every 4 hours, while the child is awake.  Ibuprofen (4-5 mg per pound) can also be given safely every 4 hours (even though the label may suggest a 6-8 hour interval).  (For more exact dosing recommendations, click here.)

If the fever is very high, or the child has an underlying medical illness that makes the fever itself a danger (such as a history of seizures, congenital heart disease etc.), we might recommend alternating acetaminophen and ibuprofen every THREE hours: acetaminophen at noon, ibuprofen at 3 pm, acetaminophen at 6 pm, etc.

Most kids can wait until regular office hours to take care of a fever — usually, there's no need to call in the first few hours of a fever at night!  And remember that fever always goes higher at night; this is to be expected.  But if there’s any question in your mind, give us a call!

– David M. Epstein, MD