Fort Worth, Texas,
11:33 AM

My child has a fever

Should we go to the ER?

“What temperature should we go to the ER for?”

I must get this question three to four times a day in the office and it's one of those things that keeps you up all night wondering what you should do. The answer, "There is no fever you should go to the ER for..."

That doesn't mean that children with fever don't sometimes need to go to the ER, but the height of the fever is not an indication that a late night drive and time in the ER wait is the right thing to do.

We always want to take the fever into the context of the following questions:

1) What are the other symptoms that the child is having?

  • Runny nose, cough? Probably not.
  • Abdominal pain? Depends on severity an location.
  • Vomiting? Not if can keep some liquids down and still peeing.

2) What is the child's behavior like? Lethargic or active. Is the child laying around all day, not even really wanting to wake up to drink or do they perk up and act like they feel better at times (especially when their fever is down). If they are lethargic, bring them in.

3) Is the child drinking and peeing?  If so, then we will almost always recommend a call to the office over an ER trip.

Common fever myths:

"The child's brain will be fried if the temperature is over 105." Ummm. No. Temperatures that the body is generating on their own as a response to illness will not cause brain damage or any of the other things that your grandmother/neighbor/best friend said they would. We commonly have children with 105-106 temps walk in and out of our office smiling cause they got their stickers for being a good boy/girl.

"If the fever gets above 103 they will have a febrile seizure." Wrong again. In fact, most febrile seizures occur when the temperature is between 102 and 103. We don't know exactly why this is but it is thought that it is related to the rate that the temperature rises and not the absolute number that the temp gets to.

"The baby felt warm so she had a fever" or "The baby was really hot so the temperature must've been about 104." Sorry to the back of grandma's hand, but judging the temperature especially trying to put a number on it by touching a child's head is incredibly unreliable. I would prefer an axillary or temporal thermometer, or in the babies less than 3 months, I'll commonly ask for a rectal temp.

"He had a low grade temp of 99" or "99 is hot for him because he usually runs 96." “Low grade temp” should really be taken out of our vocabulary. They have done studies where they took children's temperatures several times a day and have found that any temp <100.5 in a child less then 3 months and <101 in an older child should not be considered fever. These are normal temperatures that can occur during the course of the day for any child who is healthy and has no reason to be running fever.

So, what temps should I call for?

  • Any temp over 100 in a baby less than 3 months.
  • Any temp in a child who is not drinking well and with decreased urine.
  • Anything else that has you concerned.

The ultimate point is that we should not be afraid of fever. Fever is just another symptom in a long list of possible symptoms a child can have when they are sick. It means that we need to think about what is going on and watch the child close but resist the urge to panic!


About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.

Comments 1 - 4 (4)
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Kathryn Edwards MD FAAP
Thank you so much for this very well written article!!!
Kate Webber
I am a PNP in Michigan. I adore what you write and just wanted to thank you. Daily, the fever question comes at me and I always tell parents that most fevers are not a big deal. Nice to hear you talk about those smiling 105 temps. I tell parents not to alternate Tylenol and Motrin unless there is a history of febrile seizures. What is your take on this?
Justin Smith (The Doc Smitty)
Misty,That is a great question and I agree...if the child is comfortable, there is no reason to treat a fever. Giving medicine is only for reducing fever to make a child more comfortable so if you choose not to use it, no big deal.
Misty St. Clair
I've always wondered if a child has fever should we really be giving Tylenol,Ibuprofen, lower fever? Should you just let the body fight on it's own? Just a thought.