My Child's Fever Isn't Going Away. Should I Be Worried?

"My child has a fever, what could it be?"

Just a quick reminder of my big fever rules. Click the links to learn more:

1. You don’t always have to rush off to the ER for a fever. No matter how high.

2. In a well-appearing child, it’s OK to watch fever at home, even up to 5 days.

3. You only have to treat fever to keep the child comfortable. Don’t treat the thermometer.

But what if your little one has a fever and it doesn’t seem to be going away? What should you be worried about?

Let me just start by saying this…this article is intended for children 6 months to 3 years who are fully vaccinated and are otherwise acting pretty normal. Why?

• Older kids are usually much better about telling us if something hurts.
• In children who haven’t received all of their vaccinations, we have to consider some other infections that have otherwise pretty much gone away.
• If a child isn’t acting normal (is lethargic, not drinking and peeing or has other concerning symptoms), they should be taken in for care (probably to the ER).

Sometimes it’s really obvious where the fever is coming from but other times it’s not. Here are some infections we think about when it’s not really clear:

1. Ear infection – Often kids with ear infections will have fever, fussiness, runny nose/cough and will be pulling at their ears but other times it might not be so clear.

2. Pneumonia – Most children with pneumonia will have symptoms such as rapid breathing or difficulty breathing but not always.

3. Urinary tract infection – This is actually one of the most common reasons for kids to have fever without symptoms in this age group. They just can’t tell you that it hurts when they pee.

4. Meningitis – The younger you are, the more likely a child is to have meningitis only presenting with fever.

5. “Viruses” – This might be the answer you don’t like to hear but, besides ear infections, it’s probably the one you want to have. Sometimes a child will present with just fever or fever and very little else until a few days into the illness when viral symptoms like runny nose, cough or rash become more prominent.

So, if your baby’s fever doesn’t go away after 3-4 days, what should you expect?

Your doctor should take a thorough history and do a full physical. If the diagnosis isn’t clear, here are the tests that are likely to be run:

1. Blood work – A blood count and some markers of inflammation will help determine if the infection is more like viral or bacterial.

2. Urine sample – Even though it’s not fun because urine catheterization in this age is no fun for anyone, getting a urine sample is critical because UTI is such a common cause.

3. Chest X-ray – Due to the fact that pneumonia can be a cause, getting a chest x-ray will usually be necessary.

4. Other – Depending on the baby’s story, physical exam and the results of the initial lab work, further testing may be necessary.

When your little one has a fever, it can be really scary. Keep in mind that most fevers have obvious causes or go away quickly on their own. But when they don’t, now you’ll know what to expect.