What is a fever?

Fever refers to an elevation in body temperature. Technically, any body temperature above the
normal oral measurement of 98.6 F (37 C) or the normal rectal temperature of 99 F (37.2 C) is
considered to be elevated. However, these are averages, and one's normal body temperature may
actually be 1 F (0.6 C) or more above or below the average of 98.6 F. Body temperature can also
vary up to 1 F (0.6 C) throughout the day.

Fever is not considered medically significant until body temperature is above 100.4 F (38 C).
Anything above normal but below 100.4 F (38 C) is considered a low-grade fever. Fever serves
as one of the body's natural defenses against bacteria and viruses which cannot live at a higher
temperature. For that reason, low fevers should normally go untreated, unless accompanied by
troubling symptoms.

Also, the body's defense mechanisms seem to work more efficiently at a higher temperature.
Fever is just one part of an illness, many times no more important than the presence of other
symptoms such as cough, sore throat, fatigue, joint pains or aches, chills, nausea, etc.

Fevers of 104 F (40 C) or higher demand immediate home treatment and prompt medical
attention, as they can result in delirium and convulsions, particularly in infants and children.

Fever should not be confused with hyperthermia, which is a defect in your body's response to
heat (thermoregulation), which can also raise the body temperature. This is usually caused by
external sources such as being in a hot environment.

What causes a fever?

Fever is the result of an immune response by your body to a foreign invader. These foreign
invaders include viruses, bacteria, fungi, drugs, or other toxins.

These foreign invaders are considered fever-producing substances (called pyrogens), which
trigger the body's immune response. Pyrogens tell the hypothalamus to increase the temperature
set point in order to help the body fight off the infection.

Fever is a common symptom of most infections. In children, immunizations or teething in may

cause low-grade fever.Autoimmune disorders, medication reactions, seizures, or cancer may also
cause fevers.
What are the signs and symptoms of a fever?

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A fever can cause you to feel very uncomfortable. Signs and symptoms of a fever include the
following:

 Temperature greater than 100.4 F (38 C) in adults and children

 Shivering, shaking, chills
 Aching muscles and joints
 Headache
 Intermittent sweats
 Rapid heart rate and/or palpitations
 Skin flushing
 Feeling faint, dizzy, or lightheaded
 Weakness
 With very high temperature (> 104 F/40 C), convulsions, hallucination, or confusion is
possible. Seek medical attention.

How is a fever diagnosed?

Along with having the generalized symptoms of a fever, taking your temperature with a
thermometer can confirm the diagnosis of a fever. A temperature greater than 100.4 F in adults
or children is considered a fever

How should I take a temperature for fever?

Digital thermometers can be used to measure rectal, oral, or axillary (under the armpit)
temperatures. The American Academy of Pediatrics does not recommend use of mercury
thermometers (glass), and they encourage parents to remove mercury thermometers from their
households to prevent accidental exposure to this toxin.

Measuring an axillary (under the armpit) temperature for fever

Axillary temperatures are not as accurate as rectal or oral measurements, and these generally
measure 1 degree lower than a simultaneously obtained oral temperature.

 Place the tip of the digital thermometer in your child's armpit.

 Leave in place about one minute or until you hear a beep to check a digital reading.

Measuring fever by eardrum temperature

Tympanic (ear) thermometers must be placed correctly in your child's ear to be accurate. Too
much earwax can cause the reading to be incorrect.
Eardrum temperature measurements are not accurate in small children and should not be used in
children under 3 years (36 months) of age. This is especially true in infants below 3 months of
age when obtaining an accurate temperature is very important.

Measuring fever by oral temperature

People 4 years old and older can have their temperature taken with a digital thermometer under
the tongue with their mouth closed.

 Clean the thermometer with soapy water or rubbing alcohol and rinse.
 Turn the thermometer on and place the tip of the thermometer as far back under the tongue as
possible.
 The mouth should remain closed, as an open mouth can cause readings to be inaccurate.
 The thermometer should remain in place for about one minute or until you hear the beep.
Check the digital reading.

Avoid hot or cold drinks within 15 minutes of oral temperature measurement to ensure correct
readings.

Measuring fever by rectal temperature

The American Academy of Pediatrics recommends rectal temperature measurements for children
under 3 years of age, as this gives the most accurate reading of core temperature.

 Clean the thermometer with soapy water or rubbing alcohol and rinse with cool water.
 Use a small amount of lubricant, such as petroleum jelly, on the end.
 Place the child or baby prone (belly-side down) on a firm surface, or place your child face up and
bend his legs to his chest.
 After separating the buttocks, insert the thermometer approximately ½ to 1 inch into the
rectum. Do not insert it too far.
 Hold the thermometer in place, loosely keeping your hand cupped around your child's bottom,
and keep your fingers on the thermometer to avoid it accidently sliding further into the rectum.
Keep it there for about one minute, until you hear the beep.
 Remove the thermometer, and check the digital reading.
 Label the rectal thermometer so it's not accidentally used in the mouth.

A rectal temperature will read approximately 1 degree higher than a simultaneously obtained oral
temperature.

Medically Reviewed by a Doctor on 6/27/2014

What is the treatment for a fever?

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Generally, if the fever does not cause discomfort, the fever itself need not be treated. It is not
necessary to awaken an adult or child to treat a fever unless instructed to do so by your doctor.

The following fever-reducing medications may be used at home:

 Acetaminophen (Tylenol and others) can be used to lower a fever. The recommended
pediatric dose can be suggested by the child's pediatrician. Adults without liver disease or
other health problems can take 1,000 mg (two "extra strength" tablets) every six hours or
as directed by your physician.
 Ibuprofen (Motrin/Advil) can also be used to break a fever in patients over 6 months of
age. Discuss the best dose with your doctor. For adults, 400 mg-600 mg (two to three 200
mg tablets) can be used every six hours.
 Aspirin should not be used for fever in children or adolescents. Aspirin use in children
and adolescents during a viral illness (especially chickenpox and influenza, or flu) has
been associated with Reye's syndrome. Reye's syndrome is a dangerous illness which
causes prolonged vomiting, confusion, and even coma and liver failure.

An individual with a fever should be kept comfortable and not overdressed. Overdressing can
cause the temperature to rise further. Tepid water (85 F [30 C]) baths are a home remedy that
may help bring down a fever. Never immerse someone in ice water. This is a common
misconception. Never sponge a child or an adult with alcohol; the alcohol fumes may be inhaled,
causing many problems.

When should I seek medical care for a fever?

Any child below 3 months of age who has a temperature of 100.4 F (38 C) or greater should be
seen by a physician. If a child or adult has a history or diagnosis of cancer, AIDS, or other
serious illness, such as heart disease, diabetes, or is taking immunosuppressant drugs, medical
care should be sought for a fever.

Otherwise, observe the person with the fever. If they appear sick or have symptoms that would
suggest a major illness, such as meningitis (headache, stiff neck, confusion, problems staying
awake), urinary tract infection (shaking chills, burning with urination), pneumonia (shortness of
breath, cough), or any other signs of a serious illness, contact your health care professional.

Other symptoms that may be indicative of a severe illness include repeated vomiting, severe
diarrhea, or skin rashes (could be a sign of dengue fever, Rocky Mountain spotted fever, scarlet
fever, rheumatic fever, strep throat, or chickenpox).

Fever blisters (herpangina) are small blisters that turn into ulcers, usually on the lips, mouth or
tongue, caused by a virus. When a child contracts this virus for the first time, the symptoms and
the fever blisters can be quite severe. If the child is not eating or drinking, contact your child's
doctor.

On the other hand, if the fever accompanies a simple cold or virus, you can treat the fever as
described above and be assured that the fever is only a symptom of the illness. This is not to say
that you should ignore a fever. If there are other associated symptoms that are bothersome, you
should contact your doctor.

Some vaccines given in childhood can cause a low-grade fever within a day or two of getting the
injection. This fever is usually self-limited and short-lived. If the reaction seems severe or the
skin at the injection site is red, hot, and painful, contact your child's doctor.

A low percentage of all children between 18 months to 3 years of age will have a seizure
(convulsion) with a high fever. Of those with a history of febrile seizure, some will have another
seizure associated with another febrile episode. Febrile seizures, while frightening to the parents,
are not associated with long-term nervous-system side effects. Children used to be prescribed
phenobarbital following a febrile seizure as a preventive measure (prophylaxis). This has not
been shown to be beneficial and possibly may be harmful, so it is not always recommended.

Medically Reviewed by a Doctor on 6/27/2014

What are complications of a fever?

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While having a fever is generally very uncomfortable, a fever itself does not usually cause severe
complications.

High fever (>103 F/40 C) or prolonged bouts of fever can lead to

 seizures,
 hallucinations,
 dehydration.

It is important to seek treatment for the underlying cause of the fever. Many of the infections that
can cause fever can lead to severe complications if untreated.

What is the prognosis for a fever?

The prognosis for a fever depends on the cause. Most cases of fever are self-limited and resolve
with symptomatic treatment. Depending on the cause, antibiotics or other appropriate
medications may be used.
Fevers associated with severe infections, or in patients whose immune system is compromised
(such as those with cancer, elderly people, newborn infants, patients with HIV/AIDS, or people
with autoimmune disorders) can be life threatening.

Can fevers be prevented?

Fever is preventable only to the extent that the specific cause of the fever can be prevented. Most
fevers are caused by infection. Avoiding sources the infection and maintaining good hygiene
practices are your best way to prevent a fever.

Some ways to prevent the spread of infection include the following:

 Proper hygiene: Wash hands frequently.

 Avoid contact with sick people.
 Make sure you and your child's immunizations are up to date.

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Different Types of Fever

Fever can be classified according to the symptoms associated, its cause and its pattern. Fever can
be low-grade (body temperature less than 101 ºF) or high grade (temp. over 104 ºF). The pattern
of fever often helps diagnose the disease. Here are fever types according to the typical pattern of
the fever.

» Continuous Fever
The patient notices higher than normal body temperature throughout the day but he/she does not
notice severe fluctuations in body temperature. Small variation of about 1 ºC may be noticed
within 24 hours. This type of continuous fever is noticed in patients who have urinary tract
infection, typhus, lobar pneumonia or brucellosis. When children and adults suffer from typhoid
fever, they suffer from consistently elevated body temperature (sustained fever) for a prolonged
period of time. This fever subsides only after taking medication.

» Remittent Fever
When the person having fever experiences temperature fluctuations, more than 1 ºC during 24
hours, it is called remittent fever. For example, patients suffering from infective endocarditis
may experience this type of fever.

» Intermittent Fever
The patient experiences fever for a certain period of time. Then again, his/her body attains
normal temperature. This type of fever is observed during malaria, black-fever, or septicemia.
Intermittent fever is termed as quotidian fever when it is experienced for 24 hours. It is referred
to as tertian fever when it remains for 48 hours. Patients of malaria may experience quotidian or
tertian type of fever pattern. Patients suffering from plasmodium malariae suffer from fever
which exhibits 72 hour periodicity. This type of fever is known as quartan fever. A body
temperature that exhibits a typical pattern of 'highs and lows' is also known as episodic fever.

» Relapsing Fever
When fever reappears after a certain period of time, it is called relapsing fever. Not only once but
fever may reappear a number of times. Those who have a weak immune system may have to face
this problem.

» Pel-Ebstein Fever
Some doctors don't accept this as a type of fever. Some don't agree that this type of pattern
exists. This type of fever is seen in patients of Hodgkin's lymphoma, a cancer of white blood
cells. The patients suffer from high fever for one week and low fever for the next week.

This was about the patterns of fever. The type of fever and associated symptoms may vary
according to the underlying cause of the fever.

Fever and Associated Symptoms

The following information might be helpful in identifying some of the common diseases and
types of fever in children and adults.

» Rheumatic Fever: Low to high degree, seen in small children, teenagers.

Symptoms: Joint pain, affected functioning of heart and nervous system.

Disease: Chronic Inflammatory Rheumatism.

» Chills and Fever: Low to high degree fever, common in both children and adults.

Symptoms: Sore throat, body ache, stuffy nose, cough, weakness.

Disease: Influenza, Viral Infection.

» Low to High Degree Fever: Common in Children.

Symptoms: Headache, watery eyes, cough, reddish skin rash, weakness. Patients undergoing
chemotherapy may experience sudden spread of infection due to weak immune system (lack of
infection-fighting neutrophils).

Disease: Measles.

» High Fever: Common in Children.

Symptoms: Chills and shivering, excessive sweating, weakness, headache, body ache.

Disease: Malaria.

» Sudden High Fever (from 104-105 ºF)

Symptoms: Headache, joint pain, muscle pain, swollen lymph nodes, nausea, loss of appetite.

Disease: Dengue fever.

» High Fever (101 ºF and above)

Symptoms: Headache, white coating on tongue, covered with red dots; swollen glands in the
neck, swollen, reddened throat, darkening of body creases, pale skin, skin rash in the form of red
streaks.

Disease: Scarlet fever.

The list does not end here but it is just impossible to describe the types of fever and their
symptoms in one article. Children suffering from tonsillitis may have fever while elderly
members in the family may suffer from fever due to severe arthritis. One may suffer from fever
after immunization or even after excessive exertion. Various common conditions exhibit fever as
a symptom. A mild fever followed by mild symptoms may go away without any treatment but
persistent or high fever needs immediate medical attention.
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