Treating Fever

Treating fever has become a little more complicated now that both acetminophen and ibuprofen are available. Both drugs are very effective at treating fever. We recommend always starting with acetaminophen, since it has fewer side effects than ibuprofen. If the fever remains greater than 102°F 1-2 hours after giving acetaminophen, then you can give ibuprofen. Acetaminophen is dosed every 4 hours. Ibuprofen is dosed every 6 hours. Sometimes doses of acetaminophen can be alternated with doses of ibuprofen every 3 hours in cases when the fever returns sooner than 4 hours from the last medicine dose. We DO NOT recommend giving alcohol baths. Luke warm water baths can help make a child more comfortable with fever that responds poorly to medication. Remember, the important thing is to make the child more comfortable. Fever, itself, does not cause brain damage or bodily harm. Fever indicates that the body is fighting off an infection. Therefore, we treat fever in order to make the child more comfortable, not because the fever is harmful.
Avoid drugs that combine acetaminophen with cold medicines such as antihistamines or decongestants in one bottle, since it is confusing to dose these combination drugs and you may be treating with more drugs than you need.

ACETAMINOPHEN DOSING CHART( Tylenol®, Tempra®) IBUPROFEN DOSING CHART(Advil®, Motrin®)
                     
Weight Weight Typical Infant drops Chew Tabs Child Elixir Jr.Strength Tabs Infant drops Child elixir    
(lbs) (Kgs) Age (80mg/
0.8ml)
(80mg/
tab)
(160mg/
tsp)
(160mg/
tab)
(50mg/
1.25ml)
(100mg\
tsp)
50mg tabs 200mg tabs
7-8 lbs 3-3.8 kg NB 0.4 ml ** ** ** ** ** ** **
9-12 lbs 4-5.4 kg 1-2 mos 0.6 ml ** ** ** ** ** ** **
13-16 lbs 6-7.3 kg 3-6 mos 0.8 ml ** ** ** 1.5 ml 1/2 tsp 1 tabs **
17-20 lbs 7.7-9 kg 9-12 mos 1.2 ml ** 3/4 tsp ** 2.0 ml 3/4 tsp 1 1/2 tabs **
21-25 lbs 9-11 kg 16-22 mos 1.5 ml 1 1/2 tabs 1 tsp 1 tab 2.5 ml 1 tsp 2 tabs **
26-29 lbs 12-13 kg 2.5 yrs 1.8 ml 2 tabs 1 tsp 1 tab 3.0 ml 1 1/4 tsp 2 1/2 tabs **
30-34 lbs 14-15 kg 2.5-3.5 yrs 2.0 ml 2 1/2 tabs 1 1/4 tsp 1 tab 3.5 ml 1 1/2 tsp 3 tabs **
35-40 lbs 16-18 kg 4-5 yrs 2.4 ml 3 tabs 1 1/2 tsp 1 1/2 tabs 4.5 ml 1 3/4 tsp 3 1/2 tabs 1 tab
50 lbs 23 kg 7 yrs ** 4.5 tabs 2 1/4 tsp 2 tabs ** 2 tsp 4 tabs 1 tab
60 lbs 27 kg 8-9 yrs ** 5 tabs 2 1/2 tsp 2 1/2 tabs ** 2 3/4 tsp 5 1/2 tabs 1 1/2tabs
70 lbs 32 kg 10-11 yrs ** 6 tabs 3 tsp 3 tabs ** 3 tsp 6 1/2 tabs 1 1/2tabs
80 lbs 36 kg 11-12 yrs ** 7 tabs 3 1/2 tsp 3 1/2 tabs ** 3 1/2 tsp 7 tabs 2 tabs
90 lbs 41 kg   ** 8 tabs 4 tsp 4 tabs ** 4 tsp 8 tabs 2 tabs
100 lbs 45 kg   ** 8 tabs 4 tsp 4 tabs ** 4 tsp 8 tabs 2 tabs

This handout should help our families manage their children's cold symptoms, viruses, and fevers. Dosing is provided for acetaminophen, ibuprofen and most cold medicines for all age groups, including infants.


COMMON QUESTIONS REGARDING GIVING FEVER AND COLD MEDICATIONS?

  • Can I give medications at the same time? What about drug interactions?
    There are no significant drug interactions between acetaminophen, ibuprofen, any cold medication, or any antibiotic. Therefore, any of these drugs can be given together without any problem.
  • What can I give for fever if my child is vomiting?
    The best fever reducing drug to give a child who is vomiting is acetominophen by RECTAL(suppository) route. This medicine is available over the counter and the dosing is the same as indicated in the dosing chart below.
  • If the medicine bottle says, "Don't give until you call your physician", or "Don't give under age 2 years unless contacting your physician," then does this mean I should call the office or page the physician before giving the medicine?
    The answer is no. We have provided this handout with dosing recommendations for ibuprofen, acetaminophen, and cold medications for any age down to age 2 months. Therefore, you should not need to call us for dosing questions. However, please call us if you have other medical concerns or if you would like some reassurance.
  • If a child has cold symptoms, when is it necessary to page the physician after hours?
    The physicians are always available for after-hours paging. Of course, most questions can probably be handled the following morning during regular office hours. Examples of these situations include stuffy noses, coughing without breathing distress, or fever without prominent lethargy.

There are some situations that should not wait until the following morning, but rather an urgent page is recommended. These URGENT situations are listed below:

  • Any child who is very lethargic defined as not responding normally with little or no eye contact. A child who is able to point at objects, answer a question, and maintain good eye contact may be considered listless, but is not considered lethargic.
  • Vomiting many times in a row (4-5 episodes) should prompt a page.
  • A child who has severe, unremitting, and constant abdominal pain should prompt a page.
  • Any type of significant breathing distress(not just a stuffy nose) should prompt a page.
  • Obviously, an unconscious child should prompt a page.
  • Seizure activity consisting of rythmic movements of the arms and legs associated with eyes rolling should prompt a page.