Managing a Child's Fever During the Night

If you are the parent of a baby or toddler, this may be a familiar scenario: A nasty cold or flu has left your little one burning up with a fever all day. The pediatrician has assured you that with some TLC and perhaps some fever medication, the temperature would return to normal as soon the infection clears.

Now that it's bedtime, though, you're not sure what to do. Should you monitor your child's fever through the night? Or is it better to let sleeping babies lie, even sick ones? With few exceptions, letting your child sleep is the better choice.

It is important to remember that a fever—defined in children as a rectal temperature of 100.4 or greater—is a symptom of a disease and not the disease itself. In babies and toddlers, fever is a symptom of common viral and bacterial illnesses such as croup, flu, colds, gastroenteritis, ear infections, bronchiolitis, and urinary tract infections.

As distressing as a fever may be, try to remember that it is a normal part of the body's immune response. It serves as a defense mechanism by stimulating the production of white blood cells (such as T-cell lymphocytes) that actively target, control, and neutralize an infection.

One of the things that happen when you sleep is that you get a better fever response. What this means is that, even if the temperature rises, your body is more actively focused on fighting infection.

Helpful or not, a high fever can make a child feel absolutely miserable, so there is a good reason to do all you can to relieve it. To this end, the American Academy of Pediatrics (AAP) recommends that you take the following steps to manage your baby's or toddler's fever :

• Keep the child hydrated. A fever can cause your little one to lose fluids quickly and become dehydrated. This can lead to serious complications and the worsening of symptoms. To avoid this, push fluids as necessary to keep your child properly hydrated. If there are signs of dehydration, you can use an oral rehydration solution like Pedialyte. If you are breastfeeding, nurse your child more often.
• Do not overdress your child. While your first instinct may be to bundle your child up when sick, it may only add to his discomfort. If the room temperature is comfortable (between 70 and 74 F), it is better to dress the child lightly. Forcing a sweat is not a good way to treat a fever.
• Use a fever-reliever appropriately. Children's Tylenol (acetaminophen) or Children's Motrin or Advil (ibuprofen) will usually do the trick. If your child is under two or you are unsure of the dosage, speak with your pharmacist or pediatrician. However, avoid aspirin as this may cause a potentially life-threatening condition called Reye syndrome in children with a viral infection.
• Use a fever reliever only when needed. Not all fevers need to be treated. According to the AAP, fever relievers are only needed if the fever is causing discomfort, usually above 102 or 103 F. If you do decide to use one, give it just before bedtime to aid in a good night's sleep.
• Avoid outdated or unproven remedies. The AAP also advises against alcohol baths, ice packs, or "starving a fever" which can do more harm than good. You should also not give a cooling sponge bath to your baby without first providing a fever reliever. Doing so can cause shivering and may actually increase body temperature.

While it is usually unnecessary to wake up a baby or toddler at night to take a temperature or provide medication, there are exceptions.

For example, if your child is sleeping restlessly, he or she may rest better after a nighttime dose of Tylenol, Motrin, or Advil. Similarly, if your child is breathing faster than normal or irregularly, you may want to check her temperature to decide if further action is needed.

Generally speaking, you would need to call a doctor or seek emergency care if :

• Your baby is two months or younger and has a temperature of 100.4 F or more.
• Your baby is three to six months and has a temperature of 101 F or more.
• Your child is over six months and has a temperature of 102 F or higher for more than two days.
• Your child has shaking arms and legs, trouble breathing, and eyes that are rolling back. These are signs of a febrile seizure. While most are relatively harmless, those that recur or last for more than 10 minutes should be seen without exception.
• You have difficulty waking the child.

In all other cases, it is usually best to let your child sleep. As a general rule of thumb, a child will wake up on his own if a fever is serious.