When is a temp too high?

[bethin]

I work on a med/surg unit where we get peds pts. Everyone disagrees on when a temp is too high for a peds pt. A dr has said she doesn't want to see a kid in the ER or office unless their temp is 106. We have had toddlers in with febrile seizures with a temp of 101.

So, when do you have to worry about brain damage? Is it dependent on the child? We have a policy where we treat all temps over 100.

Any thoughts?

[traumaRUs, MSN, APRN]

Temp itself is not a problem. However, much depends on the age of the child. For a neonate (up to 60 days of age usually), a rectal temp of >100.4 deserves a work-up for sepsis. However, children who are older and look fine might not need a work-up until much, much higher. There is no magic number except for neonates. It is a presentation thing. Assessment is everything.

[Spidey's mom, ADN, BSN, RN]

Temp itself is not a problem. However, much depends on the age of the child. For a neonate (up to 60 days of age usually), a rectal temp of >100.4 deserves a work-up for sepsis. However, children who are older and look fine might not need a work-up until much, much higher. There is no magic number except for neonates. It is a presentation thing. Assessment is everything.

Very true - you have to look at the child and do a good assessment. How lethargic? Been drinking anything? Pulling on ears? Diarrhea? Etc.

My 5 year old went for days with a fever and ended up with pneumonia last Fall. He has had a fever of 104.3 off and on now for 24 hours . . . he is still drinking and eating and when the ibuprofen kicks in he gets off the couch and plays so I'm not worried.

As to febrile seizures - I think genetics plays a role here . . . .

steph

[vamedic4, EMT-P]

Here we will let a temp go up to 38.5 C until we treat(101.3 F)...patient dependent of course. Remember too, that a "fever" is the body's FIRST line of internal defense against those nasty critters. The hypothalamus raises the body temperature to prevent new germ cells from forming and kill off the existing ones.

Also remember that it's not just how HIGH the temp gets, but how FAST it got that high...too fast and you WILL see a seizure.

vamedic4

[bethin]

As to febrile seizures - I think genetics plays a role here . . . .

steph

Really? I'm not doubting your statement but do you have info to support this? This sounds interesting and could be a future research paper.

Never thought of genetics.

[StudyingNursing]

I think it depends on the patient.

My pediatrician says not to give anything to reduce the fever (Tylenol, Ibuprofen) unless the fever is over 103. My 3 sons can hover around 102 with no problem; they feel tired and achy, lay around and rest and recover. If I give them Tylenol, they feel better, run around and end up sicker than they would have if they had nothing for their temperature. My twins get croup and wheeze with colds if they run around too much, and I've learned it is better for them to have a low-grade fever and recover much easier than to treat the fever and make them sicker overall. The fever is there for a reason, to help them heal from whatever they are ill from.

My daughter, on the other hand, goes from 99.0 to 104 with little warning, and then has hallucinations. She never has a low-grade fever. If her temperature is 99, I treat it with Ibuprofen and a sponge bath.

Listen to the parents if they tell you how their child reacts to illness.

-New Nurse in L&D

[rierie]

The problem is not the fever itself. The fever will make a child miserable as well as scare a parent to death. The problem with febrile seizures occurs because the hypothalmus is not mature enough and the fever raises too quickly. The body then short circuits in way that causes the seizure then brings the temp down. If a child presents to the ER after febrile seizure it is most likely that you as a nurse will never see a seizure from that child. The best thing to do is educate the parents on "danger-zone" temp levels and when it's important to medicate the child with Motrin/Tylenol as well as making sure they are not keeping their child covered. I don't know how many times I see children that are completely bundled up only for me to get them in the triage room and uncover them. Of course always listen to a parent (they know their child best!), the history of the child and follow your instincts. Find out your policy is for your facility as far as treating fever. Talk to the Pediatricians and seasoned Peds nurses they have good ideas and stories. That is how I am learning...always ask. I love this site. Almost always good advice and positive help. Good Luck!