Fevers: How long is too long?
As parents, seeing your little one with a fever can be nerve-wracking, especially if it lingers for several days. Fevers are a common part of childhood and can be caused by many things, from minor infections to something more significant. If your child's fever lasts more than five days, this is often the point when pediatricians recommend a closer look. Here’s what you need to know about prolonged fevers in children, what might cause them, how your pediatrician will evaluate them, and what steps you may need to take.
*Note: This post is for fevers in babies and children over 2-3 months old only. Babies under this age should always consult with their medical provider or seek help immediately.
what to know
Most fevers in children are short-lived and typically signal the body fighting off a viral infection, like a cold or the flu. But if a fever persists beyond five days, there could be other causes. Here are some common reasons:
Bacterial Infections: While viruses cause most fevers, a prolonged fever may indicate a bacterial infection. Examples include strep throat, urinary tract infections (UTIs), sinus infections, or even pneumonia.
Post-viral Inflammation: Sometimes, the immune response to a virus can create a fever that sticks around, even after the main infection has resolved. This can be especially common in younger children.
Autoimmune or Inflammatory Conditions: Although rare, conditions like Kawasaki disease (an inflammatory condition affecting blood vessels) can cause prolonged fevers in children. Other autoimmune or inflammatory conditions might also lead to fevers lasting more than five days.
Other Causes: In some cases, a persistent fever might be due to a non-infectious cause, like a reaction to medication or an underlying chronic condition or rarely, malignancy. Your child’s pediatrician will help rule these out if needed.
what to do
There are several things you can do at home to help manage your child's fever and keep them comfortable.
First and foremost, focus on keeping your child hydrated by offering plenty of fluids, such as water, diluted juice, or oral rehydration solutions. This is especially important if your child has a fever, as it can lead to dehydration. Encourage small, frequent sips of fluid throughout the day.
Rest is also crucial—fever often signals that the body is working hard to fight off an infection, so ensuring your child gets plenty of sleep and relaxation is key.
As for fever-reducing medications like children’s ibuprofen or acetaminophen, they can be helpful for making your child more comfortable, but use them only when necessary, such as for pain or discomfort, or if your child is so uncomfortable that they’re not able to stay hydrated. If your child is comfortable and drinking fluids, it is okay to let the fever run its course, as it’s a natural part of the body’s immune response. Always check in with your pediatrician if you're unsure about how to manage your child’s symptoms.
what your care team will do
If your child has had a fever for more than five days, a visit to your pediatrician is in order. During this visit, they’ll want to gather a full picture of your child’s health to help pinpoint the cause. Here’s what you can expect:
1. Detailed Questions About Symptoms and Health History
Your pediatrician will start by asking questions to understand the full context of your child’s symptoms. Expect questions like:
How high has the fever been, and has it been consistent?
Is the fever coming down with medications or on its own or persisting?
Has the fever been high every day or slowly getting lower (called a ‘fever curve’)?
Are there any other symptoms, such as a rash, sore throat, vomiting, diarrhea, cough, or body aches?
Do they have red eyes, cracked lips, or any other rashes?
Has your child been around anyone who has been sick recently?
Have you traveled recently?
Is your child eating, drinking, and urinating normally?
Have you noticed any new or unusual behaviors?
2. Physical Exam
Next, your pediatrician will examine your child, checking for any visible signs that might explain the fever. They’ll look for things like signs of respiratory issues, swollen lymph nodes, or signs of dehydration. This helps them get clues that might point to specific infections or conditions.
3. Tests to Determine the Cause
If necessary, your pediatrician may order a few key tests to help diagnose the cause of the fever:
Blood Tests: A Complete Blood Count (CBC) checks for signs of infection by looking at white blood cell levels, which are often elevated in bacterial infections. Inflammatory markers like C-Reactive Protein (CRP) or Erythrocyte Sedimentation Rate (ESR) may also be checked to see if there’s ongoing inflammation in the body.
Urinalysis: A urine test may help rule out a urinary tract infection, which is a common source of prolonged fever in children.
Chest X-ray: If your child has a cough, difficulty breathing, or other respiratory symptoms, a chest X-ray can help check for pneumonia or other lung infections.
Other Tests: Based on symptoms, the doctor may suggest other specific tests, such as a throat swab for strep throat or tests for specific viruses.
what to expect
Once your pediatrician gathers information and completes any necessary tests, they’ll talk with you about the findings. Here’s what the next steps might look like:
Monitoring: Sometimes, even after testing, the cause of a prolonged fever isn’t clear. In these cases, your pediatrician may recommend close monitoring at home and follow-up visits to check on symptoms and temperature. If they suspect a viral infection, they may advise you to wait a bit longer, as some viral fevers can take more than a week to resolve fully.
Treatment: If a bacterial infection is confirmed, your pediatrician may prescribe antibiotics. For viral infections, antibiotics aren’t effective, so they may focus on supportive care like fluids, rest, and fever-reducing medication as needed.
Referral to a Specialist: If the fever persists and the cause remains unclear, your pediatrician may refer you to a pediatric infectious disease specialist or a pediatric rheumatologist. These specialists can help identify less common causes of prolonged fevers, including rare infections or autoimmune conditions.
when to seek help
While prolonged fevers usually don’t require emergency care, it’s important to know when to seek immediate help. Call your pediatrician or go to the emergency room if your child has any of the following:
Difficulty breathing or rapid breathing
Severe pain (such as a headache or abdominal pain)
Persistent vomiting or inability to keep fluids down
Lethargy, confusion, or unresponsiveness
A seizure or uncontrolled shaking
Signs of dehydration, like very dry lips, no tears when crying, or significantly decreased urination
Prolonged fevers can be unsettling, but they’re often manageable with the right evaluation and care. Remember, a fever is a natural response to many conditions, and your pediatrician is there to help guide you through. Don’t hesitate to reach out if you have questions or concerns about your child’s fever or health. With attentive monitoring and professional support, you can help ensure your child’s health and comfort through any fever episode. Remember, every case is unique, so trust your instincts and seek care whenever you feel it’s necessary.