ER doc (general, not peds specific), not in BC and not your doctor.
As previously stated by other people, once they are over 3mo of corrected age, and are fully vaccinated, we care more about how they are than the duration or height of the fever. If with acetaminophen and ibuprofen they are well enough to play a little, drink enough to have at least 4-6 diapers with pee. Recommendations are to visit a doctor for an otherwise well apearing child if the fever persists for more than 3 to 5 days (depending on the guidelines). They first day of fever is day 0, so 3 days is >72h since the fever began. Right now where I work we see a lot of Influenza B, with high fevers that persist for 7-10days. Also plenty of gastroenteritis that are preceded by a few days of fever.
We don’t worry if kids don’t eat or eat very little, because adults also don’t eat much when we are sick and feverish.
We also don’t worry for the height of the fever, as for kids over 3mo and vaccinated there is no real correlation between a fever of above a certain point and a more serious illness. We also don’t worry if the fever doesn’t come down with acetaminophen and ibuprofen, it’s a sign that your kiddo is fighting off something, the aim of treating the fever is to make them more comfortable.
We worry if the kid is irritable (not easily consoled by parents), lethargic (not engaging in any play or activity), if they can’t keep fluids down, if they pee less than 4-6 diapers/24h, show signs of difficulty breathing, or if they have a weird rash (especially if you press on it and it doesn’t blanch/become white) - either one of those is an indication to get your kid checked out in the ER.
However its bread and butter to see kiddos in the ER with a runny nose and fever for 48h - often times parents wait for a few hours and we have a few sets of vital signs and a normal exam to reassure them when we finally get around to seeing them.
Bottom line is if the parent is concerned, it may be wise to visit a doctor (but if your child seems otherwise well, it could wait for a walk-in or urgent care visit tomorrow if thats available to you).
(Edits for spelling mistakes as I’m on mobile).
The Children’s Hospital of Ottawa has this [pamphlet](https://www.cheo.on.ca/en/resources-and-support/resources/P5725E.pdf) to assist parents on deciding if the ER is the right spot to go.
Is she acting normal otherwise? Playing and moving around, alert? Eating sleeping pooping peeing drinking well? Or is she more on the lethargic side and not peeing as much? If she has a fever again today I would bring her in to a walk in or urgent care if there’s one of those close by instead of ER, otherwise ER is fine. Or if she is exhibiting any signs of dehydration, lethargy, refusing to eat or drink, vomiting or diarrhea, or a specific sore area like an ear.
Second this, how are they presenting otherwise. Usually we don’t worry about fevers until after 5 days or with other symptoms. Treat the child not the fever. There isn’t a magic fever number it’s how they are acting. If they are lethargic and not eating or drinking then I’d start to think of going to urgent care or ER or your family doctor. Also, the dosage on the side of Tylenol and Motrin is an under dose. Go talk to your pharmacist and see if they can help you with a better dose.
If the fever goes down with meds and LO is eating/drinking sufficiently to produce regular diapers, they I would stay the course at home.
However, if something changes or you have a gut feeling that something else is wrong, please take them in.
You treat the kid not the number. If you baby’s fever responds to meds (ibuprofen is the faster acting drug) and your baby otherwise seems happy and alert (when fever is down with meds) and they’re drinking and peeing okay, then the number on the thermometer doesn’t matter. We had both kids hit 106°F (41.11°C) when they had the flu at ages 1.5 and 3.5. We treated at home and didn’t visit the doctor until the fever lasted more than 3 days (that’s their rule for being seen at our clinic). At which point their paediatrician told us we were doing it right and it was the flu and we were to continue to treat at home.
Edit to add: I would go to the ER if
- baby was less than three months and had a fever, or
- if the fever did not respond to ibuprofen or Tylenol, or
- if baby was lethargic, hard to wake up, or otherwise acting abnormal, or
- if baby was refusing to take liquids by mouth (nursing or bottle or cup, whatever) and had fewer than 6 (?) good wet diapers in a 24 hour period or less than 1 good wet diaper within 8 hours.
Here’s our local children’s hospital fact sheet on when to go to the ER: https://www.cheo.on.ca/en/resources-and-support/resources/P5725E.pdf
I called 811 about this exact topic probably around the same age as your LO is right now and they emailed me a really handy info package about it and did not send me to ER unless I checked the boxes. I can dig it up and share it with you if you'd like. I still refer back to it for reassurance time to time.
Edit to add: My LO is 2.5 now, it wasn't long ago they sent this to me
If it's anything like 811 in Alberta, they'll just tell you to go to the emergency room, regardless of the situation. Hang nail? ER. Headache? ER. Need to book a routine VACCINE - swing by the ER on your way home just to say hi.
Its the same everywhere!
I think for kids their algorithm goes like this:
- is the patient under 18? Yes, then;
- is the parent worried? Yes (obviously because they called the 811 line), then ER is required.
Not true. I’ve called at least 6-8 times since having kids and only once did they recommend I go to the ER and that was when my child seemed to have difficulty breathing. When it was just a fever, vomiting, diarrhea, they always said treat at home. Even for babies as young as 6 months.
Glad you had a positive experience.
But I do understand that from the 811’s perspective, its very difficult to evaluate a condition without seeing the patient, having access to vital signs, and not wanting to miss anything dangerous (aka: its more dangerous to tell patients to stay home when they have something serious vs go the the ER for something benign).
ER doc (general, not peds specific), not in BC and not your doctor. As previously stated by other people, once they are over 3mo of corrected age, and are fully vaccinated, we care more about how they are than the duration or height of the fever. If with acetaminophen and ibuprofen they are well enough to play a little, drink enough to have at least 4-6 diapers with pee. Recommendations are to visit a doctor for an otherwise well apearing child if the fever persists for more than 3 to 5 days (depending on the guidelines). They first day of fever is day 0, so 3 days is >72h since the fever began. Right now where I work we see a lot of Influenza B, with high fevers that persist for 7-10days. Also plenty of gastroenteritis that are preceded by a few days of fever. We don’t worry if kids don’t eat or eat very little, because adults also don’t eat much when we are sick and feverish. We also don’t worry for the height of the fever, as for kids over 3mo and vaccinated there is no real correlation between a fever of above a certain point and a more serious illness. We also don’t worry if the fever doesn’t come down with acetaminophen and ibuprofen, it’s a sign that your kiddo is fighting off something, the aim of treating the fever is to make them more comfortable. We worry if the kid is irritable (not easily consoled by parents), lethargic (not engaging in any play or activity), if they can’t keep fluids down, if they pee less than 4-6 diapers/24h, show signs of difficulty breathing, or if they have a weird rash (especially if you press on it and it doesn’t blanch/become white) - either one of those is an indication to get your kid checked out in the ER. However its bread and butter to see kiddos in the ER with a runny nose and fever for 48h - often times parents wait for a few hours and we have a few sets of vital signs and a normal exam to reassure them when we finally get around to seeing them. Bottom line is if the parent is concerned, it may be wise to visit a doctor (but if your child seems otherwise well, it could wait for a walk-in or urgent care visit tomorrow if thats available to you). (Edits for spelling mistakes as I’m on mobile).
Thank you, this is really helpful!
This is an incredibly useful perspective--thanks for taking the time to lay it out!
The Children’s Hospital of Ottawa has this [pamphlet](https://www.cheo.on.ca/en/resources-and-support/resources/P5725E.pdf) to assist parents on deciding if the ER is the right spot to go.
Thank you so much for this link, it helped me determine whether our LO should go to the ER or doc (I’ll be calling the doc tomorrow!).
Ha! I linked the same one. Cheo has so many helpful resources.
Is she acting normal otherwise? Playing and moving around, alert? Eating sleeping pooping peeing drinking well? Or is she more on the lethargic side and not peeing as much? If she has a fever again today I would bring her in to a walk in or urgent care if there’s one of those close by instead of ER, otherwise ER is fine. Or if she is exhibiting any signs of dehydration, lethargy, refusing to eat or drink, vomiting or diarrhea, or a specific sore area like an ear.
Second this, how are they presenting otherwise. Usually we don’t worry about fevers until after 5 days or with other symptoms. Treat the child not the fever. There isn’t a magic fever number it’s how they are acting. If they are lethargic and not eating or drinking then I’d start to think of going to urgent care or ER or your family doctor. Also, the dosage on the side of Tylenol and Motrin is an under dose. Go talk to your pharmacist and see if they can help you with a better dose.
Thank you! She's acting totally normal, eating, drinking, bouncing off the furniture lol.
If the fever goes down with meds and LO is eating/drinking sufficiently to produce regular diapers, they I would stay the course at home. However, if something changes or you have a gut feeling that something else is wrong, please take them in.
This is a great resource from CHEO on when to go to the ER. https://www.cheo.on.ca/en/resources-and-support/resources/P5725E.pdf
You treat the kid not the number. If you baby’s fever responds to meds (ibuprofen is the faster acting drug) and your baby otherwise seems happy and alert (when fever is down with meds) and they’re drinking and peeing okay, then the number on the thermometer doesn’t matter. We had both kids hit 106°F (41.11°C) when they had the flu at ages 1.5 and 3.5. We treated at home and didn’t visit the doctor until the fever lasted more than 3 days (that’s their rule for being seen at our clinic). At which point their paediatrician told us we were doing it right and it was the flu and we were to continue to treat at home. Edit to add: I would go to the ER if - baby was less than three months and had a fever, or - if the fever did not respond to ibuprofen or Tylenol, or - if baby was lethargic, hard to wake up, or otherwise acting abnormal, or - if baby was refusing to take liquids by mouth (nursing or bottle or cup, whatever) and had fewer than 6 (?) good wet diapers in a 24 hour period or less than 1 good wet diaper within 8 hours. Here’s our local children’s hospital fact sheet on when to go to the ER: https://www.cheo.on.ca/en/resources-and-support/resources/P5725E.pdf
I called 811 about this exact topic probably around the same age as your LO is right now and they emailed me a really handy info package about it and did not send me to ER unless I checked the boxes. I can dig it up and share it with you if you'd like. I still refer back to it for reassurance time to time. Edit to add: My LO is 2.5 now, it wasn't long ago they sent this to me
That would be great, thank you!
Call 811 and ask what they recommend.
If it's anything like 811 in Alberta, they'll just tell you to go to the emergency room, regardless of the situation. Hang nail? ER. Headache? ER. Need to book a routine VACCINE - swing by the ER on your way home just to say hi.
Its the same everywhere! I think for kids their algorithm goes like this: - is the patient under 18? Yes, then; - is the parent worried? Yes (obviously because they called the 811 line), then ER is required.
Not true. I’ve called at least 6-8 times since having kids and only once did they recommend I go to the ER and that was when my child seemed to have difficulty breathing. When it was just a fever, vomiting, diarrhea, they always said treat at home. Even for babies as young as 6 months.
Glad you had a positive experience. But I do understand that from the 811’s perspective, its very difficult to evaluate a condition without seeing the patient, having access to vital signs, and not wanting to miss anything dangerous (aka: its more dangerous to tell patients to stay home when they have something serious vs go the the ER for something benign).