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| |    Fever: Zero to Four Months by Laura Jana, M.D., F.A.A.P. reviewed and revised by Lynn Cates, M.D., F.A.A.P. Not every infant who feels warm has a fever Babies under four months of age don't control their body temperatures very well. Becoming too warm is often related to how warmly they are dressed or bundled. If your infant feels warm to the touch but cools down quickly when unbundled, and is otherwise acting well, chances are it isn't a true fever or cause for concern. I have also found that skin-to-skin contact, such as when breastfeeding, can also cause babies to feel warm temporarily. Take fever seriously at this age Fever in a newborn or infant younger than three or four months of age requires more attention than in older infants and children. At this age, the immune system is not fully developed and infants are not as well-equipped to fight infections as an older child or adult. In addition, there are certain serious infections that are more likely to appear in the newborn period. The risk When an infant this age develops a fever, the risk of a serious infection is small but real. You should never hesitate to call your child's healthcare provider. Although your provider's definition of what temperature is considered a fever may vary a bit at this age (usually higher than 100 degrees F or 100.4 degrees F, 37.7 degrees C or 38.0 degrees C), it is relatively universal for healthcare providers to want to be informed of a fever and evaluate your child. Be sure you clarify when your infant's provider wants to be called regarding fever. But always call if you are concerned. Don't depend on fever as the only sign of infection If your child is irritable, lethargic, not feeding well, or just looks sick to you, whether or not she has a fever, you should suspect an infection. This is because an infant under four months of age may not mount a fever in response to an infection. Don't wait for a fever to seek medical attention if you have concerns about your infant's health. Viral infections are the most common causes of fever The most common causes of fever in an infant are the same as for you and me, viral infections. However, never assume that a fever is just a viral infection in an infant younger than four months of age, without discussing it with your infant's healthcare provider. Infants may become much sicker than older children and adults with the same infection. The same cold that causes a simple runny nose in an eight-year-old can cause fever, congestion, poor sleep, poor feeding, and even vomiting in an infant. Preventing infection in infants The best approach you can take with your infant is to ask all who hold her to wash their hands first, and to limit her exposure to people who are sick, especially people with fevers. By using these simple measures, you can decrease (but not eliminate) your infant's chances of getting a viral infection and therefore, fever. How fever affects your infant's eating At this age, we're generally only talking about breast- or bottle-feeding. For some infants, having a fever may not affect fluid intake, and this is very reassuring. If your baby does seem to be drinking less, pay attention to how much and how often, as well as whether she is having fewer wet diapers. Fever, as well as vomiting and diarrhea, are all potential causes of dehydration. Even if they don't have vomiting and diarrhea, infants can become dehydrated more quickly than larger children and adults. Also, poor feeding can be a sign of a more serious infection, so be sure to discuss any concerns you have with your baby's healthcare provider. Taking your infant's temperature While there are several types of thermometers available, many are not accurate or appropriate for use in infants and newborns. New parents often cringe at the thought of using a rectal thermometer, but many health professionals consider it to be the most appropriate method of measuring temperature at this age. If you have questions about the type of thermometer to use or how to use it, don't hesitate to ask your infant's healthcare provider, and even request a demonstration. When using a rectal thermometer, I find it easiest to put the baby on her back with legs folded up to her belly (like you're changing a diaper), while others prefer to have the baby lie on her belly across their lap. Using a little petroleum jelly on the metal tip, you can easily and gently slide it into your baby's rectum just far enough that the metal is no longer showing. Do not force the thermometer. Once it is in place, gently hold your baby's buttocks together to keep the thermometer from slipping. The most practical way to know when it's OK to take it out is when the mercury stops rising or the beep sounds on a digital thermometer. Be aware that every now and then, taking a rectal temperature can trigger your infant to have a bowel movement. See also: Thermometers and techniques Treating your infant's fever Many healthcare providers will ask that you not use medication to treat your infant's fever so that you can follow the course of the fever, especially in an infant who appears well, is eating and sleeping well, and behaving normally. Although healthcare providers may have slightly varying approaches to fever, there are a few accepted rules to follow. Types of medication Acetaminophen (found in Tylenol®, Tempra®, etc.) is available for use in infants, but should be given only if recommended by your child's healthcare provider. It should not be given more often than every four to six hours. Ibuprofen (found in Motrin®, Advil®, etc.) is NOT recommended for use in infants under six months of age. Do NOT use aspirin for fever in children. Dosing Acetaminophen products for treating fever in infants usually come in liquid form to be given by mouth. The infant type is usually labeled as "infant drops." Be sure you know exactly what type of liquid form you have because there are many types available, and the strength of medication will vary. Acetaminophen also can be given rectally as a suppository. Dosing is based on your infant's weight. Be sure to ask your infant's healthcare provider for an appropriate dose. The dose will change as your baby grows. Read labels of all medications carefully. Giving your infant the medicine Liquid medication in the form of infant drops usually comes with a medicine dropper. It is best given by leaning your infant back slightly and putting the dropper in one of her cheeks. Rectal suppositories are actually very quick and easy, as well as painless. Although most parents I talk to shudder at the thought of administering suppositories, they are especially useful for an infant who is vomiting, won't take medicine by mouth or spits it out, or even for an infant who is sleeping. When inserting a suppository, I find it easiest to have the infant on her back with legs folded up to her belly (like I'm changing a diaper). Using a little petroleum jelly on the suppository, you can easily and gently slide it into your baby's rectum. Gently hold your baby's buttocks together for a minute or so after inserting the suppository. Be aware that every now and then, this "procedure" can trigger your infant to have a bowel movement. If a bowel movement occurs immediately following the suppository, you can repeat the dose. But if it occurs more than a few minutes after you have inserted the suppository, discuss with your child's provider when another dose should be given so that you don't overdose your child.
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