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| |    Fever: Four to Nine Months by Laura Jana, M.D., F.A.A.P. reviewed and revised by Lynn Cates, M.D., F.A.A.P. Not every baby who feels warm has a fever Babies at this age don't control their body temperatures as well as older children. Becoming too warm is often related to how warmly they are dressed. If your baby 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. When to take fever seriously Somewhere around six months of age, your baby's immune system becomes more fully developed, and she will start to fight infections more effectively. I consider four to nine months a transitional period when fevers in otherwise healthy babies (they're eating well and not acting sick) don't automatically require a phone call to the doctor. However, most healthcare professionals will still use a little extra caution when evaluating babies this age. This would include the evaluation of any baby with a high fever (e.g., higher than 102 degrees F, 38.8 degrees C), or any baby who isn't eating well or looks sick. Providers' definitions of "fever" and "high fever" may vary a bit, so be sure you clarify when your baby's provider wants to be called about your baby's fever. Of course, you should always call if you are concerned. Also see: What's Fever and What Isn't? Don't depend on fever as your only sign of infection. Even in the absence of fever, you should watch your baby for other signs of infection such as irritability, lethargy, or poor feeding. Don't wait for a fever to seek medical attention if you have concerns about your baby's health. Common causes The most common causes of fever in a baby this age are generally the same as for you or me, viral infections. If your baby has symptoms of a viral infection, such as a cold or diarrhea, especially if she has been exposed to others with the same symptoms, she may well have the same infection. Babies may become much sicker than older children and adults with the same infection. The same cold that causes a simple runny nose for an eight-year-old may cause fever, congestion, poor sleep, poor feeding, and even vomiting in a baby. The best approach is to limit your baby's direct exposure to people who are sick, especially people with fever. How fever affects your baby's eating Many babies start eating baby cereal and foods by around six months of age. For some babies, having a fever may not affect their fluid or food intake, and this is very reassuring. It is very common, however, for babies who develop fevers with viral infections at this age to lose interest in solid foods until they feel better. There's no need to focus on how much solid food your baby eats while she has a fever and cold. However, keeping track of your baby's fluid intake is very important when she has a fever. Pay attention to how much and how often your baby is drinking compared to her normal intake. Fever, as well as vomiting and diarrhea, can lead to dehydration. Even if they do not have vomiting or diarrhea, babies can become dehydrated more quickly than larger children and adults. Offer more frequent breast- or bottle-feedings and pay close attention to whether your baby starts to urinate less often, as this can be a sign of dehydration. Be sure to discuss with your baby's healthcare provider any concerns you may have. Taking your baby's temperature Although there are several types of thermometers available, some are not accurate or appropriate for use in babies. Many new parents cringe at the thought of using a rectal thermometer, but many health professionals consider it the most appropriate method for taking a baby's temperature. If you have questions about the type of thermometer to use or how to use it, don't hesitate to ask your baby'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 I'm changing a diaper), while others prefer to have the baby lay 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, and 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 baby to have a bowel movement. Also see: Thermometers: Types and Techniques Treating your baby's fever Many healthcare providers will ask that you not use medicine to treat your baby's fever so that you can follow the course of the fever, especially in a baby who appears well, who is eating and sleeping well, and behaving normally. While healthcare providers have varying preferences in approaching fever in babies, there are a few accepted rules to follow. Types of medication Acetaminophen (found in Tylenol®, Tempra®, etc.) is available for use in babies, but should be given only if recommended by your child's health care 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 children under six months of age, and many health professionals recommend it not be used for babies under 12 months. Check with your baby's provider before using ibuprofen. Do NOT use aspirin for fever in children. Dosing Acetaminophen products for treating fever in babies usually come in the liquid form to be given by mouth. Be sure you know exactly what type of liquid form you have because there are many types available and the strength of the medication will vary. Acetaminophen also can be given rectally as a suppository. Dosing is based on your baby's weight. When in doubt, be sure to ask your child's provider for an appropriate dose. The dose will change as your baby grows. Read labels of all medications carefully. Giving your baby the medicine Liquid medication usually comes with a medicine dropper. It's best given by leaning your baby back slightly and putting the dropper in one of her cheeks. Check with your child's healthcare provider or your pharmacist before mixing medicine with either baby food or drinks. Suppositories are actually very quick and easy, as well as painless. Although most parents I talk to shudder at the thought of using suppositories, they are especially useful for a baby who is vomiting, who won't take medicine by mouth or spits it out, or even who is sleeping. I find it easiest to have a baby 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 baby 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 healthcare provider when another dose should be given so that you don't overdose your child.
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