Low Grade Fevers

Just found another thing to add to my list of pet peeves.

First, I’ll recap. There are three things that get on my nerves to the point that I have had to rant about them: Cell phones, using the term “emergency room,” and anyone who engages in “baby talk.”

Introducing #4: The “low grade fever”.

This peeve is more about doctors than it is about patients. Most patients don’t and shouldn’t know about medical definitions. I sympathize with patients and families who are inappropriately sent to the emergency department for evaluation of “low grade” fevers. Most of the time, this isn’t your fault. Just don’t go telling everyone else what your doctor said so that the problem gets worse.

The definition of a fever is either a core temperature of more than 100.4 degrees OR an increase of 2.4 degrees or greater above the patient’s basal body temperature. Before you use part B of this definition, you better be showing me some graph paper with temperatures plotted on it. Some experts even state that a temperature isn’t a fever until it hits 101 degrees. Hyperthermia is considered an elevated temperature beyond the body’s normal set points and is generally defined as a temperature of 106 degrees and above. Hyperthermia is bad news and requires immediate medical evaluation.

In 99+% of cases, fever isn’t the enemy. Fever is potentially dangerous in newborns and infants less than 30 days old. Seek immediate medical care. Fever in kids less than 3 months old is still possibly dangerous, but less likely so. Kids older than 3 months are generally safe with fevers. I’ve had several parents come to me concerned that their kid’s brains are going to fry. Your kids aren’t eggs and their skulls aren’t skillets. Brains don’t fry unless you’re in Hannibal Lechter’s kitchen.

If you’re using tympanic thermometers, don’t. There are many studies showing that tympanic thermometers are unreliable or at least less reliable than other methods. Yes, some studies show that tympanic thermometers are reliable. If you had three measuring devices showing that a cup was 8 ounces and six showing that a cup was anywhere between 6 and 12 ounces and couldn’t tell the difference between any of them, which one would you use to bake a cake?

I’m getting off track.

First, don’t try to BS me and tell me that you’ve taken your temperature or your child’s temperature when you haven’t. When parents of an 18 month old bring him in for evaluation of “low grade fever” of “ummmm 99 …. point …. 2 or3,” sorry, but my BS meter has already gone off. No Motrin for you … 1 year!

Second, I don’t care what your doctor told you. Less than 100.4 degrees is not a low grade fever. It isn’t a fever period. I know it’s probably not your fault. I know you’re trying to be a good parent. If your doctor insists that a temperature less than 100.4 degrees requires an emergency department visit, get another doctor.

A temperature of 99.4 is not a low grade fever any more than a blood pressure of 100/60 is low grade hypertension or driving 50 MPH on the highway is low grade speeding.

And no, you don’t need antibiotics for a low grade fever … even if it really is a fever. Amoxicillin doesn’t contain Tylenol and Zithromax isn’t a decongestant. They won’t help.


UPDATE NOVEMBER 4, 2014Ebola Picture

I noticed that this post still tends to get quite a few hits  and quite a few comments even though it is four years old.

My sentiments haven’t changed. Low Grade Fevers are a non-entity and until someone shows me medical research to the contrary (no, stories about your cousin’s sick child whose temperature usually runs in the 80’s don’t count), Low Grade Fevers will remain a non-entity.

It’s almost comical how many people have engaged in ad hominem attacks against me and suggest that I pick another specialty because I dare to present some medical studies and factual information to burst their bubbles about something this simple. No, your baseless assertions that I am mean, have poor bedside manner, and that I’m a female hygiene product in disguise don’t hurt my feelings. They just show me how many people possess no logic and try to win an argument by whining and crying when no one else agrees with their assertions that the world really is flat.

However, with the recent Ebola hysteria and the influenza season looming on the horizon, I had to put this question out there.

For all of you people whose systems go into shutdown when your temperature hits 98.75, let’s suppose that you are traveling internationally. Are you going to go to the customs agents and tell them “I’m not like everyone else. My temperature may be normal by your standards, but when I hit 98.75 degrees, I could be in the early stages of Ebola infection and I should be quarantined for 21 days”?

77 Responses to “Low Grade Fevers”

  1. Suzanne says:

    2 things you should know: every pediatrician I’ve taken my children to (in two different countries!) have used tympanic thermometers. Why do that if they are so inaccurate?

    And 2, where we live now, Switzerland, my ped wouldn’t give my child a vaccine because his fever was elevated–37.2 celsius–99 fahrenheit.

    This is why parents worry and use tympanic thermometers. Their pediatricians have told them to.

  2. Pink says:

    Most excellent post, sir. You had me in stitches this morning!

  3. Gene says:

    And what about the return visit because the Tylenol or Motrin “wore off” and the fever “keeps coming back”? That one is just a huge eye-roll for me.

    • Good God says:

      It’s “Hear Hear.” For Christ’s sake, don’t tell me you’re a doctor; no wonder most of the parents disagree, as the incompetence must be high-grade among you and your colleagues in agreement with this ridiculous post.

  4. Kyla says:

    Well said! It doesn’t matter how many times you explain this to some people, though, they still drag their kiddos in for 99.1 “fevers”. These are the kids who are doing cartwheels in the ED waiting area.

    • Emma says:

      I work in daycare and we have to send children home at 100* I’ve yet I have seen a child with a fever of 99 and up EVER do a cartwheel or anything other than stare off pale. And I’ve sent hundreds of ifs home thousands of times over the year. They aren’t fine in fact feverol seizures begin at 100* which I’ve also had happen. Explain that how did those children get feverol seizures If they didn’t have “fevers” at least not by your definition.

      • Jane says:

        A: FEBRILE seizures.
        B: FEBRILE seizures are more likely to start around 102, though they can start lower it is less likely.
        C: FEBRILE seizures are more harmful in that they are scary for parents and caregivers rather than directly harmful for kids.
        D: You should know more about FEBRILE seizures if you are taking care of children who so frequently experience them while in your care.
        E: Why are so many children getting so sick at the daycare in which you are employed? I would be very concerned.

      • MPeer says:

        My daughter has been running a “fever” of 99.3F-99.8F for about two months. Ibuprofen will bring it down but she’s not sick! She’s clear for strep, ear infection and flu. She’s eating like normal, jumping off the walls and playing soccer. Her nose isn’t running her throat isn’t hurting her body isn’t aching. I’m not taking her into the doctor again like an idiot.

        Also, I don’t treat fevers until they reach 102F and over (unless they’re infants) because fever is good. It’s your body’s mechanism for beating that infections butt. That’s university biology 101
        This doctor is right, too many idiotic cases that can be treated at home crowd the ER. There are people who need the ER and those people cannot walk in and get treated immediately because of this kind of BS. In order to get seen ASAP you have to take a $1200 cab ride aka the ambulance. That’s unfair.

  5. Mama On A Budget says:

    Don’t even bother with the basal temperatures and MDs. I have taken my waking temperature with a basal thermometer for over 4.5 years (with the exception of a pregnancy thrown in there). I’ve brought my records with me to every doctor’s appointment. I can prove with data and graphs that my highest temp is 98 even and my average temp is about 97 even – and they all say I’m crazy.

    Which is why when I get a fever, I drink more water, take some vitamin C, and let it burn off whatever it is that is making me sick. And yet I (as well as my 3 and 4.5 year olds) were able to survive the “Swine Flu” and 104-105 temps last year without being told to take antibiotics (that weren’t necessary) or get a vaccine for the same damn thing after the fact.

    A fever is just the body’s way of killing off the virus. If it doesn’t last more than a couple days, everyone needs to just chill the heck out. Bringing your snot-nosed febrile kid to the doctor’s office and letting them sneeze all over the toys is just your way of sharing the bug with everyone else. Then going to the grocery store to fill the unnecessary Amoxicillin Rx just gets the little old people waiting for their blood pressure meds and insulin refills sick, too. Stay home, feed them (and yourself) some chicken soup and orange juice, and get some rest – for everyone’s sake!

    • Nurse K says:

      Um, why are you randomly checking your temp? That’s a bit bizarre…

      • Gene says:

        Likely for fertility reasons. Natural family planning techniques use basal body temps (among other things) to track fertility. A woman’s body temp increases right around ovulation a few tenths of a degree (F). Women who are either trying to conceive or trying to avoid pregnancy often track BBT to assist in their endeavors. I personally know several couples using this technique. It is not uncommon.

      • Nurse K says:

        Hm…Nuva-Ring vs. “checking your temp”…I’m going Nuva-Ring.

      • Felix Kasza says:

        Nurse K — there are folks who measure BBT to _increase_ their chances of getting pregnant. You seem blissfully unaware of anything fertility-related beyond the Nuva-Ring.

      • Mama On A Budget says:

        Yes – to GET pregnant. Thanks.

        Some of us prefer to trust our bodies over big pharma. Nuva ring… around for 5-10 years. Temperature rising at/after ovulation and changes in cervical position and discharge… since the dawn of man.

      • MPeer says:

        And I think if “Mama’s on a Budget” she’ll have a problem with the Nuvaring since it’s $125/month
        Insurance rarely covers it.
        But I digress.

  6. Nurse K says:

    I think this was intended for children and worrisome young adults with fevers, although it doesn’t really say.

    However, I’d like to give a little shout-out to the fact that very elderly people with serious infections often have no fever…20-30% in fact.

  7. Nick says:

    The low-grade fever is rant-worthy, to be sure. Maybe not as frustrating as allergies (which you covered very well last year) but pretty bad.

    My fever peeve regards decimals. The nursing home tells the family the patient’s temp was 100.6, but when they’re telling me in the ED, it becomes 106. At least in that case there are records I can fall back on.

  8. DefendUSA says:

    Off topic, sort of. I never had trouble getting pregnant…but I did do the BBT as part of a paper for college. I actually discovered over 3 months of measuring that I ovulated twice a month!! I spent a ton of money to confirm it with those predictor tests, too. I got pregnant on the 7th day, 23rd day, 19th day and 14th day respectively with my four kids. I still find that amazing and I did document it!

    As for my kids and fevers…I used the tympanic thermometer, but many times felt it was wrong and did a rectal to confirm a high fever.

  9. midwest woman says:

    Body Heat..if anybody remembers that movie…Kathleen Turner was always a sizzlin’ 100 degrees or somethihg like that.

  10. SeaSpray says:

    Both community hospitals I am familiar with use tympanic thermometers ..both in the ED and on the floors. I often guide them to put it all the way in and nurses say it doesn’t matter..which doesn’t make any sense to me because when I guide them in they kind of have to go around the bend and I can definitely tell a difference. I would think it would be warmer all the way in then just on a ledge in the outer ear. ?? Does the depth matter?

    And ..if no one should use these tympanic thermometers ..then *WHY* do hospitals use them …and does it matter ..does the temp accuracy matter?
    I used to take my basal body temp for about a year. I had infertility concern with first child. However ..when you’re afraid you may never conceive ..you become a *slave* to the chart and it can get mechanical. You get so obsessed with timing.
    The Soup Nazi – My FAVORITE Seinfeld episode! Ha ha! When I think of all the scenes in that episode ..but the Soup Nazi – EXCELLENT! :)

    Another favorite – Scrubs – My Machines!


    I can watch that over and over and over and over again and now will before signing off. :(

    That actor is just PERFECT playing the extremely irate radiologist! :)

  11. SeaSpray says:

    “I can watch that over and over and over and over again and now will before signing off. :(”

    That was supposed to be a HAPPY smile face. :)

  12. hannah says:

    We had a guy that kept coming in with lowish “real” fevers (101 or so); finally got diagnosed with malaria. That was kinda cool.

  13. ERP says:

    I get irritated with that too. Just last night I had “Oh, I checked my temp and it was 99.0 so I have a fever since I usually run at 96.5″. Yeah right, prove it to me.

  14. SeaSpray says:

    One more thing …my normal temp was always 98.6 …until I had sepsis, etc back in 06.

    But ever since then ..my norm seems to be in the 97s.

    I did ask a doc about it and I don’t recall his explanation ..but an illness like that can cause the normal temp to reset to a lower norm.

    Can anyone explain that?

  15. doc99 says:

    Truly a pity that hit TV show was called ER.

  16. Roberto says:

    According to this article the gold standard for temperature measurement in the clinical practice should be RECTAL temperature. Oral temp outperformed tympanic temp measurement. All patients seeking help in the ED for ‘low grade fever’ should be alerted about these facts, and thus all need to have their temp measured up their ass.

  17. Mandy says:

    Peds do not always send fevers to the ER. When my son had a fever of 106 and we couldn’t get it go down with Motrin, I called my pediatrician (middle of the night) and he told me to just give him Tylenol with the Motrin–it worked–got it down to 103 and my son was able to sleep.

  18. Blacksails says:

    Nurse K, when are you going to reopen your blog?

  19. jb says:

    Of course, the urgency in which moms think their child needs immediate medical attention is directly correlated to whether or not they are on medicaid. It is only going to get worse now that more people are about to get “free” care…

  20. Stalwart Hospitalist says:

    “Low grade speeding.”


  21. abi says:

    in no way do i find that a fair statement. i am a mother on medicaid. i dont rush my son in for everything because its free. i took ny son to the er last night because his fever kept spiking to 104.4 despite the tylenol and motrin i had been rotating in four hour intervals. you must be the kind of know it all nasty nurse i put in there place last night. i am finishing my training as an ma now so im not an idiot, im just poor hence the medicaid. i would suggest if ypu dont enjoy working with cranky people without adopting there attitude, you should probably find another career.

  22. pet peeve…

    […]Low Grade Fevers | WhiteCoat's Call Room[…]…

  23. Concernedmother says:

    When you have a child with a fever that pretty much does not break down regardless of following the instructions (Tylenol every 4 hr), crying with headache, tummy ache, does not want to eat anything, lost almost 10lbs in 5 days, what a mother should do then? I have insurance and not on Medicaid. I don’t think it is any doctor’s business for being cautious with my child. You are getting paid so what do you care how frantic a parent feels. Doctors attend medical school to put parents and children’s mind at ease and to get paid comfortably. But I may be wrong. Maybe their main focus is the almighty dollars. Those same doctors are the ones who will quickly contact child services to state that the parent was negligent and if he or she had reached out immediate medical attention, this or that would not happen. So you know what, maybe some of the doctors in here chose the wrong profession and need to return to school for something else. This is a person-approach type of career just like Sales or Customer Service. If you (doctors) are grouchy all the times and start taking everything personal, then you will always need to post frustrating comments in similar sites to release your nerves. So chill and do your JOB!!!!

  24. Victoria says:

    Who the hell are you? You sound like an imbecile. Is this post supposed to be amusing? You seem hung up on semantics. You may not like referring to a borderline fever as “low grade” but it is a valid way to describe it. Also, as the first commenter said, there are physicians out there who will consider a 37.7 temperature to be above normal. But even if you don’t, it strikes me as ridiculous that you would waste time ranting about concerned parents. It seems that someone wants (needs?) to feel important. Were you not given enough attention growing up?

  25. AA Surgeon says:

    First World Problem. Be thankful for the compassionate parents that bring in a child for a “low grade temp” instead of the ones whose neighbors have to bring in their battered children.

  26. Alyssa says:

    So I care for a little one, I’m the nanny, anyway…the boys that I watch have a body temp of 97.4 when they are healthy. I’ve checked, many times while they are healthy. The mom is the same way. Anyway for the last 4+ months now, the baby, who is 16months has had fevers, almost daily…they usually brake with “Tylenol” and run from 99.4 (according to you not a fever) to 102. A few times 103 to 104. He has also been exteamly fussy these past months, and has at least 3+ movements of diarrhea per day. His doctor says not to worry unless he has like 5+ movements a day. He’s just not himself. His appetite comes and goes. I know that’s normal but this isn’t. I know you can’t diagnose, but does this sound like anything..? At what point do we take him back to the doctor?

  27. Lolo says:

    Err…Here’s a story about why “low grade” or non-febrile “fever”, or maybe “subjective fever” is a better terms, is an important piece of the puzzle, even and perhaps especially when it disappears by the time the patient is triaged. I seem, it first glance, like the kind of neurotic somatosizing attention seeker that clot ERs and inspire frustration, disdain, and belligerent blogs: Anxious, wan, complaining of “low-grade fever” and headache that improve miraculously by the time the disgruntled resident who drew the short straw arrives to examine me. In Dec 2011, I presented to the ER of a nationally prominent teaching hospital with all the vague symptoms you might reasonably hate at 3 am on a Friday-Sunday shift. I was told by a smirking resident I had no fever. When I quoted his hospital’s own outreach pamphlet he threatened to call security (clearly my supine position and crushing headache belied murderous intent…) I demanded to see his attending, and we discussed Dr. Smirking’s education. I was then discharged without any treatment or test.

    I subsequently discovered, ten days later, that I was suffering chronic CO poisoning within my home.

    There is no excuse for this in the NW, where “flu-like symtpoms” beset residents as soon as it gets cold and gas heaters are turned on. The CDC, the news media, public service announcements all warn that CO poisoning is the most common missed ER diagnosis, because CO poisoning mimics the flu, allergies, a cold…causes headaches, malaise and elevated body temperature. Some studies have suggested more than half of “flu” Dx in cooler months are, in fact, CO poisonings. CO poisoning often “resolves” in the wait for ER attention: Carboxyhemoglobin’s half life is only a few hours.

    And before you whinge about the impracticality of running a carboxyhemoglobin blood test on every fluish patient, please remember there are now portable pulse spectrometers that can distinguish serum Osat from carboxyhemoglobin saturations. Your hospital probably has one. If it doesn’t, go straight to risk management and demand one. Sound like too much trouble for a pain in the ass subset of patients? You might want to consider the cost-benefit analysis of a $45 blood test versus a malpractice suit for failure to Dx.

    And yet, I think I still hear the resentful teeth-grinding of ignorant curmudgeons. Still, there is NO EXCUSE for missing a CO poisoning. Even without a portable COhb enabled P-spect, even before the bloodtest(which ought to be routine during winter months in cold climates) comes back, ONE SIMPLE HISTORY QUESTION CAN SAVE YOUR ASS AND SPARE YOUR PATIENT A WORLD OF HURT:

    “Have you recently turned on or started using a different gas heater/ woodstove/ fireplace/ boiler/ old water heater/unvented gas cooking stove?”

    Are you really to busy to ask that one question? Or is it that you’ve become so hardened to ignorance you fail to recognize it in yourself?

    And why should you “be nice” to “difficult patients” like me? After all, haven’t you been taught that we’re litigious, and that your chances of being sued increase with contact time? Maybe. And maybe not. The prestigious teaching hospital failed me, and the attending missed my Dx. I suffered substantial harm as a result. But because the attending treated me with respect and kindness, I could not fault him for his mistake and have no desire to litigate.

    Believe it or not, I actually do know how hard your job is even without “difficult” patients like me. Indeed, the reason I and others like me often give you too much, largely irrelevant information is because WE WANT TO HELP YOU HELP US.

    And in case you’re wondering: When you took your CPx to get your license, your “history” segment was one I helped beta-test and standardize during the initial development of the CPx. To be a doctor, you must have credentials. But it is seeming to me that increasingly, to be a “successful” patient one must be bland as store-bought pudding.

    Hippocrates has left the building–but wasn’t that Freud I saw in the lounge?

  28. holyroar6 says:

    Hmm… All of my children suffer from genetic autoinflammatory disease ( HIDS/ TRAPS). When they flare they will run temps as high as 106. Now that being said they will run what we call low grade fevers between 99.5- 101 we call they low grade because they are taking maintenance NSAIDS daily so who knows what the temp would be if they were not on the NSAID. It may not be an “actual” fever to you but one can still feel pretty lousy with 99.5- 100.4. Just a not Dr.Kastner at the NIH you know what the NIH is right? the National Institute of Health recommends treating these flares at 99 degrees because if you don’t they temps rage and the flares are harder to control. We HATE going to the ER and only go if we can’t get a fever to drop…because I Hate running into healthcare “professional” who don’t know what they’re talking about…we’ve been battling this for 17+ years please don’t treat me like I’m an idoit.

    • WhiteCoat says:

      That’s it. You’re getting a slapdown.

      OK my punctuation-challenged commenter, show me where “Dr.Kastner at the NIH you know what the NIH is right” says every person in the emergency department with a temperature of 99.5 requires aggressive “fever” management.
      Yeah. Didn’t think you’d find anything.

      But, while we’re at it, maybe we should change standard medical treatment for every patient in the United States whose parent thinks he or she feels “warm” because you’ve got a chip on your shoulder over your kids’ genetic disease. My kids have a genetic disease, too. Maybe I could impose all of their medical restrictions on your family while we’re at it.

      If you’ve been battling healthcare professionals who don’t know what they’re talking about for the past 17 years, then why don’t you go see Dr. Kastner next time your kids have a “fever”? Get his cell phone so you have a direct line at all times to his competent care. See how well that works for you — HE DOESN’T TREAT PATIENTS.
      You expect “ER” physicians to have an in-depth knowledge of every possible disease and genetic syndrome on Earth then be at your beck and call when you snap your fingers and walk into the emergency department spouting off run-on sentences about how your kid needs STAT ibuprofen with a normal temperature? Get a clue.

      If you don’t want to be treated like an idiot, don’t act like one.

      • holyroar6 says:

        Yes my punctuation and grammer isn’t the best when I’m tired or my spelling for that matter. You are taking my post as a personal attack, which it was never meant to be. I don’t expect my ER docs to know every possible genetic disease and we don’t go to the Er for ibuprofen. Actuaally I can email Dr.Kastner and my pediatric rheumatologist.
        The point of my post was not everybody with temp under 100.4 is normal and maybe just maybe you could show some kidness and understanding to some weary parents who may be struggling with something your not familar with? By the way I don’t have a chip on my shoulder. let me give you a case senerio. 16 year old son spikes a 106 degree fever and we are sent by our pcp to ER. By the time we get there and sit through triage temp has gone down to 101. We are then told by the ER personel there is no possible way your son has had a 106 temp he wouldn’t have been able to walk in here !??? He way more tachacardic(sp?) then he should have been with 101 temp but because I’m just his parent and they are the professionals what could I possibly know? Those are the battles I was talking about. We are ever so thankful for the wonderful healthcare professionals that we deal with on a regular basis it would be nice to encounter that in the ER whenwe have to go in also.

    • Grumpy Old Bastard says:

      Your children all suffer from both HIDS and TRAPS? How unusual for 100% of children in a family to be suffering from two very rare genetic disorders, one autosomal recessive and one autosomal dominant, with defects in both chromosome 12q and chromosome 12p). The geneticists must love studying your family.

      It’s also odd that you say you only take your kids to the ER if you can’t get their fevers to drop, yet as per your second comment, an hour or two in an ED waiting room is all it takes to magically lower their temp from “106” to 101. I hope you gave that ED glowing Press-Ganey scores for having worked such magic.

    • Grumpy Old Bastard says:

      Also: “Just a not Dr.Kastner at the NIH you know what the NIH is right? the National Institute of Health recommends treating these flares at 99 degrees”.

      Every single one of your children suffers from these two rare genetic disorders, and you’ve been dealing with them for 17 years, and your regular doc hasn’t helped you learn how to treat these flares at home so you don’t have to keep rushing off to the ED? What can an ED do for a child with periodic fever syndrome running a 99 degree temp that a parent can’t do at home?

      Don’t subject your kids to hospitals unnecessarily. That’s where all the sick people are.

      • holyroar6 says:

        I have 4 children each have one mutation for HIDS. And two of them have the one mutation for HIDS and Traps. Yes we hit the genetic lottery. We do not go to the ER for 99 temp. Do you guys really read a post before answering or just react to what you don’t like? We treat a temp with prednisone at home when a temp is at 99 because if we don’t treat then it tends to be harder to control the higher the temp. We try not to go to the ED at all they are on immune suppressant meds. There have been occasions when a temp won’t drop no matter the nsaid or prednisone and then we have to go in and yes once we sat in the ED and by the time we were seen med given at home have kicked in other times they have been admitted to peds floor.

        The only reason I responded at all to this post was to point out that sometimes a temp under a 100.4 should be taken seriously. That not all parents just drive into the ED because they have nothing better to do. And it would nice to be met with compassion instead of arrogance and contempt by those we are looking to for answers. A lot of peds docs. have never heard of periodic fever syndrome it took us 9 years to get a diagnosis.

  29. How disgraceful you are to the medical profession. Those of you who think you are high and mighty, and know it all… posting that a temp. of under 100.4 is nothing to be concerned about…. that a temp like that is not a fever and basically nothing to worry about. To concerned parents reading this ridiculous thread, if your child is running frequent temps over 99.5 this should alert you that something may be wrong. Perhaps it doesn’t warrant a trip to the ER but certainly must be brought to the attention of your childs Dr. and should not be blown off. For my daughter a temp over 99.5 is typically related to a Lupus flare. Most often this is accompanied by extreme fatigue and chronic pain. Even on the naproxen she takes for inflammation and the disease modifying medication, plaquenil. And before you snarky @$$holes try the same $h!t you tried with HolyRoar6… Yes Kids get Lupus too. Maybe you should go back to med school and study up about Autoimmune disease. But please, don’t even consider going into ped. rheumatology and try to treat my my child with your condescending, narcissistic attitude.

    • JustADoc says:

      A temperature is but one data point. If the ‘elevated’ temp is the only complaints than I am unlikely to greatly care.
      However if it is accompanied by severe ear pain, abdominal pain, rash, shortness of breath, sinus pressure of 7 days duration, undue fatigue, new joint pain, or something else that suggests possible bacterial infection OR you have a history of some disease where slight changes in temperature have some meaning than this post is not about you.

    • WhiteCoat says:

      Yeah. My kids stop listening to me any time their temperature goes above 97.7 degrees. I keep telling their pediatrician about it and he just says to give them Tylenol, but it never seems to work.

      You’re another one who apparently thinks that medical treatment for the entire universe should be modified to conform to your child’s idiosyncrasies. Let’s give everyone DMARDs for a “fever” of 99.6. Woo hoo.
      So you mean to tell everyone here that your pediatric rheumatologist busts out the immunoglobulin every time your child has a “temperature” of 99.6? Bull.
      When you find any medical articles that suggest testing a child to see if “something is wrong” when the child has a temperature over 99.5, you post them here.

      Until then, if you’re relying on solely the presence of a 99.6 degree “temperature” to clue you in to your child having a lupus flare, then maybe you should read a little more about your child’s disease rather than running your yap on a medical blog.

    • DefendUSA says:

      Dear SIL: This post is not about patients who are exceptions to the rule. It seems you are taking this quite personal and you shouldn’t be. It appears that with either syndrome that children can go years without a fever and if they do have one often present with multiple symptoms. Hence the term “flare up”.
      For you to become so indignant when WC was clearly referring to people who should wait to see their GP if a fever is the ONLY symptom is just over the top. The attitude is not condescending or narcissist, but a result of frustration that people (and some general practitioners) not using common sense. It amounts to wasted ER resources and money, frankly.

  30. Victoria Ashley says:

    I have to say, I’m kind of surprised by some of the “Dr’s” comments on this thread. There is in fact such a thing as a “low-grade” temp/fever,& no it’s not nearly as serious (obviously)as a regular fever(& usually it doesn’t warrant a trip to the ER,unless the pt has some kind of underlying condition etc.) HOWEVER, with that being said…have some compassion please. This exact attitude is one of the main reason’s for the major lack of respect now for the healthcare professional in the last few years!!

    Not all future patients are up for a Darwin award Doc’s. Trust me, I get it (I’m a nursing student, so I literally see both sides of it, & sometimes the pt can be in the wrong & give the Dr undeserved grief & expect them to be Houdini.)

    Generally speaking though, parents are in fact intuitive(& can be right at times)when it comes to their child (yes,some parents can be overly extra-anal & in you’re head you can’t help but want to scream the word “Munchhausen’s” just so they stop.)However,for the regular half-decent parent, they really are just trying to do what’s right. I highly doubt most parents are thrilled at the prospect of sitting in an ER for all hours of the night, extremely tired,& with a child who isn’t feeling well. All to be told by some Doggie Houser lookalike, that it’s “no big deal” & treated like they are nothing more then over-dramatic idiot’s who wasted the very important Doc’s time.

    Put YOURSELF in their shoes Doc, the “you” BEFORE med school. The “you” before “you” knew everything. Just have a little bit of understanding, it’s not a parent’s or a pt’s fault that their particular case isn’t a runner up to help you get a Lasker Award or the like.

    The good thing is that I’ve recently heard,that med school’s are now starting to teach a little bit more about communication & the importance of it. The sad thing is that with the lay-off’s of most RN’S & LPN’s recently,in favor of “MA’s” and “PA’s”(no,NOT physician assistant’s-the other PA.)Who are just taught the simple “skill” & not the reason & theory behind it. Ma’s/Pa’s who aren’t taught(because it’s simply not in their scope of practice to) advocate for the Pt and be a valuable asset for the Doctor(like Nurse’s are required to!) Compassion is going to be nothing but a long lost English word. All healthcare in the future will undoubtedly suffer because of this, most of all the Patient’s and even the Doctor’s.

  31. picklesticks says:

    Our nephew ran a “non-fever” of 99.4 to 99.8 for for more then a week..only other symptom was some intermit. fatigue otherwise he was acting like a normal 7yr old boy..he was diagnosed with leukemia after my sister in law took him to see his pediatrician…so sorry, as a parent of 4 and an Aunt to a cancer survivor..your blog was way off the mark.

  32. Med Staff Credentialer says:

    Regardless of your medical and personal opinions, it’s obvious that you never learned effective communication skills. You’ve shown how you would (and obviously do) relate to parents and others who come to the ED with their concerns, but you have also shown the same blatant disregard for other people’s opinions that have taken the time to post comments. Whether you agree or not, your delivery and smug responses will no longer be tolerated in U.S. hospitals as they begin to fully implement focused and ongoing professional practice evaluations and sound credentialing practices. When someone treats the hospital’s “customers” with this attitude, they should be addressed immediately by the department chair and not allowed to continue this behavior. It can wreak havoc on relationships of patients and other healthcare providers, and it also has the ability to obstruct good clinical care. There are plenty of doctors out there who can deliver good care along with good customer service, and those that can’t conform will be weeded out, probably to work in outpatient clinics or private practices where there is not as much oversight and accountability for bad behavior and possible missed pathology. I hope you are intelligent enough to recognize your improvement opportunities and take advantage of them soon. Otherwise, I hope the medical staff leadership will accept their responsibilities to assist you into another career path. “First, do no harm.” Words, actions, non-actions, verbal and non-verbal communications all funnel into those powerful four words.

  33. Annie says:

    Picklesticks, thanks for sharing your nephew’s story. So sorry to hear about his diagnosis. Hope he’s doing well with the treatments. I have to agree with the importance of following up a persistent “low grade fever.” I’m not a doctor but I have been seen by a team of specialty doctors, all of whom agree that a temp 99.5-101 over 1-2 weeks and still not resolving warrants some work-up/investigation. It could be autoimmune issues, infectious disease, drug reaction, or malignancy. A normal bacteria or viral infection would have run it’s course and the patient should be well on the road for recovery. It is worth noting that GI tract will slow down significantly when the core body temp is above 99.5. When you can’t eat and digest well, you get sicker. Thus, our body is not built to be dealing with a persistent core temp over 99.5 for a long time.

  34. Kane says:

    This is an Emergency Medicine blog. All the exceptional stories here (leukemia, lupus, HIDS) really have nothing to do with emergency medicine.

    The fact remains that there is almost no circumstance in which it is either necessary or appropriate to go racing into the emergency department of your local hospital, child in tow, simply because your child has a slightly elevated temperature. Your child’s regular pediatrician is far better placed to deal with your concerns.

    And whether you like it or not, it’s not technically called a fever (“low-grade” or otherwise) unless it’s 100.4 °F (measured rectally) or higher. That’s not Dr. Whitecoat being mean, that’s just the definition.

    The emergency department is for emergencies. A temperature of less than 100.4 in a child, unless there is some underlying medical condition, is rarely an “emergency” that needs medical attention right away.

    • Emma says:

      I don’t know where you live but in ont if you don’t have a doc which is most ppl … You go to emerg… I’f you call telehealth they tell you to go emerge. My docs answering machine says to go to emerge if it something that requires attention before 2 weeks which is their booking time…

      • Lisa RS says:

        Who “doesn’t have a doc” if they have kids? Oh, let me guess… You have Medicaid so you don’t care how much a visit to the ER will cost, since the taxpayers will cover it?

      • Emma says:

        Umm I’m in Canada … A) docs have huge waiting list so now we have nurse practitioners to try to fill in the gap a little but still most people don’t have docs. Expecially when they choose addresses closest to them leaving the people in the smaller outlying areas “out of their area” B) um no I don’t have “Medicaid” whatever that is… And C) no It doesn’t cost me to go to emerg it but there is also no option to pay for even the doctors….

  35. Matt says:

    I’ve had a body temp of 99.3 to 99.6 for the past 6 months. prior to that it was around 96. I was exposed to black mold for 3 years. I know for a fact I’m fighting about 5 different infections. I’ve seen my blood under a microscope. I’ve seen parasites, lyme like microbial cysts. mycoplasmsa, I have gut dysbosis, Sibo. and fungal infection. I has a very vibrant full of life person a few years ago. Now i’m a shell of my former self. I’ve been on all the protocols for mold and lyme but it’s just not breaking.. In any event. a 99.3 persistent low grade fever is something to take seriously. Maybe if it only happens once in a while no big deal. But if you feel like crap and the fever is constant chances are you have something chronic.

  36. Katie Lemos says:

    You’re kind of a d!@%. I am very lucky to have very healthy kids. My oldest daughter has been on an antibiotic once when she was five and had a temperature of 103.5 due to a kidney infection. My second daughter is 18 months and has yet to be on an anti biotic. I, on the other hand, am not so lucky. I was hospitalized with bacterial pneumonia twice. Both times my temp didn’t get above 99.6. The my symptoms, examination, and xrays said I had pneumonia but the entire time I was in the hospital I never had a ‘fever’. I understand why parents freaking out over the bodies natural response can be annoying but do you really have to be so douchtastic about it.

    • Jane says:

      Do you teach your kids to construct an argument like that?

      Also, bacterial pneumonia tends to do the “sneak up on you” thing and ride low in terms of body temperature. I have been DX’d with it too- and if you take any NSAIDs or a couple other things that is also going to have a hand in lowering your temperature as well.

      If a person deals with patients/clients telling them day in day out that they don’t know how to do their job, they are going to get irritated. Many health professionals feel this way- but it obviously didn’t stop you from getting care.

  37. Christy says:

    I know you will just flame me, and I don’t really expect anything different after reading the posts and comments made here, but the majority of you are in the wrong profession. It is so disheartening to see that doctors and health care professionals are so cold and callus. It is unfortunate that bedside manner is not more important today. Please remember that one day you will be on the receiving end of this one day when your health fails you, and for your sake, I hope your health professionals have just a touch more sympathy and respect than the folks here seem capable of showing.

  38. medmom says:

    So.. The individual that wrote this, might as well call it quits. I am a mom of two special needs children. Not once in here does she refer to children with different than “average” health. Once my daughter hits about 99.2, her system is completely out of control regardless of what the original cause was. She ends up with a runny nose and a bad cough that is always followed with vomiting.. resulting in Pneumonia, every time. She has seizures by 100 degrees and needs hospitalization for IV fluids. This person is a quack. My son, after 100.4 is automatically hospitalized for 48 hours because of his needs. This person didn’t take any other individual other than a normal person, to thought. How disgusting.

    • Jane says:


      The fact that you refer to your children as “special” needs indicates that they are unique cases. This is a short entry, a blip document about general peeves. If you believe it does not apply to you because your children are unique and likely have immune system issues or other particular issues that set them apart? WHY are you so offended? They likely didn’t take “any other individual other than a normal person, to thought” because maybe they don’t represent the majority of the issue.

      And if the author did address YOUR specific situation, they would then have to address every “special” situation, including mine, and anyone else’s who might possibly not pass for “average”. I mean, right? Because otherwise, not “fair”?

      Get over it. Really. If they aren’t calling you out? Maybe there is a reason. I have auto-immune disfunction and documented [in medical records and frequent charting] low BBT. But it doesn’t actually matter- even when I go to an unassociated urgent care, the fact that I have an auto-immune disorder and present with symptoms along the lines of “feeling like death” even though I’m not presenting with an “official” fever, they will take me seriously. Because I’m not abusing the system and having trouble walking from the front door to the walk-in kind of signals something is amiss.

      if you aren’t abusing the system? Don’t suck and attack the author who is sounding off about people who muck up urgent care. I mean, unless you are actually doing that and are a bit sensitive.

  39. Lisa RS says:

    I also consider fever to be the body’s natural defense mechanism! It’s a sign that the body is fighting the virus that is invading the body, so why weaken it by administering Tylenol or Motrin at the first sign of fever? God knew what he was doing when he designed our immune system, so unless my family comes down with really high fevers, I leave them be, make them rest, and push fluids! At night, they may get a half dose of Tylenol to help make them more comfy so they can sleep. I’d like their livers to stay healthy, thanks!

  40. Vivian says:

    I’ve had swollen lymphs for three years. I have allergies. I have had fatigue for the last three months. My temp is now naturally any where from 99.9 to 100.8 for the past month! I was given antibiotics three times and lidocane because I asked for it. I had epstein Barr and I’m sure it’s just a flare up. No it’s more serious they say. Yeah, or you need my copays tobpay off your school loans.

    At least I know what’s wrong with me, because they sure as hell do not!

    Doctors, book smart, yes, ethical? Hell no, caring? As IF! Greedy? Hmm, bitter because insurance has their nuts in a sling? Yeah, that too!
    George Carlin said it best, “ever wonder why they call it medical practice? It’s all guess work in a white coat!”

    Never trust doctors,lawyers or insurance companies. They sure as hell aren’t in it for betting your life. They do it for the money. How about you sad sack doctors shut the fuck up and stop biting at the hands that feed you. You should all be so lucky to have a patient you ungreatful, smug,egotistical asshats! Why are any alleged doctors bitching about temps? Not like you take them, that’s what medical assistants do! Where is Dr. House when you need him? Oh that’s a fantasy, a doctor who actually knows what their doing!

  41. Stephanie Reynolds says:

    I think it’s about time for everyone here to get a grip. I, too, suffer from multiple Autoimmune diseases (Severe Crohn’s disease, Thyroid disease with a history of ThyCa, and Sjogren’s Syndrome, to name a few) and frequently suffer from Dermatological manifestations and a slightly elevated BBT when my body is entering a flare. My base temperature is between 96 and 97 F. However, I am well acquainted with procedures and medications to deal with these flares, as does most anyone with a chronic illness. White Coat and the other ED physicians posting here are not discussing chronic illness. ED physicians are not likely to diagnose chronic illness. This is the job of practicing physician who is able to perform the battery of tests and evaluations necessary for such diagnoses.
    My own diagnoses came after years of illness and suffering without a specific diagnosis.
    I still make trips to the ED when I am showing signs of emergent complications such as a bowel obstruction; however, I do not go to the ED every time my temp goes above 100 F, because I will simply see my regular physician at my next opportunity.
    When speaking of children without chronic illness, a “low grade” fever is most often a good thing as it is indicative of the bodies’ natural defenses for dealing with minor infection or viral illness.
    Crowding the ED with such minor illness that can wait until the Doctor’s office opens, simply causes chaos and diverts the ED physician’s attention from actual emergent patients.
    When you have to wait for six hours in the ED to see a physician, it is probably because patients are triaged in order of severity, and a “low grade” fever simply doesn’t rate very high on this list.

  42. Ellen says:

    Dear Doc,

    I hear you on this…see my husband is a physician and not only agrees with you 100% about the temperature thing, he even SOUNDS like you–like he has a major chip on his shoulder about why the rest of us plain folk still want to believe 99.4 degrees is a low-grade temp.

    That is until this week. I have consistently asserted throughout our marriage (and shown him on multiple types of thermometers) that my body temperature is generally at 97.2-97.6. However, for the past week and a half, every night, I have run a “low grade fever” of 99.5ish. (Complete with the aches and shivers and sweats when it breaks in the middle of the night) We ARE supposed to be leaving the country this weekend for a family vacation with all the in-laws (a year in the making), and so YES, I am going to go try to get blood work done because I DON’T want to spread something. Moreover, even he is now a little nervous that something is wrong with me. I have had no other symptoms and prior to this straight stretch of “feverish” nights, I’ve had two or three other random “fever nights” with no other symptoms since Christmas. My thought for you, is that every human is unique–should we run to the “Emergency Room” everytime–of course not, but having such a strong dismissive attitude toward thinking folks, and not admitting that there are variable situations, is a bit silly on your part.

    And the last thing I’d say, is that LOVE for our family members is why we bring them in–I don’t know if you have kids or not, but when we have a child who is visibly ill and uncomfortable, the child is scared (and so area we as the parents). If my husband wasn’t there to wrangle me in, I’m sure my pediatricians would be much more annoyed by me. As it is, I have someone under my roof with years of knowledge to prevail upon my logic. But even my stoic Doc husband, admits that something is wrong with me and that a little blood work is in order. Folks who are irritated at you on this post, just want to you to admit that perhaps, once in a very rare while, 99.4% IS evidence of something bigger. This post and your “You idiots” attitude IS contributing to the general hatred of doctors, despite the years and years of study and sacrifice you (and my family) have endured.

  43. farmgirl says:

    I hate having to go to the ER. That is a fact. The last time I was there is still very clear in my mind. I had had a “genuine” fever for eight days and finally, my breathing was too bad from my asthma that I relented to my parents and soon found myself iin the ER. My temp before driving there (about 15 min. drive) was 104, taken with a mercury oral thermometer. Once we got there, they took my temp with one of those thermometers that swipes across the forehead and it read 100.1. huh. No fever?? The ER doctor started to look a bit annoyed like I had come in for this?? He looked at me and asked “YOU think you have pnuemonia?” I said Yes. I think I have pnuemonia. He didn’t seem to believe me, but ordered the x-rays anyway. Little while later he came in in a hurry and said that I DID have pnuemonia and it was quite extensive…I should be hospitalized right away. I was so taken aback by this sudden change that I didn’t respond right away. He then went on trying to convice me but little did he know I had come packed for it.
    So, why I hate the ER is because there are so many people working there who just aren’t, yes, kind! I get pressured and scorned there when I plain don’t feel good. I’m sure they get plenty of people who don’t really need to be there, but they can still be kind.
    As to temps, I hear both back and forth all the time. My big question is about how accurate the new thermometers are. Obviously the mercury is not going to be faulty… and how could my temp drop from104 to 100.1 in 15 minutes? The answer seems too obvious to me.

  44. Jane says:

    …I last commented on this in November, but I continue to get updates.

    Since I last commented I have had to make more than one reluctant trip to the ED at Mass General in Boston. [for those not following along at home, this is hardly a medical establishment behind the times]

    I have trouble when I show up at someplace like an ED or urgent care. I don’t like going there, I show up when I really definitely know I need to- often because I am at the point where I am worried about breathing. I will kind of put up with everything up to that point [which isn’t great either]. When it comes to describing my symptoms, they’ve presented on option which kind of skirts the whole “low grade fever” issue, though. *Subjective fever*, which I often experience and is apparently helpful information, has helped to express that I feel shaky and hot and can’t get comfortable, sweaty but have something like chills, but my temperature seems to still be within the normal limits.

    This seems to have fixed many issues when attempting to communicate my symptoms. Just saying.

  45. Rather Plain says:

    Most of these comments eem either clearly dull and not worthy of a response or in support of the claim. I have to ask, is it wrong of me to call a nurse if I’m concerned about symptoms and be frustrated by the question “do you have a fever?” I’m sitting here on the line barely warm yet have symptoms and you’re concerned if my temperature is high? This nurse gave me the hardest time about not having a fever. Am I in the wrong for thinking there might be a reason I’m feeling awful?

  46. Amber Hamilton says:

    Thank you so much for this article! I am a nurse with old injuries causing muscle spasms and I have seasonal allergies. I just needed some confirmation that my persistant 99.5 temperature probably is just due to pain or allergies, or I just run high. Too many people out there believe that they must have cancer, etc. etc. But “when you hear hoof beats, first think ‘horse’- not ‘zebra’.” :)

  47. MPeer says:

    I love you right now. I just love you. My daughter is 8 and for the past two months she’s had a consistent 99+ fever. She feels absolutely fine. She’s playing soccer and hopping around goofing off like a kid normally does. The month she got the strep infection that took three rounds of antibiotics she was noticeably sick even though her fever barely reached 101F.
    I’m beginning to think her basal body temp is just higher than the average temp. The pediatrician wants to do some bloodwork to rule anything out because I have RA and Sjogrens so I normally run at a higher temp if I don’t take immunosuppressants and those AI diseases are genetic. Anyway I’m getting off track.
    You’ve eased my worries. If she’s acting fine and has no sore throat, cough, ear pain, vomiting or headaches I’m just going to let it ride.

  48. Maria says:

    I do have a question about this 100.4 C though, seems like an arbitrary number. When the basal body temperatures vary widely, why isn’t that a person might feel ‘feverish’ or their body be in a state ‘alarm’ while they are not registering a 100.4 C? I agree that a fever of 99.9 or even a 100.4 probably does not warrant a visit to the emergency room, but low grade fevers that are intermittent and recurring are a tell tale sign of a few cancers as well. it isnt exactly helping anyone by asking them to adhere to a number because their thermometer did not say 100.4 C and instead stayed 100C.

    Let me ask you a question similar to the ‘ebola’ question (in sarcasm anyway): Are you going to tell the family of a man or woman who died of undiagnosed stage 4 cancer that his ‘recurrent low grade fever’ just didnt reach the magical 100.4 number on your scale, so meh!

    Once again, a low grade fever or even a ‘fever’ might not warrant a trip to emergency room, but a magic number of 100. 4 sure as hell doesn’t mean much in terms of recognizing ‘fever’ as a symptom of an underlying cause.

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