Irritable Child, Uncertain Cause

Home care

• Feeding. Your child’s appetite may be poor. For most children, it's OK to go without solid food for the next 24 hours, as long as the child drinks lots of fluid.

• Fluids. Continue giving the usual fluids (such as milk and formula). Give extra fluids if your child does not want to eat solid foods. To prevent dehydration, you may be told to replace lost body fluids with oral rehydration solution. You can get this at pharmacies and most grocery stores without a prescription. Ask your child's healthcare provider about what is safe to give to your child.

• Activity. Encourage rest, quiet play, and frequent naps during the next 24 hours.

• Sleep. A change in usual sleep patterns, with sleeplessness or waking up often, is not unusual. You may need to spend extra time to comfort your child during this time.

• Medicine. Follow the healthcare provider’s directions on the use of over-the-counter pain medicines, such as acetaminophen or ibuprofen, for fever, fussiness, or discomfort. Also note:

  • If your child has chronic liver or kidney disease or ever had a stomach ulcer or gastrointestinal bleeding, talk with the provider before using any of these medicines.

  • Don't give ibuprofen to a child age 6 months or younger.

  • Don’t give aspirin to a child younger than age 19 years -unless directed by your child’s provider. Taking aspirin can put your child at risk for Reye syndrome. This is a rare but very serious disorder that most often affects the brain and the liver.

Follow-up care

Follow up with your child’s healthcare provider, or as advised. Continued use of pain medicines, such as acetaminophen or ibuprofen, may hide symptoms of a more serious illness. If your child continues to be fussy, and the cause of the symptoms isn't clear, contact the provider.

When to get medical advice

Unless your child's healthcare provider advises otherwise, call the provider right away if your child:

• Has a fever (see Fever and children, below)

• Is fussy or cries and cannot be soothed

• Doesn't feed well or doesn't gain weight

• Repeatedly vomits or has diarrhea, or pulls at an ear

• Has blood in the stools or vomit (black or red color)

• Shows an unexpected change in their crying pattern

• Becomes drowsy or confused

• Shows signs of belly (abdominal) pain, such as drawing the legs up to the chest while crying

• Cries without stopping for more than 2 hours

• Breathing becomes faster

• Any other worrisome symptoms

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

• Rectal. For children younger than 3 years, a rectal temperature is the most accurate.

• Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.

• Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.

• Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.

• Mouth (oral). Don’t use a thermometer in your child’s mouth until they are at least 4 years old.

Use a rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell them which type you used.

Below is when to call the healthcare provider if your child has a fever. Your child’s healthcare provider may give you different numbers. Follow their instructions.

When to call a healthcare provider about your child’s fever

For a baby under 3 months old:

• First, ask your child’s healthcare provider how you should take the temperature.

• Rectal or forehead: 100.4°F (38°C) or higher

• Armpit: 99°F (37.2°C) or higher

• A fever of ___________as advised by the provider

For a child age 3 months to 36 months (3 years):

• Rectal or forehead: 102°F (38.9°C) or higher

• Ear (only for use over age 6 months): 102°F (38.9°C) or higher

• A fever of ___________ as advised by the provider

In these cases:

• Armpit temperature of 103°F (39.4°C) or higher in a child of any age

• Temperature of 104°F (40°C) or higher in a child of any age

• A fever of ___________ as advised by the provider