What is your definition of “fever?”

Practice Points By Louise Wilson, MS, BSN, RN, NCSN | School Nurse Update#10 2/5/19

Often what distinguishes a respiratory illness as one that requires exclusion or sending the ill student of staff member home, is the presence of a fever. It might be a good PRACTICE POINT for school nurses to evaluate their current definition of fever. If you have been a school nurse for a few years you know that definition is steeped in tradition. The definition also varies even among credible professional medical organizations.

How do professional medical organizations define “fever?”

According to the American Association of Pediatrics (AAP) a fever is 100.4°F (https://www.healthychildren.org/English/healthissues/conditions/fever/Pages/When-to-Call-thePediatrician.aspx). According to Johns Hopkins Medicine a fever is defined by most healthcare providers as a temperature of 100.4°F (38°C) and higher when taken rectally. (https://www.hopkinsmedicine.org/health/conditions-anddiseases/fever-in-children). This site goes on to remind us that you have a fever when your temperature rises above its normal range. What's normal for you may be a little higher or lower than the average normal temperature of 98.6 F (37 C). Use of either 100.0°F or 100.4°F evidence based The Center for Disease Control (CDC) in its Guidance for School Administrators to Help Reduce the Spread of Seasonal Influenza in K-12 Schools (https://www.cdc.gov/flu/school/guidance.htm) has this statement:

*Many authorities use either 100 (37.8 degrees Celsius) or 100.4 F (38.0 degrees Celsius) as a cut-off for fever, but this number actually can range depending on factors such as the method of measurement and the age of the person, so other values for fever could be appropriate. CDC has public health recommendations that are based on the presence (or absence) of fever. What is meant by this is that the person’s temperature is not elevated beyond their norm.

So what is the correct temperature at which to send students or staff home from school? As so much of what school nurses must decide, it depends on individual circumstances, other symptoms that may be present, and the standards and protocols your district has (intentionally) set. The point being that school districts should evaluate why they have chosen a certain value and not just base the decision on tradition. The attached flyer from the CDC gives districts support for either choosing 100.0°F or 100.4°F.

What is agreed upon is that it is not accurate to estimate a child's temperature by feeling the child's skin! This is called a tactile temperature, and it is highly dependent upon the temperature of the person who is feeling the child's skin. Also, I found several references from both the AAP and CDC supporting students and staff staying home for at least 24 hours after their fever is gone. The fever should be gone without the use of a fever-reducing medicine.

How long should I stay home if I’m sick? Here is a helpful statement taken from the CDC website: https://www.cdc.gov/flu/treatment/takingcare.htm. CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or other necessities. Your fever should be gone without the need to use a fever-reducing medicine, such as Tylenol®. Until then, you should stay home from work, school, travel, shopping, social events, and public gatherings.

CDC also recommends that children and teenagers (anyone aged 18 years and younger) who have flu or are suspected to have flu should not be given Aspirin (acetylsalicylic acid) or any salicylate containing products (e.g. Pepto Bismol); this can cause a rare, very serious complication called Reye’s syndrome.

Here is a short video that engages parents in helping to prevent the spread of communicable diseases in schools, including picking up ill children from school when notified by the school nurse!
As always practice intentionally using 21st Century principles of school nursing.

This video shows actions that you can take at child care facilities and K-12 schools to help protect yourself and others from getting sick. Nonpharmaceutical Interventions or NPIs are actions, apart from getting vaccinated and taking medicine, that people and communities can take to help slow the spread of illnesses like flu.

Source: Practice Points By Louise Wilson, MS, BSN, RN, NCSN | School Nurse Update#10 2/5/19