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[Sticky] High fever in infants


Michael Gray MD JD
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Generally no — high fever in infants is NOT appropriate for telemedicine alone, because very young babies can become seriously ill quickly and often need hands-on, in-person evaluation (exam, labs, urine testing, vitals).

How urgent it is depends on the infant’s age and symptoms:


🚨 Seek emergency care immediately (ER / 911) if an infant has:

  • Fever ≥ 100.4°F (38.0°C) and is under 8 weeks old

  • Lethargy, weak cry, or hard to wake

  • Trouble breathing, grunting, or blue/gray color

  • Seizure

  • Persistent vomiting or refusal to feed

  • Stiff neck, bulging soft spot, or rash that doesn’t blanch

  • Signs of dehydration (no tears, dry mouth, no wet diaper ≥ 8 hrs)

Telemedicine cannot perform the urgent tests infants may need — waiting could delay critical care.


🧸 Infants 2–3 months old (8–12 weeks)

Fever ≥ 100.4°F (38°C) still often requires in-person urgent evaluation, even if the baby looks well.

A telemedicine provider will almost always refer you in.


👶 Infants older than 3 months

Telemedicine may help with triage or guidance only if the child is otherwise well, for example:

  • Mild fever

  • Eating and drinking OK

  • Alert, interactive

  • No breathing problems

  • Vaccinated and no high-risk conditions

But an in-person visit is still recommended if fever is:

  • ≥ 102–103°F (38.9–39.4°C)

  • Lasting more than 24 hours (under 2 yrs) or more than 48–72 hrs

  • Accompanied by ear pain, cough difficulty, rash, vomiting, or worsening symptoms


👍 How telemedicine may be used (in limited situations)

  • Initial advice on fever care & dosing

  • Determining where to go (urgent care vs ER)

  • Scheduling follow-up after in-person evaluation

But for high fever in infants, telehealth is usually not the final site of care.


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