The Denton Parent's Sick-Kid Guide: Fever by Age, Ear Tugging, Hand-Foot-and-Mouth, Croup

Reviewed by the Evolve Health clinical team · 2026-10-16 · 8 min read

The questions our front desk hears every week follow the same pattern. It's 11 p.m., the thermometer says 102, and you're deciding between the emergency room and waiting until morning. She keeps pulling at her ear — infection, or just teething? Daycare called about hand-foot-and-mouth: how long is he out? And then there's the cough that sounds like a seal barking, which starts at 2 a.m. and scares everyone in the house.

Fever by age: the number that matters changes

Fever is the body's normal response to infection, not an illness by itself — but the same temperature means different things at 6 weeks, 6 months, and 6 years, because what changes with age is how much backup a child's immune system has. A rectal temperature is the most accurate reading in the first two years.

Ear tugging: often not an ear infection

Ear tugging worries parents because it seems so specific. In practice, it is one of the weakest signs there is: babies tug at their ears when teething, when tired, and sometimes simply because they have discovered them. The ages overlap, too — teething and ear infections both peak in the same 6-to-24-month window, so the two get blamed for each other constantly.

Signs that point more toward a real middle-ear infection: a recent cold (ear infections usually follow a few days of congestion), fever, fussiness that gets worse lying flat — pressure builds when the head is down, which is why ear pain so often ruins naps and nights — and occasionally fluid draining from the ear. Our guide to ear infections and ear pain walks through middle-ear infections versus swimmer's ear and when antibiotics actually help. The honest summary: only an exam with an otoscope — a look at the eardrum itself — can confirm an ear infection, so when the signs line up, a same-day visit settles it.

Hand-foot-and-mouth: the daycare classic

Hand-foot-and-mouth disease is a viral illness — most often a coxsackievirus — that spreads through Denton daycares and preschools in waves. It announces itself with painful sores in the mouth and a rash or small blisters on the hands and feet, sometimes on the buttocks too. The mouth sores are the miserable part — they hurt to swallow, so kids refuse drinks.

The practical realities: children are most contagious in the first few days, though the virus can shed longer, so perfect containment at home is rarely realistic. Most kids can return to daycare once the fever is gone, the mouth sores have healed enough to swallow comfortably, and drooling is under control — but daycares set their own return rules, so check first. At home, cold drinks and popsicles, soft foods, and a weight-based dose of fever medicine keep most kids comfortable while it runs its course, usually about a week. Because sore mouths make kids skip fluids, this is where the dehydration checklist below matters most.

Croup: the barking cough at 2 a.m.

Croup is swelling around the voice box, usually from a virus, and it has a signature sound: a harsh, barking cough — parents say it sounds like a seal — that appears at night, often improves by morning, then returns the next night or two. You may also hear stridor, a high-pitched, strained sound when your child breathes in. Most episodes are mild and settle with first aid at home.

Start with calm: keep your child upright in your arms and speak softly, because crying tightens the airway further. Then try cool night air — step out onto the porch for a few minutes — or sit together in a steamy bathroom with the hot shower running. Either should ease the cough within minutes. What is not optional: stridor at rest that does not settle, visible struggle to breathe (ribs showing, nostrils flaring), drooling or inability to swallow, pale or blue lips, or a child who seems exhausted — those mean call 911 or go to the emergency room.

The dehydration checklist: the one that applies to every illness

Whatever the illness — fever, stomach bug, hand-foot-and-mouth — dehydration is the complication that turns a home illness into a hospital one, and it sneaks up gradually. Check these while your child is sick:

• Wet diapers and bathroom trips: fewer than usual — and no urine for eight hours or more is a warning sign on its own.
• Tears: crying with few tears, or none.
• Mouth and lips: dry instead of moist and shiny.
• The soft spot: in babies, a sunken fontanelle (the soft spot on top of the head).
• Energy: unusual sleepiness, or a child who is hard to interest in anything.

One mild sign means push small, frequent sips and keep watching. Several signs, a baby who refuses all fluids, or anything getting worse means same-day care at minimum.

Medicine safety basics

• Dose by weight, not by age. Children's fever medicine is dosed by pounds. Use the dosing syringe or cup that comes with the bottle — a kitchen spoon is not a measuring tool.
• Acetaminophen and ibuprofen are the usual options for fever and pain. Ibuprofen is only for babies 6 months and older. Never give aspirin to a child or teenager with a viral illness.
• No adult medicines, ever. Adult cold formulas and adult doses are not scaled-down-safe for children, and multi-symptom cold medicines are generally not recommended for young children — ask a clinician or pharmacist first.
• Antibiotics do not treat viruses. Colds, flu, hand-foot-and-mouth, and croup are viral; antibiotics help only when a bacterial infection — like a confirmed ear infection or strep throat — is actually present.

When can they go back to school or daycare?

The common rule for everyday illness: your child can return once they have been fever-free for 24 hours without fever medicine, are eating and drinking reasonably, and have the energy to join in. Stomach bugs often carry a longer window — many schools ask for a day or two after the last vomiting or diarrhea. Treat this as a starting point, not a guarantee: schools and daycares set their own exclusion policies, and Denton ISD campuses and private daycares do vary. A return date from the nurse or front office is the one that counts.

When a same-day sick visit is the right level of care

Between 'watch at home' and the emergency room sits the everyday middle ground: fevers that need an exam to find their source, ear pain with the signs above, sore throats that could be strep, rashes a parent cannot identify, and stomach bugs where you want a clinician's eye on hydration. Evolve Health is a family practice clinic, and our same-day sick visits cover the illnesses in this guide — fevers, ear infections, strep throat, rashes, and stomach bugs with dehydration concerns among them. Self-pay sick visits are $75 flat, told before your child is seen, including the clinician exam, diagnosis, treatment plan, and prescriptions sent to your pharmacy when appropriate. With insurance, coverage is verified free before the visit from your insurance card, a photo ID, and your child's date of birth. We are open Monday–Friday, 7 AM–5 PM, weekends by appointment — and if you are not sure whether your child's symptoms fit a clinic visit, call (940) 257-2002 and we will tell you straight, including when the honest answer is the emergency room.

Frequently asked questions

What temperature counts as a fever in a child?

A temperature of 100.4°F (38°C) or higher is a fever at any age. How much it matters depends mostly on your child's age and how they are acting. A fever of 100.4°F or higher in a baby under 3 months old is an emergency — get emergency care right away. In older babies and children, a child who is drinking, playing, and responding to you is usually less urgent than the number suggests, while a child who is hard to wake, struggling to breathe, or not drinking needs care now whatever the thermometer says.

Does ear tugging always mean an ear infection?

No. Ear tugging on its own is one of the least reliable signs — babies pull their ears when teething, tired, or simply exploring. Signs that point more toward a real ear infection are fever, fussiness that gets worse when lying flat, trouble sleeping, a recent cold, or fluid draining from the ear. Only an exam with an otoscope can confirm it, so if those signs are present, a same-day sick visit is worthwhile.

How long does hand-foot-and-mouth keep my child out of daycare?

Children are most contagious during the first few days of illness. In general, kids can return once the fever is gone, mouth sores have healed enough that they can swallow comfortably, and drooling is under control — often three to five days. Daycares set their own return rules, so check with yours before you plan on it.

What should I do when I hear the croup bark at night?

Stay calm and keep your child calm and upright — crying makes the breathing harder. Cool night air often settles the cough within minutes; step outside, or sit in a steamy bathroom from a hot shower. If you hear stridor — a harsh, high-pitched sound when breathing in — that does not settle, or your child is struggling to breathe, drooling, or turning pale or blue, call 911 or go to the emergency room.

How do I know if my sick child is getting dehydrated?

Watch the fluids going in and coming out. Warning signs are fewer wet diapers than usual or no urine for eight hours or more, crying without tears, a dry mouth and lips, a sunken soft spot in a baby, and unusual sleepiness or low energy. One mild sign means push fluids and keep watching; several signs, or a child who will not drink at all, means same-day care.

How much does a sick visit for my child cost at Evolve Health?

A sick visit at Evolve Health is $75 flat for self-pay, told before your child is seen. It includes the clinician exam, diagnosis, a treatment plan, and prescriptions sent to your pharmacy when appropriate. If you have insurance, we are in-network with major plans and we verify your coverage free before the visit from your insurance card, a photo ID, and your child's date of birth.

Sources

• HealthyChildren.org (American Academy of Pediatrics) — Fever: When to Call the Pediatrician (fever thresholds by age, including 100.4°F in infants under 3 months)
• Centers for Disease Control and Prevention — About Hand, Foot, and Mouth Disease (symptoms, spread, and contagiousness)
• KidsHealth (Nemours) — Croup (barking cough, stridor, cool-air and steam first aid, emergency signs)
• KidsHealth (Nemours) — Dehydration (wet diapers, tears, soft spot, and energy warning signs)

General education only: This guide helps you recognize common childhood illnesses and danger signs. It does not replace medical advice for your child — when you are unsure, call a clinician or seek care, and in an emergency call 911.