Fevers Are Our Friends

Did you know that at least one third of pediatrician visits involve a child with a fever?  One quarter of caregivers report that they'd administer Tylenol or Motrin to a child for a "fever" of less than 100 degrees Fahrenheit, and 85% of parents report that they've woken a sleeping child to administer medications to treat a fever!  Those are some shocking facts.  At least, I think so.  Few things are more worrisome to parents than a child with a fever.  But why?  I think a lot of parents perceive that an elevated temperature in and of itself can harm a child.  I'd like to dispel a few myths related to fevers today maybe even try and convince you that fevers can be useful.

First, let's talk about what a fever is and their purpose.  A fever is a temperature above 100.4 degrees Fahrenheit (38 degrees Celsius).  Anything below that... NOT A FEVER!  The degree of fever (how high it is) does not always correlate with the severity of illness; a fever of 103 does not mean your child is sicker than if they have a fever of 100.5.  Fevers signal a healthy immune system response.  An elevated core body temperature can slow growth and reproduction of the bacteria and viruses that make you sick.  It can also enhance immune system function that may help your illness pass quicker.

I was fascinated to read about a 1974 experiment involving iguanas.  A group of iguanas was infected with bacteria; horrible, I know, but the results are interesting...  The iguanas were given an opportunity to seek heat via a heat lamp.  Iguanas are cold-blooded and require an outside source to raise their body temperature.  All of the iguanas except one sought out the heat of the lamp.  What happened?  The only iguana that died was the one that didn't seek out the heat lamp!  They then infected another group of iguanas with bacteria and gave them fever-reducing medications.  Only the iguanas that were able to mount a fever despite the medications survived!

So what are some common misconceptions surrounding fever?  Many perceive that a fever will/can cause brain damage, but in a healthy individual (without a chronic health condition or decreased metabolic reserves) brain damage doesn't occur until a fever reaches and sustains a temperature of 105.8-107 degrees (41-42 degrees Celsius).  Another fear is febrile seizures.  Don't get me wrong, seizures are SCARY, but febrile seizures are short, resolve on their own, and have no long-term effects.  Febrile seizures only affect 2-5% of children under the age of 5 years.  Risk normally peaks in the second year of life.  Research shows that febrile seizures are not due to the height of fever, but are more related to how rapidly the fever spikes.  More compellingly, research demonstrates that fever-reducing drugs do not reduce febrile seizure recurrence.

So why are we all treating fevers aggressively?  I think misinformation is the main reason.  The only real reason to treat a fever is for the child's comfort, and fever alone doesn't necessarily mean the child is uncomfortable.  Instead of treating a fever to reduce body temperature alone, we should be judging whether or not to treat a fever by several other factors:

• Is the child eating and drinking?
• Is the child urinating normally?
• Does the child seem uncomfortable?

So what should you do instead of automatically resorting to fever-reducing medications?  Make sure the child gets plenty of rest.  Ensure they're adequately hydrated; fever increases the body's metabolic requirements and can lead to dehydration faster than normal.  Remove excess layers - you don't want to make the child unnecessarily warm.  Avoid cold baths, ice, and alcohol rubs as they can cause shivering, which will raise the body's temperature even further.

If you do decide to give fever-reducing medication, here are a few reminders.  Always dose the medication based on the child's weight, not their age.  Make sure to follow the directions on the medication's packaging carefully including recommended dose and how often to administer.  Infant and Children's Tylenol and Motrin come with their own dosing devices (oral syringes or medicine cups) pre-marked with the correct doses; use them instead of a teaspoon or other measuring device to ensure you're giving the correct amount of medication.  Don't give more or less of a medication based on the height of the child's fever.  Under-dosing does nothing and over dosing can be dangerous!  Motrin can be given to children older than 6 months of age.  Make sure that the child is well-hydrated before administering Motrin as it's metabolized in the kidneys and could lead to kidney injury if given in the presence of dehydration.  Never give Aspirin to anyone under the age of 18 years as it can result in a serious complication called Reye Syndrome.

There are a few instances in which you should always seek medical attention:

• A fever in a baby 0-3 months is a medical emergency.  Contact your health care provider immediately.  Do not stop.  Do not pass go.  Ok?
•  A fever that's unresolved for several days
• Lethargy or decreased level of consciousness in the presence of a fever
• Fever with headache and neck pain
• Dehydration
• Increased work of breathing
• Painful urination
• Fever with abdominal pain
• Possible exposure to toxins or poisons that could be causing fever
• Anything you're concerned about.  You know your child best; if you're worried, it's best to talk to your child's pediatrician.

So, what you do think?  Will you think twice before treating your child's next fever?  Did you learn something new?

Here are some great articles that helped me write this blog post:

Fever and Antipyretic Use in Children
Quick Guide to Treating Fever
Fever: Suppress or Let It Ride?
Pediatricians Say It's Often Better to Let a Child's Fever Run Its Course
Febrile Seizure Fact Sheet

Just a reminder to check out my disclaimer which can be found on the navigation bar at the top of the site.  This post is not intended as medical advice and should not be considered as such.  Please contact your health care provider before making any medical decisions.