Introduction
Just What Is A Fever
Anyway?
Taking Temperatures
In Young Children
Do Fevers Need To Be
Treated?
How Do You Treat A Fever?
Fever Is Not A Disease
When Should
I Be Concerned About Fever?
You
Can Be A Great Help To Your Pediatrician
Introduction
It’s 2 AM in the middle of January, and the phone rings—again!
As I groggily write down the message from the answering service, I marvel
at its similarity to all of the others that I get, particularly at the
height of the winter season: “Doctor, my baby has a fever...”
I cannot begin to tell you how upset parents get over
childhood fevers, and how much misinformation is out there about fever,
and what to do about it.
Of course, if you have kids, you almost certainly have
experienced the anxiety and concern that all parents feel when their children
become ill. When you are finished reading this article, I hope that, as
parents, you will feel more comfortable in evaluating and treating fever,
and that you will also be more confident about when to be concerned about
your child’s condition.
Just
What Is A Fever, Anyway?
One of the most frequent reasons parents call or visit
a pediatrician is when their child has a fever. But what is a fever,
and what actually causes it?
Normal body temperature
Normal body temperature is 98.6° F, but this is just
an average. Some people are normally higher, and some are normally lower.
A fever is defined as a body temperature above 100.5° F Therefore,
a body temperature of 99.5° or 100°F is not a fever and should
not be a cause for worry in otherwise normal children.
Body temperature and infection
Body temperature is controlled by the hypothalmus, a
section of the brain that acts just like your household thermostat. That
is, if the body gets too cold, the thermostat sends out instructions to
warm things up, and if it gets too hot, the thermostat tries to cool things
down. When the body is faced with an infection, it responds in a number
of ways. In addition to making antibodies that kill the offending germs,
it sends various white blood cells to the location of the infection, where
they act much like soldiers at a battle. They help the antibodies destroy
the invaders. In addition, they are able to kill the offending germs directly.
The number and types of these white blood cells are one of the things that
your doctor measures when he does a blood count.
White blood cells also produce chemicals that function
as messengers, signaling other cells to come to the area to help with the
fight. But one of the chemicals, known as endogenous
pyrogen, has a different function. It travels in the bloodstream
until it goes past the area of the brain that contains the "thermostat",
and it acts to reset the thermostat to a higher temperature—in other words,
it causes a fever.
Fever can therefore be thought of as one of the body's
normal responses to infection. And like most things that happen naturally
in our bodies, it doesn't occur just for the heck of it. There is usually
a good reason. There may be evidence that the increase in body temperature
plays a role in helping the body's defenses fight off infection. Because
of this fact, we may have to reconsider the need to "treat" fever.
Taking
Temperatures In Young Children
Before we go on to discuss when and when not to
treat fever, I want to say a word about methods of taking temperature.
Ear canal thermometer, arguable
accuracy
The new high tech ear canal thermometers are remarkably
fast and easy to use, but people argue about how accurate they are. The
companies that make them claim that they are very accurate. My personal
experience is that they tend to read a little bit high, especially with
higher temperatures, which may scare people.
Rectal thermometer, the most reliable
method
The only really reliable way to take a young child's
temperature is with a rectal thermometer. Feeling the forehead is just
not trustworthy, and young children are rarely able to tolerate oral thermometers.
They can't keep them under their tongues, and they breathe around them,
resulting in artificially low readings. An axillary (armpit) temperature
takes at least 10 minutes and is quite inaccurate as well.
In older children, the temperature reading is usually
not as critical. It’s often enough to know if the reading is high (over
103 F) or not. In very young infants and children, however, the actual
number is more important, and therefore, we would prefer a more accurate
reading. Although taking a rectal temperature is not a lot of fun for either
parent or child, it is the method that has proven most accurate.
Do
Fevers Need To Be Treated?
Recent evidence has shown that fever in children may play
a role in fighting disease. As parents, should we treat fever?
Not all fevers need treatment. A temperature lower than
100.5° is not a fever and does not need medicine. Most children with
temperatures lower than 102° generally do not feel all that bad. Earaches
and sore throats may hurt, but just having a fever does not cause much
discomfort. I feel that fevers of 102° or less, by themselves, do not
routinely need treatment if the child feels and acts relatively normally.
The increased body temperature may actually be of benefit in fighting off
the infection.
Children with temperatures above 102° are often uncomfortable
because of the fever and may need treatment. The main reasons to treat
fever are, first, to make the child more comfortable, and second, to help
you evaluate how sick he looks after you get his temperature down. A child
with a fever who is feeling and behaving well does not need to be given
medication.
How
Do You Treat A Fever?
There are many ways to treat fevers in children, some
good and some not so good. Our old favorite remedy, aspirin, should not
be used to treat fever in children under 16 years of age. Aspirin may cause
the deadly disease known as Reye’s Syndrome (a
syndrome of rapidly worsening neurological symptoms and liver degeneration)
in children with viral illness and chicken pox. Since this association
was first recognized, the use of aspirin in kids has almost disappeared,
and Reye’s Syndrome along with it.
Acetominophen and ibuprofen
Given that there are other effective medicines for treating
fever in children, aspirin should NOT be used. The most common medicines
we use to treat fever today are acetominophen and ibuprofen, both of which
are sold under a variety of brand names.
Alcohol rubs, a bad idea
Another old favorite that should be abandoned is the
alcohol rub. It is scary and uncomfortable, and it can cause serious side
effects in young infants. Alcohol rubs make kids shiver. Shivering is the
body's way to generate large amounts of heat, the last thing you want if
your child has a fever.
Tepid bath, a better solution
You can replace the alcohol rub with the more effective
and less scary tepid bath. Sponge your child down in the tub with lukewarm
water (not hot, not cold) for a few minutes. He should not be allowed to
get cold enough to shiver. Pat him almost dry, but leave him a little bit
damp, because it is the evaporation of the water from the skin that removes
heat and lowers the temperature.
Bundling up makes the body hotter
A child with a fever should not be bundled up. It will
make him hotter and can raise the body temperature of young infants.
Fever
Is Not A Disease
Thus far you've learned several things about fever. A
fever is a temperature greater than 100.5° F and is a normal body's
response to infection. The medications of choice for treating fever in
children, if treatment is necessary, are acetominophen or ibuprofen, not
aspirin. The alcohol rub should be replaced with the tepid bath.
But why all the fuss, anyhow? What I hope to teach you
is that while a fever is often cause for concern, it is rarely a reason
for panic.
Fever, only a symptom
The first thing I want to make clear is that fever is
not a disease. It is simply one symptom of an illness. The illness itself
could possibly be serious, but it is far more likely to be one of the common
viral infections of childhood, which may be scary and annoying, but in
most cases is not dangerous.
One of the most common misconceptions about fever is the
mistaken belief that a high fever, in itself, will harm a child. This is
simply not true. The highest fever a normal human can get will be around
106° F. While such a high temperature will make the child feel terrible
and scare the pants off of her parents, it will not cause physical harm
or long-term damage.
A temperature in excess of 107° F might theoretically
be dangerous, but the body will not allow the temperature to rise that
high unless there is already preexisting damage to the centers of the brain
responsible for controlling temperature. So, while the underlying disease
may be a problem, fever in itself is not dangerous.
What about seizures with fever?
They do occur, but they are relatively uncommon and are
likely due to a rapid rise in temperature. While they are horribly unpleasant,
we do not believe they result in any long-term problems in otherwise normal
children.
When
Should I Be Concerned About Fever?
When should parents be concerned if their child has a
fever? A lot depends on the age of the child. Let’s first look at newborns.
Newborns
A temperature over 100.5° F in a child under three
months of age is always a cause for concern. These youngest of infants
are simply not like older children. First of all, they rarely get fevers,
even when they are sick, so a fever is unusual even in the presence of
illness. Second, very young infants are not really developmentally able
to do much. It's hard to figure out how sick they are and if they are not
just doing the things that they normally do. Third, very young infants
can change very rapidly. One minute they look OK, and a few minutes later
they can become seriously ill. There is little warning.
For all of these reasons, any degree of fever in such
youngsters must be treated with great concern. The risk of a serious underlying
illness such as meningitis, pneumonia, kidney infection or blood infection
is much higher in newborns. You should quickly alert your pediatrician
to any abnormal temperature in an infant under three months of age. The
younger the infant, the more urgent the situation. Any infant younger than
one month of age who has a fever needs immediate medical attention.
Infants 3 months to 3 years old
Infants between three months and three years of age present
a similar dilemma, only not such an urgent one. It is much more difficult
to diagnose which fevers are significant. Once again, the younger the child,
the greater one's level of concern. Children under three are usually unable
to give you much of a clue as to what is wrong. It is up to us to observe
our children in order to decide if a problem is of concern.
You
Can Be A Great Help To Your Pediatrician
A pediatrician has years of training and experience that
prepares him or her to distinguish medically serious conditions from minor
viral illnesses in children. This clinical judgment can be aided by a variety
of lab tests, but in the final analysis, the best diagnostic tool is the
impression that the child looks sick. As parents, you can be a great help
to the doctor by providing a good history of the child's symptoms and what
you've done about them, as well as providing your opinion about how sick
your child appears to you.
What should you look at?
First, notice whether there are other symptoms in addition
to the fever. Is there a cough, sore throat, vomiting or diarrhea? How
about rashes, headache or runny nose? How long have the symptoms been present,
and in what order? What have you done about them?
The next, and perhaps most important, thing to notice
is how the child looks and acts. Is he playful and active? Does he laugh
and smile at times, or is he irritable and difficult to approach? Is he
lethargic, lying around without energy or interest in his surroundings?
In other words, does the child appear sick?
I am much more concerned about how the child appears and
acts than how high his temperature is. The child with 104° F who is
active and playful is of far less concern that the child with 102°
F who is lethargic and irritable. High fever often makes you feel bad.
Try to reduce the fever and then see how your child looks. If he perks
up and looks well again, it is more likely that your child does not have
a serious illness. If he continues to look ill despite temperature reduction,
you should be more concerned. Statistically, high fevers are more likely
to be associated with serious illness than lower fevers, but I am more
concerned with how your child behaves. Just having a high fever does not,
in itself, mean that your child is seriously ill.
Make notes, and call your doctor
if you’re concerned
It is helpful if you, as parents, have all of this information
when you call your pediatrician. If you can accurately describe the presence
and timing of symptoms, what you've done about them, and how your child
looks with and without fever, it will help immensely. And remember, if
you are concerned or unsure about the situation, it is always better to
call and discuss it with your child's doctor. Every child and every situation
is different, and you and your pediatrician must work together to choose
the appropriate course of action.
Don’t be surprised if the doctor wants to examine your
child, since it is hard to evaluate a child’s appearance over the phone.
And despite all of these general rules, fever can always represent a serious
illness, particularly in young infants. Only your doctor can determine
if this is actually the case when your child is ill.
