September 2010

Fever Phobia - Separating Fact From Fiction

Author: Lance S. Lowe, M.D.

Fever has always been one of the most common reasons for parents to contact their children’s doctor. Unfortunately, there are many misconceptions regarding fever, causing fear and anxiety as well as unnecessary concern. Many parents view fever as a sign of serious illness. But many physicians today believe that by aggressively treating fever, we may be prolonging the course of an illness.

Why then do we have such a concern to treat fever? Many have heard and believe that fever, in and of itself, can cause serious harm. Many believe that fever will cause seizures, brain damage and even death. It is true, fever may lower the seizure threshold in a child who is predisposed to seizures, but this occurs in less than three percent of children. It should be reassuring to know these febrile convulsions are almost always completely harmless. Brain damage, organ damage and death are extremely unlikely to occur in a child with fever. Some parents believe that dehydration can easily occur during periods of fever; however this is extremely unlikely, except when coupled with vomiting and diarrhea.

The normal body temperature has been defined as 98.6 degrees Fahrenheit, but can range from 97-100 degrees F and still be normal in children. Infants tend to have a slightly higher body temperature than older children. Most pediatricians define fever as 100.4 degrees F or higher. It is known there is a slight increase in serious infection if the temperature is 104 degrees F or higher.

Many parents are concerned about the proper way to measure their child’s temperature. The most accurate home measurement of body temperature is the use of the rectal thermometer. However, if the child is able to cooperate, oral measurement is adequate in most children over the age of four. Other thermometers have been developed to measure temperature in the ear and on the skin. These thermometers have a high degree of inaccurate measurements (especially in children under the age of one). Pacifier thermometers, on average, need to be held within the mouth for a minimum of four minutes and are not recommended for use. The common drugstore digital thermometer is very adequate for measuring the temperature of a child at home.

The best method of measuring the temperature of a child is dependent upon age. Infants and children up to the age of four can be reliably measured using a thermometer placed deep under the armpit and then verified rectally if the temperature is under 97 degrees F or above 100 degrees F. After the age of four, most children will cooperate with the thermometer placed under the tongue.

The ability to raise the temperature of the body is controlled by the brain. It is by inhibiting this mechanism that fever reducing medicines such acetaminophen (Tylenol) and ibuprofen (Advil & Motrin) do their job. Many parents want to treat fever to make their child more comfortable. Precautions must be taken when giving your children medicine, especially concerning acetaminophen as it is very easy to overdose on this medication, especially when many over-the-counter (OTC) cough and cold preparations contain acetaminophen as an added ingredient.

Both acetaminophen and ibuprofen work equally well at reducing fever and come in many forms and concentrations. Many parents ask about alternating dosing of these drugs, however with the potential for incorrect dosing being so high, it is generally not recommended or encouraged. Many parents also tend to use external cooling measures to lower the fever in a sick child. Tepid water baths or sponging can help lower the body temperature more quickly when combined with anti-fever drugs. Alcohol or cold water should NEVER be used with children as shivering can actually increase body temperature.

So what should you do about fever? If children (above three months of age) are acting fine with occasional periods of playfulness, drinking well and not bothered by the fever, my advice would be to do nothing. Obviously, if your child is miserable, not drinking well, not sleeping, vomiting, or has a history of febrile seizures, then anti-fever medicines can be helpful. However, there is NO specific temperature that must be treated. The brain is very smart and will not allow a fever to climb to uncontrollable levels.

There are two good rules regarding the treatment of fever in children. One, there is no need to awaken your child to check his temperature or to give him medicine. If the child is sleeping, he is doing fine. Secondly, your child needs to be without fever and no fever reducing medicines for 24 hours before returning to school or childcare.

So when should you contact your doctor? If your infant under the age of four months has a fever, your doctor should be notified immediately. No infant under three months should be given fever-reducing medicines without consulting a doctor. You should also consult your doctor if your child is inconsolable or has had a fever longer than three days, especially if there are no other symptoms. You should notify your doctor if the temperature climbs above 104 degrees F. If your child is not drinking well, is urinating infrequently, or has significant pain, your physician should be called. Also, if your child shows any signs of delirium or unresponsiveness, your doctor should be called, especially if this has never happened before.

Most importantly, remember that fever is the best way to fight of most illnesses.

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