The Facts about Fever
The following article can be found in Understanding Your Child’s Health by Susan K Schulman MD., which will be available in July, 2009 (Hamodia Treasures, distributed by Israel Book Shop)
Key points
- Fever is not dangerous
- Fever is only a sign that there is an illness in progress.
- Fever can cause headaches, nausea and poor appetite.
- Fever can be left untreated if it is not causing too much discomfort.
- Extra fluids are needed during fever.
- In this day and age fever is usually not caused by a life threatening illness.
- Antipyretics can be given to reduce fever and its discomforts.
Why We Worry About Fever
When a child awakens feeling ill, hot and flushed, his parents often experience a stab of fear. “He has a fever! Hurry! Get the Tylenol!”
Fever Phobia
“Fever Phobia” has been around for a long time. Everyone knows that when a child’s body temperature is elevated and the heat is felt on the skin, he is ill. The febrile illness causes anxiety since it could prove to be serious. Although the child is usually only mildly ill with a self-limited viral illness or an easily treated bacterial illness such as strep throat, there is a small possibility that he could, G-d forbid, have a life-threatening bacterial illness such as meningitis, pneumonia or septicemia.
Fever can cause symptoms
Although it is really a sign of another problem, the fever itself can cause headaches, nausea, vomiting, malaise and drowsiness. Occasionally, in young children, fever can cause convulsions.
Fever is not dangerous
Until recently it was feared that the fever itself was dangerous to the child’s brain. Antipyretics such as aspirin, acetaminophen, and ibuprofen were given to all patients with fever. Emergency rooms had sinks designed to bathe the child to reduce high fevers.
Recently there has been research into the physiological phenomenon of fever, and as a result pediatricians have become less concerned about fever. Here is a brief explanation of the current medical view of fever in a child.
What Is Fever?
Fever is an elevation of body temperature above the normal baseline temperature. It is a sign of illness, not an illness in itself. Fever occurs when the brain receives signals triggered by an inflammatory reaction.
To produce fever, the brain stimulates an increased metabolic rate by increasing heart rate, increasing respirations, and decreasing skin circulation to decrease heat loss through the skin. (This is why people often feel chilled when they are developing fever.)
Normal rectal temperature is 97F to 100F. (It varies during the course of the day and night.)
Fever is defined as follows:
100.4F in an infant less than 30 days of age.
100.7F in an infant 1-3 months of age.
101F in any child over 3 months of age.
Moderate fever is up to 102.5F. High fever is above 102.5F and up to 105F.
105.4F and above is unusual. When it occurs a doctor should be contacted.
Reasons to Allow a Fever to Take Its Own Course
1) Since the advent of antibiotics and modern vaccines, many common life-threatening illnesses have become preventable or treatable. For example, since the HIB vaccine was initiated, the incidence of bacterial meningitis in the pediatric population has dropped by 95% Since the initiation of Prevnar Pneumococcal vaccine recent;y, the number of children admitted to the hospital for severe pneumonia has dropped by 90 percent.
As it is, most bacterial illnesses can be successfully treated at home with antibiotics. There seems to be less concern that the fever represents a life-threatening illness. (In the early days of my practice, any child with high fever and vomiting had a possible case of HIB meningitis. I had 3 to 4 such patients a year! Since the vaccine came into use, b”H, I have had none!)
2) The fever itself does not seem to cause direct harm to most healthy patients. There is basically no danger just from the heat of the fever.
3) In some studies the actual illnesses subsided faster when the fever was not reduced by medications or bathing. Fever is a part of the immune response.
4) Most febrile seizures in patients brought to emergency rooms were found to be due to the HHV7 virus, the one that causes Roseola. It is thought that the virus itself causes the seizures, not the actual fever. The seizures often occur when the fever is rising for the first time, not during the subsequent days of fever.
These facts are all reassuring. Maybe we do not have to treat fever at all. Often we do not need to trest it. There are, however, many instances where treating the fever is appropriate.
Reasons to Try to Control Fever
1) Fluid loss– When a child has fever, he requires extra fluid intake to make up for the water loss from sweating and evaporation. If the fever or the illness is resulting in poor intake of fluids by causing nausea or lack of appetite, dehydration might ensue, which causes even more illness and physiological derangement. When this happens, the administration of acetaminophen or ibuprofen is indicated just to get the child to be more interested in drinking and eating.
2) Aches and pains– There are frequently genuine discomforts associated with fever, such as headache and body aches. If the child is feeling miserable, it usually helps to give antipyretics, which also are good pain controllers. When the fever is down, the child feels better. Many people would rather have a sick but comfortable child remain ill for an extra day than to have an utterly miserable child who recovers one day sooner.
The Young Infant With Fever
Any fever (100.4F or above) that occurs in an infant less than one month of age is considered an emergency. Treating the fever itself is not important; it is the cause of the fever that requires attention. These neonates are susceptible to serious infections due to immaturity of the immune system. If merely unbundling the child does not take away the fever, the doctor should be contacted.
A temperature of 100.7 or higher in an infant 1 to 3 months old should be evaluated. It is, however, only considered an emergency if the infant is unable to maintain fluid intake or he appears ill.
When a Child Over 3 Months Is Ill With Fever
The first assessment must be made by the parents. Is the child feeling very ill, or is he being cute? If the child seems to be very ill, medical care must be sought.
If the child is coping with the illness, maintaining adequate fluid intake, and acting alert, he can be observed for a couple of days to see how he will do. If he gets progressively sicker, has more symptoms (like a worsening cough) or has a decrease in intake that is worrisome, medical care should be sought. If the fever persists more than 2 to 3 days , it is probably a good idea to have him checked.
If there are specific symptoms, such as abdominal pain, cough, swollen lymph nodes, redness of a certain area of skin, diarrhea with blood and mucous, sore throat, ear pain or other signs of infection, the doctor should be consulted.
Treatments of fever
Bathing – A Reasonable Treatment of Fever
A bath in tepid water for about 20 minutes will often help reduce fever. Sponging with tepid water and allowing the water to evaporate off the skin is actually quicker than the bath. (Never put alcohol in the water. The fumes are dangerous)
Antipyretics- fever reducers
- Acetaminophen (Tylenol): 10-15 milligrams per kilogram of body weight (100mg – 150mg per 22 lbs. of body weight) every 4 to 6 hours. It is important to look at the dosage in milligrams for each teaspoon or dropper on the bottle.
- Drops = 80 mg in .8cc
- Children’s liquid 1 tsp. = 180 mg
- Chewables = 80 mg per chewable tablet
- Suppositories come in varied dosages.
- Ibuprofen (Motrin or Advil): 10 milligrams per kilogram of body weight (100 mg. for 22 lbs. of body weight) every 6 hours.
- Drops = 50 mg in 1.25cc
- Children’s liquid = 100 mg per tsp.
Common Sense
When a child has fever, it is important to stop and think. A parent’s fear can be alleviated just by looking at the child and assessing his clinical condition. Most of the time simple observation, time, and extra fluid are all that is needed. If the child’s illness appears more serious, a physician should be consulted.
If a fever lasts more than two days a physician should be consulted.
There is no reason to keep a feverish child indoors. The outside air gives the child and the caregiver a refreshing sense of well-being.
With a little bit of understanding and common sense, parents can feel more confident dealing with a febrile child. Most pediatricians today are trying to implement this approach to eliminate “Fever Phobia.”