Fever and Fever Phobia

One of the most common reasons for a visit to my office or an after-hours phone call is parental concern about fever.  There are a multitude of “Old Wives’ Tales” about fever that have persisted since long before I was born, and continue unabated today.  So below is the real, truthful scoop on fever, why it happens, and what (if anything) to do about it.

Fever is defined as a temperature above 100.3 degrees Fahrenheit that is caused by infection or inflammation.  The average human’s temperature is 98.6 degrees Fahrenheit.  Therefore, ½ of the population is below 98.6, and ½ is above, and the amount above or below can vary by up to 1.8 degrees.  So we as physicians don’t even consider a temp below 100.4 to be an actual fever.  If your kid has a temp of 98.8, it isn’t fever.  It is normal, and giving fever reducers won’t work.  If your kid has a temp of 97.8, it isn’t too low, it is normal.  So the normal range for humans (both adults and kids) is from 96.8 to 100.3.  Some people run hot, some run cold.  It’s all in our genes.

Fever is our body’s natural response to an infection.  Elevated temperature can also be due to a few other rare things (more on that later), but by and large it is our own internal mechanism of trying to kill germs, and therefore is part of our immune function.  Fever in response to an infection is harmless.  Yes, harmless.  It does not cause brain damage, does not mean the illness is serious, and does not predict if a child will have a febrile convulsion. It simply means that you are ill.  And the ability of medication to relieve or not relieve fever does not indicate the severity of the illness.  Fever in and of itself does not need to be treated.  Fever is not a disease, it is a symptom.  Sounds almost blasphemous, doesn’t it?

What’s really important is why.  “Why does my child have fever”? That is the real question we should be asking.  For instance, if a child has a 105 degree fever and has a virus, my recommendation is to go home, keep him comfortable, encourage fluids, and call me for changes.  But if a kid has a temperature of 100.8, is lethargic, breathing rapidly, and I suspect has pneumonia or meningitis, that kid is going straight to the hospital for IV fluids and antibiotics.  So the height of the fever is fairly unimportant, but what is causing the fever is very important.

But we are supposed to treat our kids’ fever, right?  Wrong.  There is only one reason to treat fever, and that reason is PATIENT COMFORT.  If your kid is uncomfortable, then use fever meds, and if your kid is relatively comfortable, don’t.  Making your child comfortable will help with eating, drinking, sleeping and will reduce his complaining.  (You will probably sleep better also, because your kid won’t wake you!)

You may use either acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) for a fever reducer.  These are the only two meds available to you.  If they don’t work, you’re stuck.  But remember, neither of these products can cure an illness; neither of them can shorten the course of an illness; and if neither were available, we would survive and live, but would be most miserable when ill! There is evidence in our scientific writings that the use of fever reducers may even prolong an illness.  So the decision whether or not to treat is really up to you (and how miserable your kid is).  The dose of each of these products is determined entirely on body weight, not age.  So please ask us for the dose, or for a dosage sheet.  Also, keep your child lightly clothed, but if he shivers, then lightly wrap him in a blanket till the shivering stops, then remove it.  Luke warm baths can lower fever temporarily, but only for a few minutes.  It’s hardly worth the time or mess!

Many of our parents ask about “alternating” doses of acetaminophen and ibuprofen.  While this has been shown to reduce fever better than either product alone, there are some drawbacks.  First, each separate product has a different concentration (Drops, liquid, with a dropper, without a dropper, etc).  Next, each is dosed at a different amount (acetaminophen at 15mg/kg, and ibuprofen at 10 mg/kg).  Third, each is dosed at a different schedule (acetaminophen every 4 hours, ibuprofen every 6 hours). To most parents, this is quite confusing and can result in both under dosing and over dosing.  So I recommend that you pick a single product, and stick with it.  This is simpler and much safer.  Remember, we are trying to make your child more comfortable, not cure a disease.

Several rather unusual conditions exist in which “hyperthermia” (an elevated temp not due to an infection or inflammation) is an issue.  Wrapping a kid in multiple blankets, or keeping them in a closed environment (i.e., a car) when the outside temp is hot can cause deadly hyperthermia.  Also, a rare anesthetic problem called Malignant Hyperthermia can cause life threatening hyperthermia.  And if a kid exercises in extreme heat and doesn’t hydrate properly, then heat exhaustion or heat stroke can exist, which is life-threatening.

Hope this has been helpful.  Feel free to ask questions at your next visit about fever.

Copyright 2012, Albert G. Karam