My Child Has a Fever, What Should I Do?
I get this question so often in my practice that I decided to sit down and actually write an article on the subject. After all, fever is the most common cause of visits by children to their pediatrician. While fever in infants less than 2-3 months of age can be a cause for concern, most fevers are merely an indication that the body is functioning properly. Well meaning parents actually prolong conditions that would have ended sooner if their child's fever were allowed to run its course. Let's explore this subject more closely to gain a better understanding of why fever is not something to be feared, but rather embraced.
First a basic understanding of how to get your child's accurate temperature is necessary. There are lots of different types of thermometers available these days, but due to variations in how they are used and inaccurate readings, I only recommend digital thermometers. The actual core temperature of the body is the one we are discussing in this article. Core temperature can only be determined rectally. Oral temperature is roughly 1 degree Fahrenheit lower than core, and axillary, or armpit temperature is roughly 2 degrees lower. Normal average body temperature is 98.6ºF but can vary throughout the day from 97.5 - 99.5ºF. Fever is defined as a core body temperature of greater than 100.5ºF.
Now let's get this out of the way. These are the cases where fever IS a cause for concern. These cases require evaluation by a physician:
- A fever (at any temperature) in an infant under 3 months of age could be the result of a bacterial infection which could become life threatening very quickly.
- Any child with a fever over 104.5ºF.
- A feverish child who is difficult to awaken.
- A child with fever and a stiff neck or one who cries when moved or touched.
- Any child that experiences a febrile seizure.
Please keep in mind that these scenarios are very rare. Febrile seizures occur in fewer than 4% of children with fever.
Most parents that I discuss this topic with share the same primary concern. "Won't a high fever cause brain damage?" The answer is, Yes. High fever over a prolonged time period can cause brain damage. However, the temperature would have to be over 107ºF. Most fevers remain below 106ºF. Keep in mind also that fevers tend to spike in the late afternoon and evening, so a slight increase in fever during this time is not necessarily cause for alarm.
During the cold and flu season most households are afflicted with common viral infections. The fever associated with most viral infections will range from 101ºF to 104ºF. These fevers can easily run for 2-3 days. There is no cause for concern at this temperature. Rather, these are the cases where the fever is a blessing! Let's look at how the fever actually benefits the body.
- Raising of body temperature kills many microorganisms and has an adverse effect on the growth and replication of others. Viruses and bacteria actually grow best at temperatures lower than that of the human body.
- Higher body temperatures decrease blood serum levels of iron, zinc and copper, all of which are needed for bacterial replication. As these minerals are reduced in the blood stream, bacteria are starved.
- Increased temperature causes lysosomal breakdown and auto-destruction of cells thus preventing viral replication in infected cells.
- Heat increases white blood cell formation and motility, thus facilitating the immune response. The white blood cells, which carry out the destruction of the invaders, get where they are needed faster and do their job more efficiently.
- Phagocytosis (cellular clean up) is enhanced and production of antiviral interferon may be augmented.
"What about the medications that bring down a fever, they can't do any harm can they?" This is another common question. Well, Yes, they actually can do some harm:
- A study of adults with colds found that aspirin and acetaminophen suppressed production of antibodies and increased cold symptoms, with a trend toward longer infectiousness.
- In a study of children with chickenpox, acetaminophen prolonged itching and the time to scabbing compared to placebo treatment.
- In test-tube studies, therapeutic levels of aspirin suppressed the ability of human white blood cells to destroy bacteria.
- Another study found that a host of pain relievers, including aspirin and ibuprofen, inhibited white-cell production of antibodies by up to 50 percent.
So, as you see, well meaning parents trying to ease their child's discomfort can actually prolong the disease course. These medications also carry risks of side effects, including liver damage with acetaminophen, stomach upset with Ibuprofen and Reye's syndrome with aspirin (it's recommended that children under 19 not be given aspirin when they have a fever, due to the link to Reye's syndrome).
Remember, the point of the fever is to stimulate the immune system and create an inhospitable environment for invading organisms, essentially turning up the heat high enough that the invading microbes cannot live. So anytime you lower a fever artificially you're making your body more hospitable to the invading pathogens.
Hippocrates (Ancient Greece 460-377 BC, the "Father of Medicine")
- "Give me fever, and I can cure your patient."