Fever by The Pediatric Group

Fever

The Pediatric Group, February, 2011

During this season of influenza and strep throat, many parents worry about their children having high fevers, especially when acetaminophen or ibuprofen has failed to lower the temperature. Uncomplicated fever, when allowed to run its course, may be associated with some discomfort, but is not dangerous. It is actually part of the body's immune response that fights bacteria and viruses.  If your child is less then 3 months old, however, a fever is more concerning, and your pediatrician should be contacted with every fever. 

Once a disease has been identified by the history of the illness, the child's physical findings or confirmatory laboratory studies and after any needed specific therapy has been instituted, doctors do not worry about the height of the fever, but rather use it as an indicator of whether the body is still fighting the illness. What, then, is a dangerous level of fever for a child? The answer relates not to a number, but to the child's functional state and associated symptoms. If a child with an identified condition has a fever at any level and responds to social interaction in a manner that is appropriate for the child's developmental stage, then concern is lessened. Well being is not tied to a number on a thermometer. We have all seen children who are cranky and uncomfortable in the absence of fever. We have also seen children with fever contentedly watching television and asking for juice without apparent discomfort. So it is the ability of the child to interact rather than the number on the thermometer that is more telling.

The timing of a fever can suggest whether a child needs more specific medical intervention. Fevers related to viral illness usually occur at the onset of the illness, oscillate for one to three days and disappear. Since viral disease generally resolves without specific treatment in children, the fever associated with it is not indicative of a worrisome event. When a child has a viral condition for several days and then develops fever, that may indicate a secondary bacterial infection which requires antibiotic treatment. This later appearance of a fever, though not dangerous, indicates the need for a physical examination. Once specific therapy for any complication is instituted, the fever usually dissipates without anti-fever treatment.

The exact level of the fever is unimportant. Indeed, knowing whether fever is present helps identify that a child is ill and perhaps contagious, but it is the discomfort suffered by the child, not the level of fever, that guides the administration of medication. If the number of the temperature must be known with any precision, the old fashioned glass thermometer is the most reliable, most accurate and most economical tool. Newer digital thermometers can achieve a similar accuracy with far greater speed at greater cost, but if dropped or jostled, their reliability can be compromised. The popular ear thermometers are notorious for over-reading a temperature, especially for children under three or four years of age (when higher fevers are more likely).

When we recommend acetaminophen or ibuprofen, our goal is usually the comfort of your child, not reduction of the fever. The aches and crankiness that accompany an illness may be associated with a normal or elevated temperature. Unless your child has a known predisposition to problems from fevers, forget the fever and treat the discomfort. Bathing a child with a fever may help increase the child's comfort level after the bath. However, you can anticipate a moderate amount of complaining by a child placed in a tepid bath when his or her body is trying to generate a higher temperature. We recommend against alcohol bathing or rubs because the body is chilled too quickly, causing uncomfortable shivers and more fever. Also, alcohol accidentally splashed in the eyes of a struggling child can irritate. Taking a febrile child out of doors makes absolutely no difference in the course of the child's illness and is considered safe. Caution regarding exposure of a febrile child to others is warranted, however, in order to prevent spread of the infection to others.

If a parent does feel that fever reducer is warranted, it is important that it is used with caution.  Administering a safe dosage of ibuprofen and acetaminophen is crucial.  Many parents (up to 50%) give an incorrect dose.  The dose should be determined based on your child’s weight and should be given with an accurate measuring device.  Doses should not be given early.  In general, one should choose either acetaminophen or ibuprofen (not both), and time given, amount given, and type given should be recorded.  Only one adult in the household should give fever medicine to avoid duplicate doses.

Fevers in childhood are common. They signify that a child is experiencing and fighting an inflammatory condition, usually an infection. The fever is not in itself a disease, but rather a helpful natural biologic mechanism for combating the disease. Fever need not be feared nor treated medicinally but for exceptional circumstances. If you have questions regarding the approach to fever, discuss it with your pediatrician. Hopefully the winter flu season will pass quickly and not force you to face the prospect of dealing with an ill child. Spring is just around the corner!

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