Imagine ... the day almost over and you are on the way to your child’s daycare. The caretaker informs you that your child was not as playful as usual, and was not eating well. At home you check his temperature and there are no doubts – he has a fever. Now what?
Your mind is supplying you with information on last year’s news about several deadly cases of flu and meningitis. You call the nurse triage line and the nurse seems to be concerned; but this only adds to your worries! You have a decision to make: Should you give your child Tylenol and wait until morning or rush to the emergency room tonight?
Sounds familiar? Everybody who’s raised a child has had to make these decisions at least once in their lives. Among all the various symptoms of illness, fever seems to be one of the most disturbing. You might even hear things like fevers are bad for children, they can cause brain damage or seizures, or if they are high then the illness has to be serious.
This article will give you more information about fever’s facts and myths, so you can cut the stress and anxiety out of doctoring your child.
Myth: All fevers are bad for children and need to be brought down to normal.
Fact: Fever is not necessarily bad. In fact, a fever is a normal response to an infection and activates the body’s immune system, preparing it to fight more effectively. Therefore, fevers needs to be seen as one of the body’s protective mechanisms.
Myth: Fever can cause the brain damage or fevers over 104 degrees F (40 C) are dangerous.
Fact: Fever in response to an infection is a very controlled process. There is a biological thermostat in the brain that is responsible for maintaining the body temperature both in health and during illness, and this mechanism is not broken during illness; it is just reset to maintain a new temperature in response to a new challenge faced by the child. The brain will not raise the temperature high enough to damage itself. In fact, only temperatures above 108 F (42 C) were shown to cause brain damage. It never goes that high when the brain is in charge. It only happens when the inner thermostat is broken, such as during heat stroke which can occur after dehydration on a hot day. That, unfortunately, does happen and requires immediate medical attention.
Myth: Without treatment, a fever will keep climbing.
Fact: 99.9 percent of the time, it will not. True, it may go above our comfort zone, but it will not go beyond the new preset point chosen by the brain to fight the infection. Sometimes, though it is possible to tell if the fever will go higher: if your child’s body is hot but the hands and feet are cold – the temperature is still rising; conversely, when the whole body is warm (including the hands and feet) the temperature has probably reached its level and will not increase anymore (the body is now opening the blood vessels on the extremities in an attempt to disperse the excess of heat produced). It is just an observation, but it may serve as a useful assessment tool.
Myth: If the fever is high, the cause is serious.
Fact: If the fever is high, the cause may or may not be serious. It depends on many factors; the most important of them is what your child’s symptoms are. Sometimes it’s appropriate to bring the fever down with medication to see if your child perks up and seems to be feeling better; that’s always a good sign.
Myth: High fevers will trigger dangerous seizures.
Fact: Only a small number of children between the ages of 6 months and 5 years (about 4 percent) may develop febrile seizures (seizures triggered by fever). These seizures are scary to watch, but they usually stop within 5 minutes. They cause no permanent harm. Children who have had febrile seizures do not have a greater risk for developmental delays, learning disabilities or seizures without fever. They usually don’t occur after 5 years of age.
Myth: All fevers need to be treated with fever medicine, and with treatment fevers should come down to normal.
Fact: Fevers need to be treated only if they cause discomfort preventing the child from drinking well. (Usually that occurs with fevers over 102-103 F (39-39.4 C). It is reasonable to bring the fever down below that level.) There is a significant water loss related to fever--if the child is not eating or drinking, he or she can quickly become fatigued and dehydrated if the fever stays high. But the intention here should not be to treat the number, but the child. If he has a fever of 104, but happily runs around, drinks plenty of fluids and snacks on the popsicles and his favorite foods that fever can safely be left alone.
Fevers in children younger than 3 months of age deserve special attention. These children tend to have higher number of serious infections associated with fevers and should be seen quickly by a doctor. Do not give Tylenol to the child younger than 2 months of age without talking to your doctor first, especially if the fever is mild. And do not initiate the treatment with leftover antibiotics from a previous ear infection – it makes things much more complicated that they need to be.
I hope that this article will reduce your level of anxiety next time your child has a fever. And remember, that you can always contact your doctor if you have any questions or concerns.
— Marat Plotkin, MD
(Dr. Plotkin can be contacted at HealthPoint Pediatrics, 105 Greencastle Rd., Tyrone, 770-631-1040.)
