Having a fever not always a cause for fear

Acommon reason parents contact their pediatrician’s office or the on-call provider is for advice on what to do when a child has a fever.

They worry the fever will cause damage to their child, or that the fever itself is an illness that must be treated. There is a significant amount of unnecessary fear of fever suffered by parents and families and efforts to “treat” the fever may sometimes be harmful.

A fever is a body temperature above 100.4 degrees Fahrenheit (38 degrees Celsius).

A normal body temperature for most people is 98.6 F (37 C) and there is variability in our normal temperatures that can be impacted by age, the time of day, phase of the menstrual cycle, and level of activity.

Our temperatures are lowest in the morning, and peak in the afternoon or early evening. The body’s thermostat is controlled by a part of the brain called the hypothalamus, and it is responsible for maintaining a temperature set-point within a range of about two degrees Fahrenheit.

This is true even during illness when a fever is present, but the temperature range has a higher baseline set-point.

The hypothalamus increases the body’s temperature in response to factors in the blood that can be released by cells in response to an infection or from tissue damage. It then turns up the body’s thermostat and causes the body to conserve heat as well as to produce heat through shivering.

Fever may help our body to fight infection better by impairing the activity of some viruses and bacteria, and supporting the body’s inflammatory response to fight an infection.

A fever does not damage organs and typically does not go much above 105 F.

Hyperthermia is significantly different from fever as it produced by environmental temperatures or from drugs that interfere with our body’s ability to regulate temperature. Hyperthermia can be very serious causing hot dry skin, a change in mental status, seizures or even death.

Because it is not directed by our own regulatory systems, it causes damage at temperatures that are normally well-tolerated when caused by fever. Treatments effective for fever are ineffective for hyperthermia; the best treatment is prevention.

NEVER leave kids in a hot car and limit outdoor exposure when temperatures are high.

Digital thermometers are generally accurate and measure temperature rectally, orally or in the axillary (armpit) area.

Rectal temperatures give the most accurate reading and are recommended for infants and young children when a precise reading is needed.

Oral temperatures may be taken once kids are able to cooperate, usually around the age of four. Axillary temperatures are not quite as accurate but can be taken easily.

Temporal artery thermometers, used by running the device across the forehead, are another option but their readings can be impacted by ambient temperature and sweating. Infrared thermometers measure temperature on surfaces such as the tympanic membrane (ear drum) or the skin on the forehead. These point-and-shoot type devices may be impacted by user error or ambient temperature. Never use a mercury or glass thermometer.

Fever care should be comfort care. If a child has a fever but is drinking, playing and is comfortable, there is no need to treat. If a child is fussy, not drinking or seems listless, then provide treatment.

Acetaminophen and ibuprofen are oral medications that treat fever and pain. Always follow the dosing guidelines provided on the packaging and opt for weight-based dosing over age-based dosing, as it is more accurate. Do not give a higher dose or dose more frequently as this may cause organ damage.

Alternating between acetaminophen and ibuprofen has been associated with dosing errors, so it is best to stick with one medicine given on the recommended schedule, as needed.

Aspirin is not recommended for kids. For kids under two, or if your child has other medical issues or is on other medications, contact your pediatrician.

A cool cloth to the forehead or neck can also provide some comfort, as well as keeping them lightly dressed. Offer your child plenty of fluids to drink, and watch for signs of dehydration which includes decreased urine output, dry mouth or not producing tears when crying.

Have your child evaluated if he or she has had a fever for more than a few days, has a fever consistently over 104 F, looks like they are working harder to breathe, has any mental status changes or has a stiff neck.

Any baby younger than three months of age should be evaluated immediately if found to have a fever.

Provide that much-appreciated TLC and don’t fear the fever.