Fever

"Give me a fever and I can cure the child." – Hippocrates

There is a strong motivation to do something when your child is not feeling well.

Fever, more than almost any other common condition, causes great parental anxiety. Parents fear fever not only because it makes their child look and feel ill, but also because they're concerned that the fever indicates that there is a serious medical problem, or that the fever is going to harm their child. The majority of calls to pediatricians are related to fevers in children.

Historically, due to more serious illnesses of the past, fevers were indeed potentially devastating and, to watch old movies, a fever was something that could lead to catastrophic outcomes short of a dramatic breaking of the fever at dawn.

Fear of fever is still part of the collective consciousness because in the modern day there is so much advertising of fever-reducing medications, and pediatricians' offices readily give samples and dosage advice for these drugs. It stands to reason that it must be necessary to take steps to abolish the fever, even waking a peacefully sleeping child to do so.

Actually, fever represents a universal, ancient, and usually beneficial response to infection. It is one of the body's most effective weapons for fighting disease. Usually the best thing you can do is to let the fever run its course and do its job. There have been enough scientific studies over the years to show that fever is not harmful and that lowering fever can be counterproductive.

Just what is a fever and what does it do?

Fever is not an illness. It is an elevation in body temperature, usually in response to a viral or bacterial infection. When an illness is detected, a part of the brain called the hypothalamus increases the body's metabolism while decreasing its ability to disperse heat.

A Fever:

• Makes it very difficult for infections to thrive because illness-causing germs will likely not survive in the higher temperature.
• Reduces the amount of iron in the blood stream that is needed by the invading virus or bacteria, thus starving the infection of needed nutrients.
• Increases the activity of white blood cells that kill bacteria in the body.

The makers of such drugs as Tylenol (acetaminophen) and Motrin (ibuprofen) certainly want you believe that fever is something to be suppressed. However, because fever helps the body combat viruses and bacteria by retarding their growth and by stimulating an immunological response, reaching for a drug to bring down a child's fever may delay recovery. A growing body of research shows that letting a fever run its course may reduce the length and severity of such illnesses as colds, flu and other viral syndromes. In studies of children with routine infection, those who were treated with antipyretics (fever reducers) stayed sick longer.

Fear of Brain Damage

No scientific tests or investigations have ever confirmed the common fear that fever could cause brain damage. In the rare cases of meningitis or encephalitis, though, the opposite is true. These conditions themselves cause brain damage, which can then interfere with the brain's ability to control the body temperature. In neurologically normal children, the brain has an internal regulatory mechanism that does not allow fever to rise out of control. Fevers produced by viral or bacterial infections will not cause brain damage or permanent physical harm, despite the myths about children being severely compromised by having a high fever.

Febrile Seizures

A small percentage (about 3%) of children have an underlying predisposition that causes them to have a brief seizure when the temperature rises at an extremely rapid rate. They most often occur between the ages of six months and three years. The seizures are brief and are not harmful in any way. Most of the children that have this type of seizure will never have another one. Most children (97%) will never have a seizure, no matter how high their fever goes or how quickly it rises.

These seizures, or febrile convulsions, usually occur at the very beginning of an illness before the parents even realize that there is a fever. For this reason, aggressively treating fever does not prevent seizures.

The first time this happens is understandably terrifying to parents, but children who experience febrile convulsions are no more likely to develop a seizure disorder than children who have no previous history of them.

Newborn

Parents are advised to seek medical help when fever arises in a newborn in the first two months, as there is a heightened level of concern in such a young baby. Breastfeeding plays a critical role here, as breastfed babies are protected from a vast range of illnesses and have a lesser risk of developing febrile illnesses in the newborn phase.

Home Treatment

When a fever occurs, it is not necessary to artificially lower the temperature. It is, however, important to have the child drink plenty of fluids, because during this time of elevated body temperature, it is easy to become dehydrated. Signs of dehydration can be difficult to detect in young infants, but they include dryness of the mucous membranes (dry lips, dry eyes, no tears when crying), dry skin, infrequent wet diapers and a sunken fontanel (soft spot on the skull above the forehead). Encourage children to drink plenty of water or at least sips of water at frequent intervals. Honey or lemon can be added or dilute fresh juice given if preferred. Breast milk is perfect for nursing infants and will probably be all that is wanted anyway. Juice pops, soup broth, and herbal teas are great choices because they replace electrolytes that are used up in the fever process. Older babies or young children may be reluctant to drink, so sucking on ice cubes, frozen juice or a wet cloth or sponge may be an effective alternative. Rest during times of fever allows the body to use its energy to fight off infection.

Don't be too concerned if a feverish child does not want to eat. It is common for children with an elevated temperature not to have an appetite, so don't insist they eat. This reduced appetite is a good sign, actually, as fasting helps the body to further eliminate toxins and allows the body's energy to focus on recovery, rather than digestion. Encourage a hungry child to eat light wholesome meals that are easily digested like vegetable soup, or raw or stewed fruit.

How your child looks is more important than the exact reading on the thermometer. Children with a fever who are acting normally rarely have a serious medical problem. The illness is probably not serious if your child is alert and interested in his/her surroundings, is drinking and generally seems well. No treatment is needed other than fluids and rest.

Deciding to call the doctor

Fever is a natural process, but any time that you feel concerned, it is reasonable and expected that you request that the child's doctor evaluate for a possible serious infection. A child with a fever might have an underlying illness that needs to be diagnosed and possibly treated, so advice to let a fever run its course is not the same as ignoring what might be a serious condition if there is something about your child's condition that does not seem right. Your pediatrician will look for the possible source of fever, ask questions about your child's illness and do a thorough exam.

Call your child's doctor if:

• Your baby is under two months old and has a fever. Infants do not fight infections very well. Because of this your doctor will be more concerned about your infant with fever.
• An older child is persistently warm and does not respond to home treatment within three days.
• The fever is associated with respiratory difficulty. Look for labored breathing while at rest or noisy breathing.
• The baby or child refuses to drink or breastfeed (there is a risk of dehydration).
• Your child is always lying down, even after the fever has dropped, and does not have times of wanting to play and drink fluids (there might be a more serious illness).
• There are associated symptoms such as irritability (difficult to console), abdominal pain, limping, or pain with urination.