Javelina Pediatrics

Information may not be reliable

This discussion of fever pertains to children over 3 months of age. Parents of infants 3 months old or younger who have fever of 100.4 F or higher are advised to immediately seek medical attention. Newborns have weak immune systems and fever at this age can be a sign of serious illness.
ALWAYS CONTACT YOUR CHILD'S DOCTOR IF YOU HAVE QUESTIONS ABOUT YOUR CHILD.
What is Fever
The human body does a fairly good job of regulating its temperature, usually in the range of 96-100 Fahrenheit. If you check your own temperature throughout the day, you will find that it varies by several degrees in a normal, healthy state; usually you will be coolest in the morning and warmest in the evening. There is also normal variation between people. There is nothing magical about 98.6! We consider the body temperature to be a fever only when it is greater than 100.4 F.
Fever occurs mostly in response to illness, when white blood cells release a chemical which resets the brain’s thermostat (the hypothalamus) to a higher setting. This, in effect, causes the body’s “furnace” to turn on, and the temperature begins to rise. Symptoms of this furnace working include shivering, goosebumps, and a sensation of feeling cold. Collectively, these symptoms are called “chills”. Chills occur when the fever is rising. When the brain’s thermostat is reset back to normal (as when a child receives acetaminophen or ibuprofen, or when the illness subsides), the brain turns on the “air conditioning” and the temperature begins to decline. Symptoms of this “air conditioning” working include sweating, red, flushed skin, and a sensation of feeling hot. These symptoms are referred to as “sweats”. Sweats occur when the fever is breaking.
The body’s temperature can rise for reasons other than fever. For example, runners will raise their temperature when they run on a hot day. This is not called fever, the term for this is hyperthermia. In hyperthermia, the body thermostat remains set at “normal”.
Myths about Fever
1 Fever is harmful: Fever is a natural and useful part of the body’s attempt to combat illness. It is not caused by the illness itself. Fever is the body's way of "cooking" a virus or bacteria so it cannot reproduce. Fever is a good response to infection.
2 Fever will rise out of control if left untreated: The body has a built-in limit on how high fever can rise; for most people, that limit is about 106 F. While this sounds high, most people (children especially) have fevers in this range with no ill-effects. You cannot cook your
3 The higher the fever-the worse the illness: Children with life-threatening illness may present with only a low-grade fever, or none at all! Children with common viral illnesses often have very high fevers, occasionally even over 105 F. Other symptoms and behaviors must be used to determine whether or not an illness is serious. These include observations of the child’s alertness and level of activity, their ability and willingness to take fluids, and other objective signs such as diarrhea, vomiting, runny nose, cough, shortness of breath, ect. The thermometer, by itself, should not be the basis for either panic or reassurance.
4 Fever can cause brain damage and seizures: If it did, we would all have brain damage, because we have all had fever! About 5% of children have a genetic predisposition for febrile seizures between 6 months and 6 years of age. These seizures are alarming but do not usually lead to epilepsy. This type of seizure is triggered by a rapid change in body temperature up or down and not by the level of fever. Thus, there is one reason to avoid rapidly lowering a child’s temperature during a fever.
5 Sponge bathing is a good way to lower a fever: Sponge baths are uncomfortable and may cause shivering which creates more heat. More importantly, sponge baths do not change the setting of the brain thermostat, so fever treated in this way is likely to return after the sponge bath. Never rub a child with alcohol to lower a fever!
6 Fever medications like actetaminophen and ibuprofen cure fever: Fever medications only "hide" fever by blocking the chemical signals to the brain. As soon as the medication wears off, the fever will rise again. This is a signal that the body is still fighting the illness. Alternating two medications as some doctors suggest, does not improve fever control and may be harmful to the internal organs.
Reasons to treat fever
The only reason to treat a fever is comfort. Temperatures higher than 102 F are often associated with malaise. If there is fever-associated discomfort, it is reasonable to treat it. High fever will often cause a child to act or appear more ill than he or she really is. If reducing the fever helps the child to look, act, and drink more normally, the parent will be reassured that the illness is probably not serious. Persistent fever will increase the child’s fluid losses and thus increase the need for supplemental fluids.
Reasons to avoid treating fever
Fever helps the body combat common illnesses. While fever does cause some discomfort, so may fever therapy, especially if it is over-zealous (Alternating acetaminophen and ibuprofen may injure the liver and is unnecessary!).
The most serious problem with aggressive fever therapy is that, too often, parents become so focused on monitoring and treating a child’s fever that they neglect to watch for other more worrisome signs and symptoms. A decrease in the child’s alertness and activity, less responsiveness to a parent’s comforting, and refusal to take liquids are all of far greater concern than the number on the thermometer.

When your child is ill, you should pay attention to all of the symptoms, but especially those less tangible behavioral symptoms described above. Don't treat a fever just because it is there. Remember that fever occurs for a reason, and it is doing no harm. If the fever is causing your child discomfort, it is reasonable to treat with a dose of acetaminophen (Tylenol®) or ibuprofen (Motrin®/Advil®). The goal of this treatment should be to improve comfort – do not be concerned if the medicine does not produce a significant drop in the temperature.
Consult your child’s doctor for fever lasting over 3 days without an obvious cause, or fever with listlessness, stiff neck and refusal to drink fluids.
adapted from Barton Schmitt