Fever is not a disease
but rather a symptom of an illness.
Childhood fevers frighten grownups.
Fever is maligned and misunderstood.
Controversy surrounding the management of fever
causes anxiety for parents, because they are not completely sure what to
do when their child has one.
It may help parents to remember that fever is only
one part of the picture of an illness. In fact, for children under eight
years of age, and especially for infants, the severity of
a fever is an unreliable indicator of the severity of the child's
illness.
For example, infants and toddlers can be very sick
with a low or even subnormal temperature. Conversely, children three to
eight years old can be running about quite cheerfully with a fairly
impressive fever. The important thing is how your child is acting, not the
thermometer reading.
Defining Fever
First, let's define normal body temperature. Most
people say 98.6ºF (37ºC) is normal, but this doesn't account for
individual variations or the fact that kids tend to run slightly hotter
than adults. You can think of anything between 97º and 99.4ºF (36º and
37.4ºC) as normal.
Consumption of hot food, recent exercise,
overbundling, hot weather, or an overheated room can drive body
temperature up a degree or two. Body temperature also varies during the
course of the day, and, with teenaged girls, the menstrual cycle.
Fevers usually hit their highest point in the late
afternoon.
Conversely, kids often have their lowest temperature
of the day early in the morning. So don't panic at 4 p.m. when your
child's fever rises slightly; this does not necessarily forebode a raging
fever. On the other hand, if your child has a low-grade fever upon
awakening, you may want to keep him home.
How Fever Happens
Infections most commonly launch fever, especially in
children. Other triggers include transfusion reactions, juvenile
rheumatoid arthritis, tumors, inflammatory reactions caused by trauma,
medications (including some antihistamines, antibiotics, or an overdose of
aspirin), immunizations, and dehydration.
Most physicians do not believe that teething
directly causes significant fever, but we have seen it happen.
When infectious "bugs" stimulate white blood cells
in a specific way, they release a substance called endogenous pyrogen,
which signals the brain's hypothalamus to raise the body's thermostat
setting. In turn, the body heats up by increasing its metabolic rate,
shivering, or seeking warm environments.
It also minimizes heat loss by restricting blood
flow to the skin, giving it a pale appearance. Once body temperature
rises, the skin flushes and sweats. A fever sufferer may lose appetite and
feel lethargic, achy, and sleepy. When these phenomena happen to our
children, we just tuck them into bed and let them sleep.
A basic fever, one due to minor bacterial or
viral illness, can be an expression of the immune system working at its
best. Given that most animals
(vertebrates anyway) mount a fever in response to illness, it's likely
that humans have preserved this evolutionary response because it improves
survival. Some research supports this theory; animal studies show when
fever is blocked, survival rates from infection decline.
Fever increases the amount of interferon (a natural antiviral and anticancer substance) in the
blood. A mild fever also increases the white blood cells that kill
cells infected with viruses, fungi, and cancer, and improves the ability
of certain white blood cells to destroy bacteria and infected cells. Fever
also impairs the replication of many bacteria and viruses.
Bottom
line: A moderate fever is a friend, but not one you want to
spend a lot of time with. So it makes sense to avoid suppressing moderate
fevers with drugs, while continuing to monitor your child for dramatic
increases in temperature and worsening of any other of his
symptoms.
Can Fever Do
Harm?
Any time body temperature increases, salt and water
are lost via sweating, and stores of energy and vitamins, especially the
water-soluble ones, are burned up. During moderate fevers, we can
compensate for these losses by drinking appropriate fluids, ingesting
nutritious foods, or taking vitamin supplements.
Replacing water-soluble vitamins (chiefly C and Bs)
makes sense. However, during fevers, the body makes some minerals
unavailable for a good reason - bacteria need them to thrive. In terms of
energy stores, our bodies switch from burning glucose (the favorite meal
of bacteria) to burning protein and fat.
This means a few days of poor appetite is
probably adaptive. In other words, don't cajole or coerce your children
into eating during fevers if they don't feel hungry; they will likely regain any lost weight quickly after the
illness ends. You do, however, need to encourage fluids, because
dehydration alone can drive up fever.
Very high fevers - those above 106°F (41°C) - can harm the heart
and brain. Some authorities, however, say
that fever is unlikely to cause brain damage in a previously healthy
child. During most infections, the brain keeps body temperature at or
below 104°F (40°C). So in most - not all - cases, you don't need to be
afraid that your child's temperature is going to continue to rise above
that point.
What About Febrile
Seizures?
First, let's define them. These abnormal jerking
movements occur in children between the ages of three months and five
years in association with a fever, but without evidence of infection of
the nervous system. The seizure lasts no longer than 15 minutes (usually
five minutes or less) and causes twitching all over. About 3 percent of
kids get febrile seizures.
The reason some children have this susceptibility
isn't well understood. Of those kids who have a first-time febrile
seizure, about one-third have a recurrence. Risks for recurrence go up
with younger age at the first seizure (16 months old or less) and a family
history of febrile seizures.
Frightening as these seizures are for
parents, they're benign; once they
pass, the child continues to develop normally. Often pediatricians can
help parents learn to block high temperatures by giving ibuprofen or
acetaminophen when fevers start. For the few children who have recurrent
febrile seizures, anticonvulsants or sedatives may be used.
What to Do If Your Child Has
a Febrile Seizure
Try to stay calm. That's a tall order, but your
child needs you to be collected. Take a deep breath. Let it out. Tell
yourself that the seizure will not last long (although it may seem like
forever) and that your child will likely be fine afterward.
Look at your watch to time the length of the
seizure. This sounds like a big demand, given the anxiety a parent
naturally feels. However, you will otherwise overestimate the time, and
the duration of the seizure is important information for the doctor. If it
exceeds five minutes, call 911.
Turn your child on his side. This reduces his
risk of gagging on or inhaling secretions.
Make sure the immediate environment is safe.
Remove objects your child might hit.
Do not restrain your child.
After the seizure is over, comfort and reassure your
child, then call your doctor for an immediate appointment. He or she will
want to evaluate your child for any abnormalities (other than fever) that
may have triggered the seizure. If the seizure lasted longer than five
minutes and/or your child seems to be very sick, your physician may tell
you to go to the emergency room right away.
Over-the-Counter Medications
for Fevers
It makes sense to us that if fever helps defend against infection, giving fever-reducing
medications may make things worse. In addition, some
fever medications can have undesirable side effects. On the other hand, no
one likes to watch a child suffer. And fever can deplete a child's energy.
Here's a profile of over-the-counter medicines for reducing fever and
discomfort.
Acetaminophen reduces fever and pain but not
inflammation. Follow the package instructions. Because of the risk of
liver damage, do not dose more frequently than every four to six hours or
for more than five consecutive days. There is no need to awaken your child
to give her a dose; sleep will do far more good.
Ibuprofen (Children's Motrin, Pediaprofen, Advil)
reduces fever, pain, and inflammation. Follow the package instructions. Do
not give more often than every six hours unless your physician advises
otherwise. This medicine can cause stomach upset.
Aspirin reduces fever, pain, and inflammation, but
pediatricians rarely recommend it.
Use of aspirin in children during viral illness has been linked
to Reye's syndrome, a disease characterized
by severe liver dysfunction and brain swelling. Symptoms include
effortless and repeated vomiting, then a change in the level of
consciousness (lethargy, stupor, combative behavior, delirium, seizures,
coma).
No one knows what the cause of Reye's is, but it
seems to be linked with aspirin use during viral illnesses. For this
reason, authorities have recommended that children under 21 years with
symptoms of viral respiratory illness or chickenpox do not take aspirin.
Sometimes herpes outbreaks and viral gastroenteritis (marked by vomiting
and/or diarrhea) are included in the list of illnesses during which
aspirin must be avoided.
Unfortunately, it is often difficult to be certain
of the cause of an illness when it starts. Aspirin is a component of many
cold and flu over-the-counter medications, so avoiding it requires careful
label reading on your part.
Medications for fever can act as a screen. Here are
some pros and cons to giving your child over-the-counter medication to
ease a fever.
Medication such as acetaminophen can help sort out
whether your child feels miserable because of a fever or because of an
infection. Some physicians use a trial of acetaminophen as a screen. If,
after the drug kicks in, the child looks and acts better, it is less
likely that he has a fever or that his infection is a serious
one.
Fever medications can make your child feel better.
He may be more likely to drink fluids, nibble food, and sleep. All can
help him recover.
Fever medications can mask symptoms. In
other words, your child acts as though his health has improved, but it really hasn't.
Fever medications may actually prolong the illness.
This opinion of some practitioners is backed by a few studies. Assuming
the response of the body to illness (fever, inflammation, sleepiness) is
adaptive, it seems reasonable to assume that interfering with the process
may do more harm than good. The following are some examples that support
this theory.
A study of adults with colds found that aspirin
and acetaminophen suppressed production of antibodies and increased cold
symptoms, with a trend toward longer infectiousness.
In a study of children with chickenpox,
acetaminophen prolonged itching and the time to scabbing compared to
placebo treatment.
In test-tube studies, therapeutic levels of
aspirin suppressed the ability of human white blood cells to destroy
bacteria. Acetaminophen did not have this effect. Another study found
that a host of pain relievers, including aspirin and ibuprofen,
inhibited white-cell production of antibodies by up to 50
percent.
The bottom line. Use these medicines
sparingly when your child is in pain or suffers discomfort from a fever
over 102°F (38.8°C). Ask yourself whether you are administering the
fever-reducing medicine to make your child more comfortable or to decrease
your own anxiety.
Nondrug approaches can go a long way toward helping
your child feel better. If the situation does not seem urgent, you might
want to consider a trial of herbal treatment before you pull out the
acetaminophen.
Home Management of
Fevers
Do give your child lots to drink.
Fever increases fluid loss, and dehydration can drive up your child's
temperature. Kids with fever often do not feel thirsty, or by the time
they do, they're already dehydrated. So keep offering fluids.
Small,
frequent sips are often best, especially if the child feels
nauseated. If necessary, use a plastic medicine dropper to gently insert
water into your child's mouth. The type that holds several ounces is best
to use.
Dress lightly or bundle? The
answer depends on your children's perception of temperature - follow her
cues. If your child looks pale, shivers, or complains of feeling chilled
(things that tend to happen in the early stages of fever), bundle her in
breathable fabrics so that sweat will evaporate, but make sure she can
easily remove the layers. If she is comfortable and her fever is low,
dress her snuggly and give warm liquids to assist the body's fever
production. If she sweats and complains of heat, dress her lightly and let
her throw off the covers. Older kids will take care of these needs
themselves.
Don't push food. People with
fevers generally don't have much appetite. Let your child determine when
and what she eats. Just bear in mind that consumption of sugary foods
could delay the natural immune response.
Herbal Remedies for
Fevers
A rule of thumb that herbalists like to use during
minor illness with fever is: "First, do nothing," meaning that a short period of
observation ought to precede any action against the illness. Follow our
guidelines above for seeking medical assistance for feverish children
under the age of two, and encourage fluids. For older children, give
liquids, make them comfortable, and observe closely.
Is your
child drinking fluids well? Urinating at least once every eight hours
(ideally, every three to four hours, or wetting eight to ten diapers per
day)? Does your touch console her? Is she playing normally? If the answer
to these questions is yes, she is probably not seriously
ill.
