Fever Phobia

The first thoughts that go through my mind when my child has a high fever are the same as any parents; my baby looks horrible! Breathing fast and just lying there, he must be really sick. Then my pediatrician brain kicks in and I remember that fever is our body's best way of fighting off infection; changing the body temperature helps to kill the invading virus or bacteria. Fever is defined as rectal temperature greater than 100.4 F, but most physicians agree that the height of the temperature is not the most important symptom nor can it predict their illness (viral versus bacterial). Children tend to reach much higher body temerpature than adults, even with the same illness.  Most children look miserable when they have a high fever; flush, breathing fast (panting), with a fast heat rate and low energy. They feel BAD! So, our job as parents is to make them feel better and to make sure that they don't feel bad when their temperature goes down. The only exception to this rule is when you have an infant under the age of 3 months with a temperature over 100.4 F - they need to be evaluated by a doctor immediately

The best ways to reduce fever and make children feel better are:

1.     Ibuprofen or acetaminophen. You will hear many different opinions on how to give these medications. My personal preference to to pick one and give it as directed by your pediatrician, then use the other when your child has a fever or feels badly in between doses. Never give ibuprofen to infants under 6 months or aspirin to a child under 18 years. 

2.     Take your child's clothes off and place a thin, cotton blanket over them. Remember that your child's temperature will go up when wrapped in blankets. 

3.     Put them in a lukewarm bath - the temperature of the water should be normal body temperature (98.6 F), so it should not feel warm or cold to your wrist. Do not give a cold bath, ice bath, or alcohol rub, this will cause the child to shiver and it will raise the body temperature.

The most important parts of fever are the associated symptoms and the length of time it persists. Most fevers in children are from viral infections and do not last much longer than 3-5 days. Fever is rarely an emergency, but there are times when you will want to take your child to see a pediatrician. 

1.     Fever that lasts longer than 3 days

2.     Difficulty breathing, especially with wheezing, barking cough, or grunting

3.     Fever with persistent vomiting or signs of dehydration 

4.     Fever with urinary tract symptoms - pain with urination, accidents in a potty trained child, peeing more or less than usual

5.     Fever and headache, neck stiffness, or a rash that looks like bruises or "blood" dots 

6.     Fever without common viral symptoms - that means no congestion, runny nose, cough, vomiting, diarrhea

7.     Fever with abdominal pain in the right lower side 

I know that fever can be scary. No matter how much reassurance I give, parents tell me that they are still worried that their child has a serious bacterial infection, will get brain damage from high fever, or have a seizure. It is a parent's job to worry so let me state the facts: brain damage does not occur with high fever produced by the body due to an illness and febrile seizures (fever seizures) occur with changes in temperature and not specifically with high fever. If your child is going to have a febrile seizure, there is nothing you or a physician can do to keep it from occurring.

Children with serious bacterial illnesses do not look good when their temperature is normal. Treat your child's symptoms and not the fever – make them comfortable and know that if your child still looks ill when their fever is gone, that is the time to seek immediate medical attention. As always, it is always best to use your parental "gut" feeling, because you know your child best and no one will question you for seeking medical care if you are worried about your child.

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Heather Joyce, MD