Fever is Your Friend

Published by the Children's Clinic of Ocean Springs

Pediatrician Dr. George D. Fain, M.D.

Office Telephone (228) 875-1184 or 1185 -- 24 hours

It’s two o’clock in the morning. You waken to the quiet restlessness of your child. Walking to her bedroom, you notice that she is burning up with fever. The thermometer reads 104 Fahrenheit rectally. What do you do? Often the parents will run the child to the emergency room terrified that there is something dreadfully wrong with their child. This usually leads to a large emergency room bill and a lost night of sleep. For the next few minutes, I want to address this problem and perhaps give some guidelines for treatment and a greater sense of security in the management of fever in your child.

What is fever? What causes it? Why is it so high in children? All living creatures have a temperature. A Fahrenheit temperature that is accepted as normal in the human is based on an average of humans of all ages who were not ill when measured. That accepted temperature is 97 to 98.6 degrees. An elevation over this accepted normal is called “PYREXIA”. This is what has become known as “FEVER”.

Many things can cause a fever in a child. Some of these causes are fever and some are not. Elevated temperature can be attributed to: over-wrapping or overdressing the baby, elevated environmental temperatures, or hard physical activity. The temperature can also be elevated due to more serious conditions like arthritis, malignancy, or even emotional stress. The most common form of fever in children, however, remains infection.

Infection can take many forms. Viral, bacterial, fungal, granulomatous diseases like Tuberculosis (TB), and parasitic infections can all cause fever. Children tend to have much more intense and more rapid responses to infection. A part of the brain called the HYPOTHALAMUS serves as a person’s built in thermostat. Children tend to have a much more labile thermostat than adults. Therefore, their fever tends to be higher. Where a simple viral cold in a child will cause a much more exaggerated response (104oF), the same infection in her parents may only cause a low grade elevation (99oF).

“Great”, I hear you say, “if that’s true then what guidelines can I use to call the doctor?” There are a few rules that you can use. First and FOREMOST take the temperature. It is really somewhat disheartening to be called at 3:00 AM by an anxious parent with a complaint of fever in their child when it has not been measured. The human hand is a wretched thermometer. It cannot distinguish between a 99 degree fever and a 103 fever. Before your doctor can give you good advice, it is important to give him all the data he must have. Keep a thermometer in the house. For very small children keep a RECTAL thermometer in the house. Aural (ear) thermometers are fairly accurate in accessing body temperature. RECTAL temperatures are still the Gold Standard. Axillary temperatures, while easy to take, are not much more accurate than feeling the child’s head. If a decision is made to hospitalize a child on the basis of fever, a true and accurate temperature should be taken. Axillary temperatures can be 99oF while the rectal temperature can be 99 - 104oF. If you think a temperature is significant enough to call about, take the temperature first. Secondly, write it down. It is easy to make a mistake or forget when you child is sick and you are nervous.

What do you do now with a real elevated temperature? All parents of small children should keep a supply of ACETAMINOPHEN (marketed under the names Tylenol, Tempra, Panadol, and others) in the house in a form that your child will take. Doses should be worked out beforehand based on the child’s weight. This can be obtained from your doctor or from the label of the bottle. Remember that Acetaminophen can be FATAL in over dose.

Another good fever medicine is IBUPROFEN (marked as Advil or Motrin). It is also does by the weight of the child. It is a good fever medicine by itself and, like Acetaminophen, comes in liquid, infant drops, chewable tablets, and pills. In very high fevers, both Acetaminophen and Ibuprofen can be taken either alternating every four hours or together every six hours. When taken together the effect is called synergism. The effect of the two together is greater than the sum of either medication by itself.

A medication that SHOULD NEVER be used without a doctor’s specific recommendation is ASPIRIN. At the present time there appears to be a connection between Aspirin use with a febrile illness and a disease called REYES syndrome. Reyes has been seen in children from infants to teenagers and is usually connected with a febrile viral illness. Research into Reyes continues, but for now, Aspirin should NOT be used in ANY febrile illness unless your doctor specifically needs for it to be used.

A good way to help the temperature descend safely, is a cool bath. If the child is placed into a lukewarm bath and bathed for 30 minutes with a coarse wash cloth, the temperature will come down two degrees. In prior times, it was customary to use either ice water or even ALCOHOL baths. This should NOT be done! In some cases these practices have been known to cause a febrile seizure and can even RAISE the temperature by causing the peripheral circulation to clamp down. The baby feels cooler, but his core temperature can be as much as three degrees hotter.

Do I go to the emergency room now? This is a decision that can only be made by the parents, however, there are some guidelines that can be used to make an informed decision. Rectal or oral temperatures of over 104oF should always result in at least a telephone call to your doctor or emergency room. There fevers have a greater than 50% chance of being bacterial in origin. You and your doctor need to make the decision of needed laboratories, ER visits, and medications together. Temperatures of 102-104oF is less likely to be bacterial and more likely to be from some other cause. If the temperature responds to Acetaminophen or Ibuprofen and a cool bath, it is most likely due to a virus.

If the fever comes down and the child is comfortable, you can wait until the next day to have your doctor see the child. If the child is uncomfortable or in pain, you will have to decide then which is the best course. A telephone call might help make your decision easier. If the fever is less than 102F, it is most likely viral in origin. If you make the baby comfortable and realize this simple fact, you can save yourself an expensive and tiresome trip to the emergency room. While it is still important to monitor your child for the rest of the night, it can afford you a few more hours of needed sleep.

There is one important EXCEPTION to these guidelines. In a child under the age of two months, any temperature over 101oF rectally needs at least a call to the doctor. While investigation will usually show that the baby has the same etiology as the older children, two out of a hundred (2%) will have a serious bacterial disease and have a low grade fever. Babies do not have the same degree of fever response as older children.

Fever in your child is actually a good warning sign that some sort of process is going on that you need to be aware of. Fever is your friend in managing your child. It is not a disease itself, but a sign of one. The best attitude to have about fever is not to panic, but use the data to intelligent decisions about how to best deal with a beloved child who is hurting or uncomfortable. God knew what He was doing when He gave us this built in “early warning system” in the rearing of His precious gift of our children.

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