If we had to choose ONE issue that most parents express concern about at one time or another, it would be fever. There seems to be an aura of–well, dare I say it–fear when it comes to fever. Of all of the signs and symptoms children have associated with illness, this is the one that prompts calls to the office.
What is it about fever that is so worrisome? In our opinion, the primary reason for ‘fever phobia’ is rooted in history. For centuries, long before bacteria and viruses were discovered, fever equaled sickness. And, back then, people died more frequently when they became ill. Since there was such a limited understanding of the causes of illness, fever was assumed to be the culprit for the person’s demise. With a lack of understanding about causal factors, treatment was limited. Today, as our knowledge of illness and diseases is far more comprehensive, we understand that fever is merely a sign of illness and we look beyond the temperature to determine how the child or adult is handling the illness.
Another possible explanation, especially in regard to children, is based in advice given to all brand new parents while still in the hospital after the birth of their new baby. The list of “warning signs” indicating problems includes fever. You might remember hearing that fever before age 3 months is a problem and the advice would always be to call your doctor. Although fever in an older infant or child is not generally alarming, it is hard to unring that bell.
In our practice, we regard fever in a child as an adaptive response. It is part of the language of the body and simply indicates that the immune system is responding to an illness. As it turns out, scientists knew that fever was a critical part of the mammalian immune response at least as far back as the 1970s. A study was conducted in which dogs were injected with bacteria in order to investigate their immune response. Some of the dogs were kept on ice so that their body temperature could not go up, while other dogs were allowed to experience the normal temperature rise associated with fighting the infection. The dogs whose temperature was allowed to rise survived, whereas the dogs kept on ice did not.
Another pivotal study from the 1970’s was published by McCarthy who provided evidence of the crucial role of the child’s behavior in illness. Far more important than body temperature, behavioral changes are a much better indicator of the way that a child is handling illness. How illness affects sleeping, eating and mood tells a lot about what we need to know to treat them (or not).
Fast forward to last couple of years when researchers demonstrated for the first time that if very young children with a viral illness are aggressively dosed with fever-reducing medications (acetaminophen or ibuprofen), those viral illnesses tend to last longer. When we medicate children to reduce their fevers, we actually interfere with the body’s immune response. This study reported that temperatures of around 101 actually crank up the immune system to do its job more effectively.
And finally, again in a recent study, scientists have demonstrated that if children are routinely given fever-reducing medicine after receiving vaccinations, the expected immune response to those vaccinations can be reduced.
So what do we make of these findings? We regard fever as a beneficial sign as it is a critical part of the body’s immune response. It is important to keep in mind that fever, in and of itself, does not tell us what is going on with your child and it does not dictate treatment. Temperature up to 100.4 rectally (or the equivalent such as forehead or ear temp) is considered normal. By the way, we will always ask where on the body the temp was taken. There are differences if taken rectally, orally or under the arm. If we know where the temp was taken and the reading, we can make the conversions. Consideration of how the child is handling a fever-producing illness is more accurately accounted for by changes in the child’s physiology and everyday behavior. When parents call our office for advice about fever, they will always be asked about behavioral signs and symptoms rather than the absolute degree of the thermometer reading. How does the child look? What is his or her mood? Are there any changes in sleep patterns or eating/drinking? Is anyone else in the family sick? How long has the fever persisted?
If we can help dispel the fear of fever and shift attention to the resultant impact on the child’s health, we will be in a better position to help the child through the illness. It is still important to call the office if a baby under 3 months has a temperature (rectal or equivalent) of greater than 100.4, but in the older child we look beyond the fever.