Dealing With Fever
Our nurses have received quite a few calls about fever this month (and many office visits). Here is helpful information for the winter season:
Infections cause a variety of responses from the body and elevated temperature is one of the most noticeable. Children’s temperatures seem to rise faster and higher than an adult’s does. Call the doctor right away if your child is younger than 3 months old and has a fever. For a baby 3 to 5 months old, call the doctor if her temperature reaches 101 degrees or higher. Once she’s 6 months old, call if her fever reaches 102 degrees or more. More importantly, know that you can call your doctor anytime you feel like you need advice/support.
Fevers help to fight infections because white blood cells move faster and kill viruses and bacteria better at 102 degrees than they do at 98.6. Additionally, many germs have a limited range of viability and do not grow as well when the temperature is higher.
The problem is that most children do not eat, drink or sleep very well when they have high fevers. They are also not easy to assess medically at 102 either. To a parent or a doctor, a child with a high temp looks pretty bad even when the illness causing the fever is “just a cold.”
There are two reasons to bring down the temperature:
- To make a child more comfortable so they have an easier time staying hydrated and getting a little more rest.
- To be able to observe a child with a lower temperature and realize that it was a large fever and a small underlying illness making them look a lot worse than they really are.
In adults, the height of the fever often correlates well with the severity of the illness. In children, this is not always the case: a two-year-old can develop a 105 fever with a viral cold or could be sick with pneumonia but only have a 100.8 temp. Bringing the temp down on that first child will give you a fairly normal child for an hour or so but bringing the temp down for the kid with pneumonia or some other more significant illness won’t do anywhere near as much to make them feel a lot better.
I recommend long lukewarm tub baths as the best way to lower temperatures when you need to. Also, make sure to “unwrap” your baby or child to allow heat to radiate out from the body rather than being trapped underneath heavy clothing or blankets. This is much more important than many parents realize.
Most doctors also recommend Tylenol type drugs or Advil/Motrin type anti-inflammatory medicine. More natural approaches favor not bringing down the fever at all but just working for good hydration and comfort while allowing the immune system’s natural mechanisms (including fever) to work on the infection. This is not a bad course of action, but a lot of parents I know are not very comfortable watching their child’s temp go up and stay up. If this is the way you feel, try lowering the temperature at least once to reassure yourself and your doctor that under this big fever is a small illness.
Aspirin must never be used in childhood or teenage years because of the statistical association with Reye’s syndrome, a potentially fatal liver disorder.
A word about febrile seizures: From about 18 months through age five years or slightly later, about 1 out of 50 children will have a convulsion with the fever. This is an innocent occurrence about 99.99% of the time but one of the most frightening things you’ll ever see. Remain as calm as you can, call your doctor right away, and do not put anything into your child’s mouth. Hold them upright and slightly tilted forward so that they have an easier time with secretion or vomit. The seizure will last 1-3 minutes (it will feel like an hour) and then your child will sleep or act very lethargic. Immediate medical evaluation is needed for at least the first of these seizures. Over half the kids go on to have a second convulsion with a fever but virtually none of them develop epilepsy or other complications. Call your doctor. Most families also call 911 and this is not a bad idea except that transporting your two-year-old by ambulance to the nearest hospital may put you in an ER inexperienced or over reactive to sick kids. Over reaction may be better than a laissez-faire approach by far, but it is not the best way.
To summarize: fever is natural, helps end the infection faster, but may need lowering for the child’s comfort or the parents’ reassurance.