Why we worry about fever
When a child awakens feeling ill, hot and flushed, his parents often experience a stab of fear. “He has a fever! Hurry! Get the Tylenol!"
“Fever Phobia” has been around for a long time. Everyone knows that when a child’s body temperature is elevated and the heat is felt on the skin, he is ill. The febrile illness causes anxiety since it could prove to be serious. Although the child is usually only mildly ill with a self- limited viral illness, or an easily treated bacterial illness such as strep throat, there is a small possibility that he could, G-d forbid, have a life threatening bacterial illness such as meningitis or pneumonia or septicemia.
Although it is really a sign of another problem, the fever itself can cause headaches, nausea, vomiting, malaise and drowsiness. Occasionally, in young children, fever can cause convulsions.
Until recently it was feared that the fever itself was dangerous to the child’s brain. Antipyretiics such as aspirin, acetomenophen, and ibuprophen were given to all patients with fever. Emergency rooms had sinks designed to bathe the child to reduce high fevers. Recently there has been research into the physiological phenomenon of fever and, as a result, pediatricians have become less concerned about fever. Here is a brief explanation of the current medical view of fever in a child.
What is fever?
Fever is an elevation of body temperature above the normal baseline temperature. It is a sign of illness, not an illness in itself. Fever occurs when the brain receives signals triggered by an inflammatory reaction. To produce fever the brain stimulates an increased metabolic rate by increasing heart rate, increasing respirations, and decreasing skin circulation to decrease heat loss through the skin. (This is why people often feel chilled when they are developing fever.)
Normal rectal temperature is 97 F to 100F. (It varies during the course of the day and night.)
Fever is defined as:
100.4 in an infant less than 30 days of age.
100.7F in an infant 1-3months of age
101F in any child over 3 months of age.
Moderate fever is up to 102.5
High Fever is above 102.5F and up to 105F
105.4 and above is unusual, but when it occurs, a doctor should be contacted.
Reasons to allow fever to take its own course
1) Since the advent of antibiotics and modern vaccines many of the common life threatening illnesses have become preventable or treatable. For example, since the HIB vaccine was initiated about 9 years ago, the incidence of bacterial meningitis in the pediatric population has dropped by 95%. Since the initiation of Prevnar Pneumococcal vaccine two years ago the number of children admitted to the hospital for severe pneumonia has dropped by 90%. As it is, most bacterial illnesses can be successfully treated at home with antibiotics. There seems to be less concern that the fever represents a life threatening illness. (In the early days of my practice, any child with high fever and vomiting was a possible case of HIB meningitis. I had 3-4 such patients a year! Since the vaccine, I have had none!))
2) The fever itself does not seem to cause direct harm to most healthy patients. There is basically no danger from just the heat of the fever.
3) In some studies the actual illnesses subsided faster when the fever was not reduced by medications or bathing. Fever is a part of the immune response.
4) Most febrile seizures in patients brought to emergency rooms were found to be due to the HHV7 Virus, the one that causes Roseola. It is thought that the virus itself causes the seizures, not the actual fever. The seizures often occur when the fever is rising for the first time, not during the subsequent days of fever.
These are all reassuring facts that imply that maybe we do not have to treat fever at all. There are, however many instances where treating the fever is appropriate.
Reasons to try to control fever
When a child has fever he requires extra fluid intake to make up for the water loss from sweating and evaporation. If the fever or the illness is causing poor intake of fluids by causing nausea or lack of appetite, this can easily lead to dehydration which causes even more illness and physiological derangement. When this happens, the administration of acetaminophen or ibuprofen is indicated just to get the child to be more interested in drinking and eating.
There are, frequently, genuine discomforts associated with fever, such as headache and body aches. If the child is feeling miserable it usually helps to give the antipyretics, which also are good pain controllers. When the fever is down the child feels better. Many people would rather have a comfortable sick child remain ill for an extra day than to have an utterly miserable child who recovers one day sooner.
The young infant with fever
Any fever (T100.4F or above) that occurs in an infant less than one month of age is considered an emergency. Treating the fever itself is not important; it is the cause of the fever that requires attention. These neonates are susceptible to serious infections due to immaturity of the immune system. If merely unbundling the child does not take away the fever, the doctor should be contacted.
A temperature of 100.7 or higher in an infant 1-3 months old should be evaluated. It is, however, only considered an emergency if the infant is unable to maintain fluid intake or he appears ill.
Reasons to seek medical care and advice when a child over 3 months of age is ill with fever
The first assessment must be made by the parents. Is the child feeling very ill, or is he being cute? If the child seems to be very ill, medical care must be sought.
If the child is coping with the illness, maintaining adequate fluid intake, and acting alert he can be observed for a couple of days to see how he will do. If he gets progressively sicker, has more symptoms (like a worsening cough) or has a decrease in intake that is worrisome, medical care should be sought. If the fever persists more than 2-3 days, it is probably a good idea to have him checked.
If there are specific symptoms, such as abdominal pain, cough, swollen lymph nodes, redness of a certain area of skin, diarrhea with blood and mucous, sore throat, ear pain or other signs of infection, the doctor should be consulted.
Bathing - a reasonable treatment of fever
A bath in tepid water for about 20 minutes will often help reduce fever. Sponging with tepid water and allowing the water to evaporate off the skin is actually quicker than the bath. (Never put alcohol in the water. The fumes are dangerous)
Dosage of antipyretics
Acetomenophen (Tylenol) 10-15 milligrams per kilogram of body weight. (100mg -150mg per 22 lbs of body weight) every 4- 6 hours. It is important to look at the dosage in milligrams for each teaspoon or dropper on the bottle.
Drops = 80 mg in 8cc
Children’s Liquid 1 tsp= 180 mg
Chewables=80 mg per chewable tablet
Suppositories come in varied dosages
Ibuprophen (Motrin or Advil) 10 milligrams per kilogram of body weight (100 mg. for 22lbs of body weight) every 6 hours.
Drops = 50 mg in 1.25cc
Children’s Liquid- 100 mg per tsp
When a child has fever it is important to stop and think. A parent’s fear can be alleviated just by looking at the child and assessing his clinical condition. Most of the time simple observation time and extra fluid is all that is needed. If the child’s illness appears more serious a physician should be consulted.
There is no reason to keep a sick child indoors. The outside air gives the child and the caregiver a refreshing sense of wellbeing.
Do not send a sick child to school or day care. This is to protect the other children. The general rule is that the fever should be down for 24 hours and the child should not have a cough, runny nose, eye drainage or diarrhea that could result in contagion to classmates.
With a little bit of understanding and common sense parents can feel more confident when dealing with a febrile child. Most pediatricians today are trying to implement this approach to eliminate Fever Phobia.
We pray that G-d will protect our children from serious illness and that he provide a quick recovery from any illness that befalls them.