When and How to Treat a Fever: a Pediatrician’s Perspective

I have posted in the past about fever and many of the myths surrounding it (Kids Will Get Sick: 5 Facts a Pediatrician Wants You To Know).  In this post I would like to deal with the causes, nature of fever, benefits of fever, and some “treatments”.  It is one of the most common reasons people bring their children to the Emergency room and probably among the least significant reasons for doing so.

Fever is a symptom of an illness such as cough, runny nose, headache, and many others and, except for the discomfort of the associated symptoms (chills, achiness, drowsiness, etc.) fever, in and of itself, does not need to be treated.  As far as what is the definition of fever, it depends on the age of your child or infant. Just about any fever in an infant less than 3 months of age is considered to be significant for the purpose of evaluation.  As your baby/child gets older the level of fever at which the concern rises does so with the height of the fever and the associated symptoms.  Beyond the immediate newborn period (up to age 3 months) fever (or better termed higher than normal body temperature) is generally considered to be over 100.4 to 100.5 Fahrenheit.

Fever is part of the immune reaction that your body goes through to identify the offending agent and muster the resources to fight off that agent.  Some studies have shown that the presence of fever helps your body fight off the disease in a more rapid and efficient way.  As such, it is easy to see that in fighting off an illness, the reduction of that fever for its own sake is not necessarily the best thing to do.  As I mentioned in my last post about fever, if your child is very uncomfortable due to the presence of fever, it certainly is reasonable to give a medicine such as Tylenol or Advil, but not just because the fever is there.

In an effort to reduce fever by worried parents many methods have been tried; such as placing a child in a cold bath or sponging with cold water, even to go as far as placing ice packs in supposedly strategic places.  This would seem logical at first blush but in fact, human beings have a very good method of warming a cold body, and that is shivering, wherein the muscles go into a hypermetabolic state producing heat by metabolic processes.  It is possible to place someone with a fever in a cold bath and have him or her come out with a higher temperature than before the bath.  So the reasonable approach to comfortably lower a fever is to undress a child with fever but not enough to stimulate chills or shivering, place your child in a warm (skin temperature) bath of only a few inches of water and sponge off your child frequently allowing for natural evaporative processes to cool the skin.  Offer your child plenty of cool fluids that will do some cooling from within as well as keeping him/her well hydrated- fever will cause extra fluid loss through sweating and the hypermetabolic state.  Do not wrap your child in blankets just to “sweat the fever out” as doing this may also inadvertently raise fever, and increase fluid loss and discomfort- certainly covering the child enough to relieve chills and shivering is appropriate for comfort.

In trying to determine whether someone who runs a lower than “normal” natural body temperature is running a fever, just use the reading you get with the thermometer as the difference between a normal temperature and one that “runs low” is very small and would not be significant medically.  Furthermore body temperatures vary throughout the 24 hour day in the same person- so when that “normally low” body temperature was taken becomes important.

So you can almost expect fever to accompany any illness of an infectious nature whether mild or severe.  Keep calm, it is not the fever that is important, but the appearance, behavior and the presence of certain other symptoms that your Doctor with be most interested in when you call his office.

About the Author

Dr. Joseph Skoloff received his undergraduate degree from the University of Pennsylvania and his medical degree from The Jefferson Medical College in Philadelphia. He is a past Vice Chairman of the Department of Pediatrics, a past Chairman of the Infection Control Committee at the Loudoun Hospital Center and a Fellow of the American Academy of Pediatrics. In his 41 years as a practicing pediatrician he has kept hundreds of kids and families healthy and safe and plans to continue to do so for years to come. Dr. Joe believes strongly in the combined power of parent and physician working together for the health of their children. He is an advocate for children everywhere and and adheres strongly to the principles of the American Academy of Pediatrics.Dr Joe is a member of the PedSafe Expert team

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