Don't Fear the Fever - An Article Written by Ruben J. Rucoba, MD

Don't Fear the Fever - An Article Written by Ruben J. Rucoba, MD

Don’t Fear the Fever

April 3, 2013

By Ruben J. Rucoba, MD

Fever phobia is a common problem among parents. While on call, I am frequently phoned by frantic moms and dads who are worried about their children’s fevers. Although Salubrity focuses on prevention, I’d like to present the important facts about fever to try to prevent some parental anxiety.

Our temperatures normally vary throughout the day. Our “normal” temperature of 98.6° Fahrenheit (or 37° Celsius) can vary a degree or more in either direction. With illness, our fevers creep higher in the late afternoon, evening and nighttime. Fever is a natural part of the body’s defense against illness, especially infection. When the body’s temperature rises, the immune system works more effectively to fight an infection. So not only is it a natural response, it’s beneficial. Don’t think of fever as an evil thing.

The problem is when fever gets so high that it makes the children uncomfortable, and in some cases, makes them miserable. When a child gets a fever of 104° or 105° F, as often happens, parents fear the worst. I can hear it in their voices as they ask me, “How high is too high? When is it dangerous?” I think they think the child’s brain will melt. The simple answer is that a fever is never dangerous until 107° F (or 41.7° Celsius). Children’s fevers almost never get this high with an infection, but only with extreme external causes, such as being trapped in a burning building or being exposed to intense desert heat for a long time. These are truly dangerous situations, and I’ve seen those cases, but I’ve never seen a fever that high from an infection.

I know what you’re thinking: what about a seizure from a fever? The reality is that most of those seizures are due to the individual child’s response to fevers, not to the height of the fever itself. Only 5% of children ever have a febrile seizure, despite high temperatures in most children at some point in their lives. Many febrile seizures occur because the fever rose quickly, not because it rose to a high level. And in fact, seizures from fevers are never dangerous. Don’t get me wrong; they are horrible to witness, and incredibly frightening. But an uncomplicated febrile seizure leaves no lasting damage to a child’s brain or other organs. When a parent watches a child have a febrile seizure, the parent has that image seared into their memory, while the child has no lasting impression or effect of the seizure.

And children get much higher temperatures with illness than adults do. A mother will sometimes call me and tell me the whole family is sick, and that both her husband and her child have fevers of 104°. I always tell them I’m more concerned about their husband than about their child with fevers that high.

So what to do when a child has a fever? Perhaps the most important thing is to find out what’s causing the fever. If your child is less than two months old, she may be at risk for has a serious bacterial infection, so you should call the doctor. For older children, any high fever without any obvious symptoms warrants a call to your provider to discuss the case. If the cause of the fever seems obvious, such as a common cold, then treating the fever may not be necessary if it is not bothering the child.

But if the child is uncomfortable, then by all means try to make them feel better. Tylenol is acceptable for most children. Motrin is not safe for children under six months old and for other children with certain medical conditions. The dose for each of these depends on the child’s weight. And it doesn’t matter how old a patient is or the type of formulation you have. Provided the dose is correct, an infant can take the children’s suspension and a child can take the infant drops. Dosages can be confusing for parents, and one common dosing chart can be found here.

Please remember that unless instructed by a physician, aspirin is not given for fevers in children to prevent a serious condition known as Reye syndrome. A cool washcloth on the forehead or a warm bath may help with fever reduction and comfort, but never give a febrile child a bath in cool or icy water. Actually, this can make the temperature go up.

And it is important to put the fever in the context of the entire illness. Some parents only focus on the temperature, and ignore other signs or symptoms. A low-grade fever with severe abdominal pain is much more critical than a high fever in a child who is otherwise well and comfortable. As I always instruct parents on the phone, “Don’t look at the thermometer, look at your child. Now tell me what’s going on.”

Fever is frightening to parents. But rest assured, your child’s brain is safe, and you can make the situation a little better. As always, call your doctor, but if you know these facts about fever, it will be a little less scary.