Fever (2)

     Fever is the most common reason for parents to bring their child to the doctor.  Dr. Barton Schmitt coined the term “fever phobia” when describing the fear that most parents have about fever. The common misconception is that fever is a sign of a serious infection or that fever can cause damage. Fever caused by high external temperatures or as an unusual reaction to anesthesia can be dangerous. Fevers that children have with infections are never dangerous. Fevers can cause seizures (see “Fever Seizures”) which are frightening, but are not dangerous. Fever is not a disease; it is a symptom of a disease. The disease might be dangerous, but the fever is not.

     The key concern for parents is the reason for the fever. If the child has an obvious upper respiratory infection (runny nose, cough), the parent should watch the pattern of the fever (see “Fever (1)”). The daytime fever should go away in about 3 days and not return. The child should feel better when given fever/pain medication.

     If the child only has the fever and no other symptoms, the situation is more complicated. In the 1980s and 1990s, a child with a fever and no other symptoms would have blood work, a urine sample and, occasionally, a chest X-ray. Now, the vaccines for H. influenza (not “flu shots’) and Pneumococcus have eliminated the risk of these serious diseases.  Now, if a child has a fever, especially a fever over 102, and no other symptoms, it depends on how sick they are acting.  If they are acting well and seem to feel better with a dose of fever medication, the best thing to do is to check them again in about 24 hours. If the child is acting ill, they should have an examination and probably have lab work, especially an evaluation of their urine for a possible urinary tract infection. Although parents don’t like it, if a child is too young to give a good “catch” sample, the urine should be a catheterization sample. This is especially true if a male child under 2 years old is not circumcised – they have a high risk of urine infection.

     Fever with infection rarely goes above 106 and, as mentioned, is not dangerous. However, almost all parents surveyed felt that fever could harm their children. About half of all parents surveyed say they check their child’s temperature at intervals of about 1 hour and 85% of parents said they woke their child up at night just to give anti-fever medication. It was found that 14% of parents gave acetaminophen too frequently and 44% gave ibuprofen too frequently. 66% alternated acetaminophen and ibuprofen and most of them were told to do it by their doctor! Although combination therapy might lower the fever faster, it most certainly increases the risk of overdosing one or both of the fever medications. This is especially true if the child is also given a “cold medicine” which can also contain acetaminophen. Fever is part of the body’s normal defense mechanism and is necessary to fight the infection. The parent should focus more on the child’s symptoms than on the number on the thermometer.
     A helpful use of fever, however, is the "School Rule" for older children. If your child wakes up on a school morning and says " I don't feel good" or if they are recovering from an illness, take their temperature. If they have a fever, keep them home or you will get a call from the nurse to come and get them at school. If they do not have a fever (101 or above) send them to school. Many schools have a "24 hour fever-free" rule which is stupid.The fever from a viral infection can last an extra 2-3 days in the evening but these children are well during the day and can certainly go to school.