Fever (3)

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     I have written previous articles on fever in children, but, because fever is the most common reason that parents contact physicians, it always deserves more mention. The American Academy of Pediatrics recently released an updated clinical report on fever authored by Janice Sullivan M.D. and Henry Farrar M.D.  This is a review of that article.

     The article repeats the facts that fever is not an illness, does not worsen an illness and does not cause brain damage. The only goal in treating fever with anti-fever medications is to make the child more comfortable.  Anti-fever medications don’t necessarily lower the temperature and certainly do not prevent fever seizures.  There is never a reason to wake a child at night to give these medications.

     The fever that comes with an infection is not the same as a fever that comes with hyperthermia.  Hyperthermia (the problem that causes heat stroke) is a condition in which the body loses its ability to control temperature and can result in death. It does not occur as part of the body’s reaction to illness. However, studies show that most health care workers, including physicians, wrongly believe that temperatures above 104 can be dangerous in a child with illness-created fever. This contributes to the irrational fear of fever called “fever phobia”.

     Either acetaminophen or ibuprofen makes the child with fever more comfortable. Acetaminophen can cause liver damage if it is over-dosed. Because it comes in so many different forms and dosages, parents need to only give it according to directions and to adjust the dosage according to weight rather than age. It is not recommended to give ibuprofen to children under 6 months of age because of the possibility of kidney damage.  It seems that alternating acetaminophen and ibuprofen is slightly more effective in lower temperature than either agent alone, but alternating increases the risk of over-dosage of either medication and is not recommended.

     When giving either medication, parents need to check any other cold or cough medications they give the child. Many of these medications contain acetaminophen or ibuprofen and giving them also increases the risk of over-dosage.

     Finally, fever, although it is not dangerous, still means that the child has an infection and the infection itself might be dangerous. In the first three days of the fever when it is up and down day and night, I recommend giving anti-fever medication because the child’s response to the medication helps me to decide how serious the illness is. If an hour after giving the medication, the child is a little more active, has a little better appetite or drinks a little more, and, in general, is acting less sick, then I am less worried about the child. A child who seems more weak or sick an hour after a dose of acetaminophen should give the parents concern and should be watched closely. As I have said in other articles, the fever might still be present in the evening on the fourth and fifth days but then resolves and does not return. If the fever does not follow that pattern, the child should be seen by his caregiver.