Fever

     Up to 30% of acute-care visits in pediatrics are related to concerns about fever.  It is important that parents know the facts about fever so that they will not be frightened by fever and they can actually learn to use fever to evaluate their child’s illness.   

      Fever is a normal part of the body’s response to infection or inflammation. It has long been known that fever helps the body combat disease (Hippocrates felt that fever helped to bring the body’s humors back into a normal balance).  But, in recent times, fever has been wrongly viewed as being dangerous. Both practitioners and parents often react to fever as if it is a disease itself that needs to be treated.

     Fever in children is usually caused by infection. The body develops fever as one of the immune system’s many ways of fighting infection. Often, fever is the first thing a parent notices when the child is sick – late in the afternoon, the child begins to feel poorly and the parent notices that the child “feels hot”.  Feeling the child is an inaccurate way of telling how high a fever is (101, 102, etc.) but feeling a child is an accurate way of telling whether he has a fever or not.

     Most fevers are caused by simple viral infections such as colds or gastrointestinal infections. These fevers usually start in the early evening, run up and down for three days - always spiking higher at night. After three days, the daytime fever resolves but the night fever remains for another night or two. When the fever is spiking, the child feels poorly and has no appetite but when the fever comes down a little, the child should feel better. During the first three days of illness, when the fever is up and down, it is fine to give acetaminophen or ibuprofen to make the child feel a little better. These medications do not make the fever go away; they do not prevent fever seizures and the child doesn’t become ”immune“ to them. The best way to give acetaminophen or ibuprofen is on a routine schedule through the day being careful to give the proper dosage and to follow the proper dosage interval. Don’t delay giving the medication until the fever is high and the child is miserable – it works better if given at regular intervals.. Parents should not alternate acetaminophen and ibuprofen or give other “cold” medications that may contain acetaminophen or ibuprofen. There is no need to wake a child at night to give fever medication.

     The concern we all have is whether a fever is caused by a simple virus or by a more dangerous infection. With either one, the fever can decrease with fever medication, but, with a less serious infection, the child usually feels better when the fever drops a little. With a more serious infection, the child still feels poorly even after taking fever medication and continues to act more lethargic and ill. That child needs to be examined by his caregiver. Other situations when a child needs to be examined are: when the daytime fever lasts more than three days; when the fever resolves in three days but the daytime fever returns after a few days of being gone; or anytime the parent is becoming concerned that the child is acting more ill.