July 16, 2009


Fever is one of the things our bodies can do to fight infection. It isn’t fully understood, but we know that many bacteria and viruses find the higher temperature a less appealing environment. There are many, many causes. Infection is the most common, but it can be caused by other problems as well.

In the second year of medical school, students are taught about all kinds of diseases. Some, of course, are serious, and some are usually not a big deal. Some diseases are common, and some are very rare. But nearly every student gets ‘medical student disease.‘ Day after day, they hear about exotic diseases that start…with fatigue. Then there’s the feeling that it’s difficult to concentrate. Maybe occasional headaches. They can’t help but put 2 and 2 together and end up with 73. That’s about the time when they are taught a favorite expression among doctors. ‘When you hear hoofbeats in the distance, it’s much more likely to be horses than zebras.‘ Which is simply a way of saying that when your kid gets a bloody nose, it's probably not Congo-Crimean Hemorrhagic Fever. For this reason, and as I’ve said before, it’s a mistake to ask a doctor ‘what could it be?’ That’s what medical textbooks are for, and I use them as references when needed. ‘What could it be?’ could only be thoroughly answered with zebras (all 4 kinds), camels (both kinds), and an occasional Java Rhino. Of course, your kid doesn’t have any of the vanishingly rare diseases that a single symptom—fever, for example—could possibly be.

I get a lot of calls about fever. For the most part, I can be very reassuring. It’s the body’s natural way of fighting off an infection. Fever from illness, it is generally thought, doesn’t get high enough to cause brain damage. Even a high fever (to the 105’s (41C)).

Hyperthermia can. That’s when our bodies are exposed to heat way beyond what our bodies can generate on their own. People stranded in the desert, for example--there’s a reason they call it Death Valley; or those tragic stories we read about every summer about a baby left in a car. Our bodies usually do a reasonable job in keeping us cool, by sweating. But if we get dehydrated and don't sweat enough, we could be in trouble if it were hot enough. Hyperthermia, though it does cause an abnormally high body temperature, isn't a fever.

Fever , then, doesn’t generally worry me. But what’s causing the fever? If I treat the sick child, it will be for the underlying illness, not the fever. Here's the scenario I pose to parents. If your child has a fever, but looks OK, is breathing fine and playing and active as usual, would you worry? Something is causing the fever, so I'll concede the child might be coming down with something, but that wouldn't worry me. Compare that to your child acting in a worrisome way—complaining of pain, for example, or sleeping all day and refusing to walk—but not having any fever. Is that reassuring? To me, that's much more worrisome.

So why do we treat fever at all?

There are purists out there who think that we shouldn’t treat it, and let the child’s body fight off the natural infections as millenia has designed us to. There are conspiracy theorists who believe that the companies marketing fever medicine want to support the mass delusion that fever must be treated.

For me, trying to see this from the child’s point of view, an empathic approach, is helpful. True enough, treating the fever does nothing to help get the child better faster or treat whatever illness they might have. But whenever we have a fever, we feel really bad. Sometimes fever can cause a headache, but it can certainly worsen a headache. But even without any specific symptoms, fever makes us feel sick. When we reduce the fever, we just feel better. And making children feel better is, as I look at it, an important part of my job.

I think parents with sick children often feel helpless as they watch their sick child. The fever is the only objective marker of the illness, whatever it is, and so by lowering the fever they feel like they are taking a pro-active approach. And they get positive feedback when their children perk up as their body temperatures go down.

If the child has a fever but is OK, I think it's all right to watch them and not treat the fever. If they feel awful, I would treat the fever. I don't think making the child suffer accomplishes much from a medical standpoint. But there's a few points that should be mentioned.

All kid's fever medicines are not the same. There are generally 2 choices of ingredient: acetaminophen (in Tylenol and a lot of store brands), and ibuprofen (in Motrin and a few others). They both work in most people, but it does seem that one will work better than the other in some people. Acetaminophen is safe when the directions are followed. It shouldn't be used for more than a few days, however, because at doses much higher than we should be giving, it can be toxic. Besides, if your child is really having a fever for more than about 3 days, it's probably a good idea to try and figure out what the kid has. A doctor might be able to help with that.

About 1 in every 25 kids get febrile seizures. They don’t seem to have epilepsy, but when their temperature is high enough, they have a brief seizure. It’s almost always in toddlers. As you can imagine, this is really scary for the parents. Fortunately, it’s quite common (about 1 in 25 toddlers have one), and most of those who have one never have another. The seizures do not cause brain damage, usually only last less than a minute, and usually do not mean that the child will go on to have a seizure disorder.

Every now and then, I see a child with fever who has been covered in as many blankets as the parents can manage. This is not a difference in parenting philosophy—it's just wrong. When we have a fever, our bodies are too hot. Even if we feel cold or are even shivering. In order to relieve the symptoms of fever, we have to lower our temperature. So dress your child minimally, and get rid of the heavy quilt on the bed. One of the best techniques I have found is to put the child in a bath. Not a cold bath! That would annoy anybody, especially a sick child. So draw a regular-temperature bath for them. It will still be about 20 degrees below their elevated body temperature. After soaking for 15 minutes (with you there—don't leave them alone in the bath), the water will have absorbed some of their temperature, and they will feel much better. You can do this as often as needed, without concern of overdosing.

Fever that has been relentless for more than 3 days, say 4 or 5 days, is worthy of a doctor visit. I'm still not worried about the fever causing damage, but I am concerned about finding a cause.

Elvis Presley live: Fever

Fever does, in fact, usually go up at night.

No comments:

Post a Comment

Please let me know what you think. Do you know a child or situation like this?