Fever in Children

Lisa Buenger, MD, OakLeaf Pediatrics

Your 2-year-old child is awake at 2 AM, feels feverish, and is crying. She's had a cold for the past week and now you wonder what to do. Should you take her temperature? Should you call the doctor?

Fever is technically defined as 100.4°F, taken rectally. Many people believe that fever in and of itself is a disease. Rather, a fever is a response to illness occurring in the body. Fever works to protect people during infections, most commonly caused by viruses or bacteria. The fever itself doesn't harm, but it can make a child uncomfortable. And when a child is not feeling well, there can be fear and anxiety in parents and patients.

To treat or not to treat

Antipyretics are medications like acetaminophen and ibuprofen that reduce fever. These medications provide comfort, but not a cure. They should be used when the child is uncomfortable, from illness and/or fever. There is no reason to treat them with medication if the child is sleeping or playing and unaware that they have a fever,. However, if the child looks uncomfortable, medication would be encouraged whether or not the child has a fever. If the child is less than 3 months old, it is important to contact your physician before giving anti-fever medicine.

Common Myths

Myth: Fever causes brain damage.

Many believe that brain damage or death can occur from fever alone. A normal body temperature ranges between 97-100¡F with fluctuations throughout the day. Human temperatures rarely exceed 106¡F without an external heat source such as in a closed car on a hot day. Unless a child is severely dehydrated or exposed to high heat sources, fever itself will not cause harm, just discomfort.

Myth: Teething causes fever

Parents continue to blame a host of symptoms on teething, including fever, fussiness, otitis media (ear infection) and diarrhea. Many physicians don't attempt to correct these misconceptions. The association between fever and teething was not studied until 1992. Over a five-month period, mothers of 46 healthy infants took their baby's daily temperatures and kept a log of behaviors prior to the eruption of the first tooth. The study showed that tooth eruption was not associated with temperature above 100.4°F, diarrhea, ear infections or cold symptoms. What was apparent was the common occurrence of upper respiratory tract infections, ear infections, and diarrhea around 6-12 months of age, to coincide with tooth eruption.

Myth: Fever causes seizures.

It is true that fever may unmask seizures in people already predisposed to them. The fever does not actually cause the seizure, just lowers the threshold to have one. These are often "seizures, with fever". In contrast, fever does seem to play a role in febrile seizures. Febrile seizures occur in 5% of children between the ages of 6 months and 5 years. It is believed that they are associated with a viral illness and triggered by the rate of rise in fever rather than the actual temperature. Only 1/3 of children who have a febrile seizure will go on to have another seizure. No permanent damage occurs as a result of a febrile seizure and parents must be reassured of their benign nature.

Infants less than 3 months of age

In a young infant, fever is taken very seriously due to the child's immature immune system. If the child appears ill, feels warm, isn't eating the same, or is acting differently, his temperature should be taken. Rectal temperature in infants remains the standard. Simply lubricate the digital thermometer with water or petroleum jelly and lay the child on his back. Lift his feet like changing a diaper and insert the thermometer about 1/2 inch into the rectum. If the temperature is above 100.4°F, a physician should see the child.

Call the physician if

• Your child is under 3 months and has a fever higher than 100.4¡F (38C).
• Your child complains of a sore throat or shows signs of ear pain.
• Your child has additional symptoms, such as abdominal pain or pain upon urination.
• Your child is not drinking fluids or has a decreased amount of urine.
• You are worried about your child's breathing, level of activity, or intake/loss of fluids, whether or not your child has a fever.
• The fever has persisted for more than 3 days without an obvious source of illness.

Or call OakLeaf Pediatrics: 715.830.0732 / www.oakleafpediatrics.com