Don’t Fear a Fever
Why is it that your children almost always get fever in the middle of the night? You are startled out of a good night’s sleep, a bit dazed, faced with a miserable child and your pediatrician’s office doesn’t open for six hours. Should you worry? Is this an emergency? What if the temperature is 104, 105, even 106? Is that cause for panic? Can a fever be dangerous? These are all excellent questions and very common concerns that just about every parent has. Let’s review what exactly causes fever, what to do about it, what not to do and when to be concerned.
What causes fever?
Fever occurs when the body sends a signal to that part of our brain the regulates our temperature telling it to pump up the heat. Why would the body do this? This is our body’s first line of defense against invading germs. Turns out that those germs that make us sick prefer a comfortable climate of 98.6 degrees. When it gets too hot it makes it hard for those germs to live and multiple. So actually, fever is the body’s way of fighting off an infection. Sure, it makes us feel achy and weak and miserable, but it serves an important function.
Can fever be dangerous?
It is certainly not fun to have a fever. That elevated temperature can make your head hurt, your muscles ache, your body shiver. But fortunately fever in and of itself is typically not dangerous. Even a fever of 106 will not cause brain damage, epilepsy, or paralysis. What about febrile seizures? Febrile seizures occur most commonly in young children. It is actually not the height of the fever but the rapid change from a normal body temperature to a high body temperature that is thought to trigger a febrile seizure in children that are susceptible to them. Febrile seizures are scary but fortunately not dangerous and most children who have a febrile seizure will not go on to develop a chronic seizure disorder. If you suspect your child is having or just had a febrile seizure for the very first time you should have them evaluated immediately to make sure it was in fact a febrile seizure and nothing more serious.
What to do?
Before picking up the bottle of Tylenol or driving to the ER, assess your child. How do they seem? If your two-year-old has a runny nose and a temperature of 101 but is active, happy, and playful there is not much to do. Remember that elevated body temperature helps to fight off the germ, so if the fever is not affecting them in a negative way there is no need to give medicine or run to the doctor. Simply encourage fluids and keep a close eye on your child for any changes. By all means if your child is cranky and uncomfortable due to a fever, please treat those symptoms with a fever reducer medication. It is not necessary to wait to see the doctor before giving medication. Here are guidelines for the different types of fever reducing medications:
1. Acetominophen (generic name for Tylenol)
For use in children over 2 months of age
Dose: 10-15mg/kg/dose every 4 to 6 hours
Check with your pediatrician’s office if you are not sure how much to give or do not know your child’s weight in kilograms
Side effects: There are no side effects when given at the appropriate dose. However, taking more than recommended over a prolonged period of time or taking a very large dose (accidental ingestion) can lead to liver failure. Keep this and all medications out of reach of children
2. Ibuprofen (generic name for Motrin, Advil)
For use in children over 6 months of age
Dose: 10mg/kg/dose every 6-8 hours
Check with your pediatrician’s office if you are not sure how much to give or do not know your child’s weight in kilograms
Side effects: Upset stomach. It is best to give with some food to avoid GI upset. Long term use can cause stomach ulcers and GI bleeding
3. Alternating acetaminophen and ibuprofen: If your child’s fever does not come down much and is still uncomfortable you can alternate the two medications. It is very important to make sure you are not giving acetaminophen more frequently than every 4 hours and ibuprofen more frequently than every 6 hours. The best practice is to keep a log of what medication you give when so that you can avoid any mistakes.
What not to do:
Alcohol baths, ice baths, cold baths, cooling blankets and cold sponge baths will temporarily make the skin colder. However, fever is controlled by the brain and when the brain senses that the skin is cool it will raise the body temperature, driving the fever right back up. Fever reducing medications work by telling the brain to stop making fever. Thus, they are far more effective and safer than trying to cool off the skin. By all means, a cold compress to the forehead can make a headache feel a bit better and taking sips of cold water or juice will feel comforting and keep your child well hydrated- another important way to help fight off the germs and keep the fever down.
When to worry:
Remember, it’s not the fever that can be dangerous but rather the bug that is causing the fever. Assessing your child is the best way to know when and what kind of help to get them. If your child has a fever but is interactive, drinking well, appears to be breathing comfortably and has no significant complaints, give fever reducers as needed, encourage fluids, and keep a close eye for any changes. Always keep your child out of school or daycare when your child has a fever. They should be fever free without any medication for at least 24 hours before returning to school. Here is a list of symptoms that require medical attention:
Infants under 2 months of age: Fever in a newborn can be a sign of serious illness. Get medical attention immediately
Inconsolable: If you cannot get your febrile child to stop crying and they seem to be in significant pain get medical attention immediately
Lethargic: If your febrile child is very difficult to arouse get medical attention immediately
Difficulty breathing: If your child appears to have trouble breathing, is breathing very quickly and their ribs appear to be sucking in, get medical attention immediately
Dehydration: If your child is not drinking well, has had vomiting or diarrhea, and has not urinated in 12 hours seek medical attention immediately
Sore throat: Fever with a sore throat could be Strep. Bring your child to the doctor
Ear Pain: Fever with ear pain may indicate an ear infection. Bring your child to the doctor
Cough: Cough and fever can be a sign of pneumonia. Your doctor can also test for Covid, Influenza and RSV in mot offices
Pain with urination, foul smelling urine: This may indicate a kidney infection. Your doctor should collect a urine sample.
Fever lasting 5 days: If a fever continues for 5 or more days your child should be seen by their pediatrician to look for the specific cause of the fever.
Sure, fever can be scary for parents. We hate to see our children sick. Fever is our body’s way to protect us. It’s the germs that are making us sick. Just remember to listen to your kids. They are sometimes smarter than us and will let us know when we really need to worry!!