Friend or Foe?
by Jeffrey Snedeker, M.D.
Fever is one of the most common reasons parents call the doctor or take
their children in for an office visit. They are concerned about getting the
fever down as quickly as possible, especially if it seems high.
What many parents lose sight of is that fever is not the enemy; rather, it
is the underlying disease that has the potential to cause harm. Fever is simply
one of the body's defense mechanisms, part of the natural immune response that
helps the body fight off certain types of infections.
If your child is running a fever, it's important to assess what else is
going on. Is the child eating, drinking, and active? Or, is the child vomiting,
lethargic, or covered with a rash? This is important information to gather
before you call the doctor. A child with symptoms of illness and a low fever
may be much sicker than a child with a relatively high temperature who is
active and feeling fine.
What should I do if my child has a fever?
This depends in part on the age of the child. If a baby under six weeks of
age develops a fever, you should seek immediate medical attention. Between six
weeks and six months of age, a child with a fever should be seen within 24
hours by a doctor. To measure body temperature
properly, make sure you follow the instructions provided with your thermometer.
Beyond six months of age, parents should look at the context of the fever.
Is there a fever, rash, vomiting, or a sore throat or sore ear? If there is,
you should see a doctor. If there is a fever, but no other symptoms, the
chances are the child has a mild viral illness. However, these children should
be watched closely and if any new symptoms appear, or if the fever does not
disappear in a few days, your doctor will want to know.
If your child is shivering, bundle her up. If the child is hot, keep him
lightly dressed. Baths are usually not helpful, but are safe provided the water
is lukewarm and not cold. If the bath is cold, the skin will cool too rapidly,
the child will stop sweating, and the internal temperature may go up instead of
down. If the child starts shivering in the bath, it's time to get out.
Should I medicate the child for fever?
When trying to decide if the child needs medication, you should assess his
or her comfort level. If the child is not uncomfortable, you don't have to
medicate. By and large, a higher fever is not more dangerous provided the child
is drinking plenty of fluids. If the child is uncomfortable, then you might try
acetaminophen (Tylenol and other brands) or ibuprofen (Advil, Motrin and other
brands) to bring the fever down. Do not use aspirin. Getting lots of fluid into
your child is very important.
Both medications in proper doses are very safe and effective. It is
important to use the right amount: remember, the dose
varies with the child's weight. It also helps to be realistic about what fever
medications will do. They may not give your child a normal temperature, but
they will probably lower it. If the temperature goes up after taking the
medication, it doesn't necessarily mean the medication isn't working; it may
mean your child's temperature would have gone up even more without it. Some
parents have been told to switch back and forth between acetaminophen and
ibuprofen; however, it's better to stick with whichever one you prefer. And
remember that without sufficient fluid, all the medication in the world will
not bring the fever down.
Do I have to worry about brain damage as a result of fever?
Brain damage rarely occurs as a result of fever. A temperature of 106
degrees, which is fairly uncommon, makes a person feel terrible, but doesn't
cause brain damage. Brain damage is much more likely to occur during heat
stroke, which is not fever. You should be concerned about heat stroke if your
child plays outdoors in the hot weather and doesn't drink sufficient fluid.
Once the body temperature reaches 108 degrees and above, which can and does
happen in hot weather, brain damage can occur. Certain children under age 5 may
rarely have brief seizures with high fever, but such seizures do not cause
brain damage and are not dangerous to the body.
is board certified in pediatric medicine and pediatric infectious disease. He
is a member of the medical staff at Cayuga
and is in practice with Northeast Pediatrics and Adolescent Medicine. Dr. Snedeker can be reached at (607) 257-2189.
update: August 2006