What to do about fever or why some like it hot.
I propose we look at fever as friend and not foe. First of all, it alerts us to the fact that the child is sick. Secondly, both the chemical reactions leading to fever and the fever itself help fight infection by increasing metabolism and producing more antibodies and infection fighting cells.
When fever is present, the important task confronting both the parents and the doctor is determining the cause and seriousness of the illness. This task is detectives' work. We look for clues and evaluate all of the symptoms present. The height of the fever is but one piece of this puzzle -- and not a very important piece at that. Except for fever in the extreme range (105-106[degrees]F and higher), the exact thermometer reading is not very important. Fevers in the extreme range are only important because they increase the likelihood of the presence of a more serious illness like pneumonia (infection of the lung tissue), meningitis (infection of the brain lining), pyelonephritis (kidney infection), septicemia (bacterial infection of the blood stream), etc. Carefully evaluate the other pieces of the puzzle (other symptoms) such as degree of cough, cold, vomiting, diarrhea, sore throat, earache, glandular swelling, activity level, appetite, etc. These clues are at least as important as the degree of fever.
Except in very rare situations such as heat stroke, malignant hyperthermia of anesthesia, severe heart and lung disease, and children with known convulsive disease (epilepsy), fever is not damaging. Contrary to folklore and old wives's (and husbands') tales, it is not true that fever causes brain or any other organ damage. The illness that causes the fever, such as meningitis, can be damaging, but the fever itself is not damaging. Fortunately, most febrile illnesses in children are caused by non-serious, viral infections.
During the course of an illness, the fever will cycle up and down until the illness is no longer active. For most illnesses this period is 2 to 4 days. There is a tendency for those cycles to reach higher peaks in the evening. Fever is associated with miseries such as headache, body ache, listlessness, loss of appetite, etc. When the fever is higher, these miseries tend to be more pronounced. In fact, in otherwise healthy children, the only reason we treat fever is to lessen these miseries. We are not in a battle with the thermometer.
So what do you do when your child has fever and feels rotten? First, be a detective and evaluate all the symptoms present. If you suspect a serious or life threatening illness, an immediate call to your doctor is necessary. Except for unusual situations, the actual treatment of fever is of minor importance. If you suspect a non-serious viral type infection, institute the following measures to lessen any aches or miseries present in your child:
Acetaminophen (Tylenol, Tempra, Liquiprin, Panadol, and others): Please obtain appropriate dosage from your doctor. This can be used every 4 hours if your child is uncomfortable. Remember acetaminophen drops and syrup are not the same. The proper dose of one is not the proper dose of the other.
Ibuprofen (Advil, Nuprin, Motrin): This is now available by prescription in liquid form for younger children and non-prescription form for older children. If the acetaminophen alone does not provide enough comfort, adding ibuprofen to acetaminophen every 6 hours provides a potent medicinal combination to relieve the aches miseries associated with fever.
Aspirin: Do not use! Using aspirin in children may be associated with the development of Reye's Syndrome, a very rare illness which may result in serious neurologic impairment.
Bathing: If your child derives pleasure from bathing and is still uncomfortable, bathing in tepid (warm) water for 20-30 minutes may lower the fever enough to make her feel more comfortable. Bathing doesn't keep a fever down. Do not use cold water or rubbing alcohol.
Liquids: Encourage, but don't force, liquids.
Dressing: This is a good one -- don't overwrap or underwrap! During the fever there is usually a cycle when one is hot and throws off the covers. In this part of the cycle dress the child lightly. During the part of the fever cycle when the child is shivering, dress the child more warmly for comfort. Try to anticipate how much clothing the child needs to provide comfort. CAUTION: It can be dangerous to overwrap an infant. This can lead to heat stroke.
When Should A Parent Worry?
1. If the parent suspects the cause of the illness is a serious or life-threatening illness. Serious or life-threatening illness require an emergency call to your doctor. The following symptoms are more likely to be present in serious illnesses in chilren:
There is an absence of perky periods. All illnesses have rotten periods. Serious illnesses only have rotten periods.
Almost all serious illnesses in children lead to vomiting. However, the converse is not always true. In other words, not all vomiting illnesses are serious. The absence of vomiting is an encouraging sign.
The child has a pasty color or pallor. Most febrile illnesses cause a flushed appearance. Having fever and looking pasty worries me.
The child has a stiff neck. Stiff means rigid, difficulty in flexing or bending. It does not mean painful. This is how you check for "stiff neck" in children older than 6-8 months. Sit the child upright on someone's lap. Catch the child's attention with an object (in the office I use my otoscope light). Place the object on the child's naval area. If the child looks down at the object and places his chin on his chest, he does NOT have a stiff a neck.
2. A fever that lasts more than 4 or 5 days.
3. A fever that is associated with earache, very chesty cough, breathing difficulty, sore throat, persistent vomiting.
. A fever that is associated with unusual symptoms such as unexplained swelling, limping, redness, etc.
5. A fever in children under 2-3 months.
6. Anytime the parent's intuition tells them they should call the doctor.
Remember when you are treating a fever you are only treating a symptom, one that may be beneficial. If the fever bothers you more than it bothers your child, perhaps it would be more beneficial for you to take the medicine, not your child.
So, next time you are confronted with the frightening, terrifying word "fever" remember, some like it hot!
Dr. Pellman's monthly column addresses different aspects of child care. He welcomes your comments and ideas.