Fever

The most common reason for parents to seek medical attention for their child is fever. Fevers account for many missed school and work days, doctor’s office visits and emergency room visits. Historically, before the development of modern medicine, fever was often the first sign of a what could very well be a fatal disease. So, it is not surprising that it seems to be ingrained in us to be afraid when our children have fever. But what exactly is a fever?

Fever is an increase in the body’s core temperature above the normal range. While the average normal body temperature is around 98.6°F (37°C), a fever is generally considered to be present when the child’s temperature rises to 100.4°F (38°C) or higher in an infant, or 101°F (38.2°C) or higher in an older child. While a mother’s hand is often a good gauge, the most accurate way of checking a child’s temperature is with a thermometer. The type of thermometer – rectal, oral, axillary or temporal (forehead) – is not as important as is following the manufacturer’s instructions for proper use. 

Fever is not an illness itself; rather, it is a sign that the body is responding to an underlying infection or illness.

While the average normal body temperature is around 98.6°F (37°C), a fever is generally considered to be present when the child’s temperature rises to 100.4°F (38°C) or higher in an infant, or 101°F (38.2°C) or higher in an older child.

What causes fever?

Our body has a normal average temperature range set by our internal thermostat, located in the hypothalamus region of the brain. Under certain conditions, such as in response to certain infections, the set temperature is raised, and we call this a fever. The most common causes of fever are:

Infections: Most fevers in children are caused by viral infections, such as common cold viruses, influenza, and viral gastroenteritis (“stomach bugs”).  Less often, fever is caused by a bacterial infection such as strep throat, urine tract infection or bacterial pneumonia. 

Immunizations: Some vaccines can cause mild fevers as a normal response to building immunity. This is more common in booster shots, as the body has been previously primed to recognize the vaccine and has been trained to mount a response against the pathogen for which the child is being vaccinated. This type of fever is rarely something to cause concern.

Environmental factors: Exposure to extreme heat or sunstroke can lead to a fever.

Inflammatory conditions: Certain inflammatory disorders, like juvenile rheumatoid arthritis or inflammatory bowel disease, can cause fever.

Associated Symptoms:

Apart from the elevated body temperature, a child with a fever may exhibit other signs and symptoms, such as:

1. Irritability or fussiness
2. Decreased appetite
3. Fatigue or lethargy
4. Headache
5. Muscle aches
6. Chills and shivering
7. Sweating
8. Dehydration

Treatment:

In most cases, fever is not harmful and can be managed at home. The main focus of treatment is to keep the child comfortable while addressing the underlying cause. Here are some steps to manage a fever in a child:

Ensure adequate rest: Let the child rest and sleep to aid their recovery.

Maintain hydration: Encourage the child to drink plenty of fluids, such as water, clear soups, or oral rehydration solutions, such as Pedialyte, to prevent dehydration.

Dress appropriately. Dress the child in light, breathable clothing to help regulate body temperature. Cooling the child down too much with cold baths or air conditioning set colder can paradoxically increase the body temperature by inducing shivering, a natural response to a cold environment.

Antipyretics: Medications such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can be used to lower fever and provide relief from discomfort. The important thing is not the lowering of the fever but rather it is to keep the child comfortable. If the child has a fever, but is acting normal,  drinking well and not in discomfort, there is no need for fever reducing medication.  Always follow the appropriate dosage for the child’s age and weight, as recommended by a healthcare professional.

Baths: If the fever is high or the child is uncomfortable, a lukewarm sponge bath can help reduce the body temperature. Again, it is important to not use too cold a water temperature as this will induce shivering, and raise the child’s core body temperature.

Common myths about Fevers

Fevers cause brain damage – fevers, on their own, do not cause brain damage. Fever can be associated with certain infections or conditions that can cause brain damage. These are usually accompanied by seizures, changes in personality or difficulty waking. 

Fevers always need to be treated – in most cases, fevers do not need to be treated. Rather it is pain or discomfort that needs to be treated. The fever is a symptom, not a cause of the underlying illness. The fever is a part of the body’s normal response to infection, and there is evidence that it may assist in fighting the infection. There are studies that even show aggressively treating fevers after vaccination can interfere with the vaccine’s effectiveness.

That being said, in some conditions, such as children with a history of heart conditions or febrile seizures, more proactive fever control may be warranted. Speak with your child’s pediatrician if you have concerns that your child falls in this category.

When to Seek Medical Attention:

In most cases, fever in children is not a cause for serious concern and will resolve on its own within a few days. However, certain situations warrant medical attention:

Infants younger than 3 months with a temperature over 100.4°F (38°C) or lower than 97.6°F rectally, should be evaluated by a doctor promptly.

If a child’s fever persists for more than a few days, does not respond to the above measures or is unusually high.

If it is accompanied by signs of dehydration: Few or no wet diapers, dry mouth, sunken eyes, or lethargy.

If it is accompanied by other symptoms such as lethargy, inability to be consoled,  change in mental status, inability to keep down fluids, difficulty breathing, severe headache, stiff neck, or persistent vomiting.

Children who are not up to date with their immunizations, or who are immunocompromised for any reason, are at higher risk of more serious infections and should be evaluated sooner, particularly if they exhibit additional symptoms.

Any other worrisome symptoms or concerns about the child’s well-being.

Always consult a healthcare professional, such as At Your Door Pediatrics, if you have any doubts or concerns about your child’s fever. They can provide proper guidance and diagnose any underlying conditions that may require treatment. 

As always, if you believe your child is experiencing a medical emergency, seek immediate medical attention or call 911. 

“This information is for educational purposes only and not meant to be taken as medical advice. The information presented does not substitute for professional medical advice, nor should it be used to treat yourself or others. Please consult with your physician for any medical issues or concerns that you have for your child or yourself. Please seek immediate medical attention at your closest Emergency Room or call 911 if you believe you are having a medical emergency.”