Demystifying Fever

by Dr Marika Geis ND

There’s nothing quite like waking up to a screaming child at 3 am and discovering that they have a fever. Half asleep, the worry creeps in; there’s no cough, no sniffles, no apparent discomfort, only the disconcerting cries of your child and what feels like a forehead about to burst into flames. Conventional wisdom and parental instinct often compel parents to fight their child’s fever. Who can blame them? Your child is suffering and is looking to you to for help. Naturally, reducing the fever is the surest way to ease their discomfort and persistent crying. Here’s the thing though, the fever is not the disease. In fact, your child’s fever is confirmation that they have a healthy and robust immune system.

Defined loosely as a form of inflammation, fever makes it less likely for harmful viruses and bacteria to develop into serious infections. It’s quite simple really: bacteria and viruses have a hard time replicating in warm environments. A beautiful example is chickenpox. Here, lessons will take longer to crust over if a fever is reduced prematurely. Besides making your body inhospitable to potentially harmful microbes, fever has several other roles that encourage healing. It stimulates cell growth, stimulates thyroid function, increases circulation, increases filtration by the liver and kidney and increases the production of immunoglobulins or antibodies.

In children aged 3 to 36 months of age, the viral infection is the most common cause of fever and can last up to three
days. It’s also important to know that the level of a fever does not necessarily correspond to the severity of the illness. A child with a mild cold can have a fever of 104.5 F (40.5) while a child with a serious illness can have a fever of 100F (38.0C). There are a few other reasons for fever, however. Teething, dehydration, insect stings, allergic reactions, overdressing and reactions to some medications can all produce a fever and should, therefore, be ruled out before deciding on a course of action.

But what about the number one fear of parents of a child with a fever, febrile seizures? Parents can take comfort in the fact that fevers rarely cause seizures. They do not seem to be related to the height of the fever or the rates at which it rises, but rather an idiosyncratic predisposition of certain children (about
4%). ½ of children who experience a febrile seizure will go on to have another one. About 1/3 of those will go on to have a third. They are more common in boys and most will occur from 6 months to 4 years peaking between 17-22 months.

Although terrifying to watch, there is no evidence that having a febrile seizure causes any permanent harm or that having this type of seizure will lead to epilepsy or other seizure disorders. That said, if your child does experience a febrile seizure they should be evaluated to rule out any underlying condition. A seizure should not last more than 15 minutes.

A few guidelines are provided for you as we head into this next wave of cold and flu season.

• Consider the big picture: how sick does your child seem? How is their feeding pattern, ability to be consoled, level of irritability, responsiveness, level of activity, appearance (pale or flushed, dry or perspiring?)
• Fever is defined as a rectal temperature of over 38 (100.4), oral temperature over 37.5C(99.5) and axillary (armpit) temperature of 37.2 (99)
• Rectal temperature is considered the most accurate and is preferable for children aged 5 years and under. After that oral temperature is recommended.
• A temperature ranging from 101.5-102.5 F (38.6- 39.2) is considered bacteriostatic, i.e. that it stops cell growth.
• Temperatures over 104 F (40) are bacteriocidal, i.e. that it kills bacteria
• VERY high temperatures of 105 F (40.5) can result in cell death
• Tepid water baths may be helpful but never ice or alcohol baths due to their discomfort and potential toxicity
• Mint tea and cold socks have saved my kids more than one occasion
• Teething rarely elicits a fever of more than 38.4 or 101.2

You should seek medical attention immediately if your child is:

• lethargic
• unusually sleepy – difficult to wake up
• in pain, cries when touched or moved
• extremely irritable, inconsolable or whimpering
• if he complains of a headache and stiff neck
• having difficulty breathing
• Appears confused or loses consciousness, or
• Has purple spots on skin
• Child is drooling profusely and unable to swallow anything
• A convulsion has occurred

In general, low-grade fevers 102 F (38.9) rarely need treatment, however your child may be very uncomfortable and unable to rest. With a fever of more than 103 F (39.4) your child will look and feel quite ill. Here, you may want to moderate the fever and not suppress it. Make sure your child is well hydrated particularly if they have diarrhea or are vomiting, even if it’s only a teaspoon every few minutes. If, after you’ve brought down the fever, your child looks and feels noticeably better it’s a good indication that the fever was responsible for your child’s discomfort. A child with a serious bacterial infection will continue to look unwell.

Each parent has their own threshold for deciding when and how to intervene. At the end of the day, it’s important to remember to treat your child and not the thermometer. There are times when allopathic intervention is needed, but in the vast majority of cases, supportive measures are all that is required: a cuddle, quiet distraction, rocking them to sleep and making sure they are hydrated and well-nourished can help them get over a fever faster. As a parent, sometimes the hardest thing to do is to do nothing except watch and behold the wonder of how our children’s bodies can learn to be well… all on their own.