Childhood Fevers - A Parental Phobia

Katherine Herczeg, MSN, APRN
Bitterroot Physicians Clinic South
3334 DVN Lane
Darby, MT 59829

Childhood Fevers - A Parental Phobia
As a parent myself, I know the hype surrounding fevers and our children. Fever in a child can be quite worrying for parents, and is one of the most common reasons parents seek care from their healthcare provider. There are so many old wives' tales out there, unsolicited advice, not to mention the internet, that the most experienced parent can be found panicked when their little one has an elevated temperature. Let's not forget advertising and media that play a role in this phobia. Child and infant care equipment is a multi-billion dollar industry that preys on parents who want the "best" to care for their child. An example of that is the digital, wireless thermometer that can send the readings directly through your Bluetooth device while giving 24 hour continuous readings. When did society get here? When did a fever become so catastrophic and anxiety-producing?

Let's first talk a bit about the medical definition and pathophysiology of a fever in terms we can all relate to. A fever is a rise in body temperature. It's usually a sign of infection and a normal response of the body to invaders like bacteria and viruses (germs). Fever is not a result of damage TO the body BY germs but a response of the body TO the germ. The average body temperature is 98.6 F (37 C). But normal body temperature can range between 97 (36.1) and 99 (37.2) or more depending on the method you took the reading. Your body temperature can vary depending on how active you are or the time of day. Generally, older people have lower body temperatures than younger people.

The following thermometer readings generally indicate a fever:
  • Rectal, ear or temporal artery temperature of 100.4 (38 C) or higher
  • Oral temperature of 100 F (37.8 C) or higher
  • Armpit temperature of 99 F (37.2 C) or higher
During a 24-h period, temperature varies from lowest levels in the early morning to highest in late afternoon. Your brain has an internal "thermostat" much like your home. In response to different chemicals, some of which may be the chemicals produced by infections, your brain responds by raising the temperature on the "thermostat" as a protective mechanism to try and "heat out" the infection. Various infectious organisms require certain body temperatures to thrive so by raising that temperature, our body creates an unfavorable environment assisting in the fight. In other words, fever is beneficial in many ways to fighting infection and a sign of a good working immune system.

So what about "frying" the brain with high temperatures? What is that about? It is not unusual for a child to run temperatures upwards of 104-105°F. To cause brain damage, a child's temperature would need to reach 107.6°F - hard to imagine, unless for instance, the child was trapped in a very hot car, had a serious brain infection that damaged the body's "thermostat" or a traumatic brain injury. These are all special cases and apply to less than 1% of the pediatric population. The body has a natural protection system that doesn't allow the temperature to get dangerously high enough to cause damage to an organ.

What if they have a seizure? They will be brain damaged! That is incorrect as well.

Febrile seizures (seizures caused by fever) occur in 3 or 4 out of every 100 children between six months and five years of age, but most often around twelve to eighteen months old. A febrile seizure usually happens during the first few hours of a fever. The child may look strange for a few moments, then stiffen, twitch, and roll his eyes. He will be unresponsive for a short time, his breathing will be disturbed, and his skin may appear a little darker than usual. After the seizure, the child quickly returns to normal. Seizures usually last less than 1 minute but, although uncommon, can last for up to 15 minutes. Seizures occur in 2-6% of children with high fevers. It is thought that these seizures are the body's protective mechanism against rising fevers, like a circuit breaker. Although they can be quite traumatic to parents, they are not the result of, nor do they cause damage to the nervous system. Febrile seizures are harmless to the child and do not cause brain damage, nervous system problems, paralysis, intellectual disability, or death.

Level of temperature does not always correlate with severity of illness. I have experienced children with 98°F temperatures running around the office happy and playful but the exam shows a terrible inner ear infection and pneumonia. I also have seen children who have 104° temperatures also acting normally with no findings of specific infection that go on to be normal developing children without complications or need for antibiotics. Let us not forget that viral infections do NOT need antibiotics and fevers do NOT mean it is a bacterial infection requiring an antibiotic. Our body is quite capable of fighting most infections on its own.

So then what do I do as a parent when my child has a fever? Parents should focus on the general well-being of the child, his/her activity, observing the child for signs of serious illness and maintaining appropriate fluid intake. You should not wake up a sleeping child to administer a fever-reducer. Antipyretics (Motrin, Ibuprofen, Advil, Acetaminophen, Tylenol etc) must be stored safely to avoid accidental ingestions. Parents should be aware that the correct dosage is based on the child's weight, and that an accurate measuring device should always be used. The American Academy of Pediatrics (AAP) suggests calling the health care provider if a baby is between 3 months and 6 months old and has a fever of 101 degrees F (38.3 degrees C) or higher, or is older than 6 months and has a temperature of 103 degrees F (39.4 degrees C) or higher - and has symptoms such as a loss of appetite, cough, signs of an earache, unusual fussiness or sleepiness, or vomiting or diarrhea.

I hope this served as a basis of knowledge to get you through your next fever issue. The AAP has great online resources for parents. When in doubt, your healthcare provider is always happy to see you and evaluate your child. Always use your "mamma and daddy bones" otherwise known as intuition. If it tells you something else is going wrong, no one should ever fault you for taking your child in for evaluation.

Questions and or comments regarding this week's health column please contact, Katherine Herczeg, MSN, APRN at Bitterroot Physicians Clinic South, a service of Marcus Daly Memorial Hospital, 3334 DVN Lane, Darby, MT 59829, a service of Marcus Daly Memorial Hospital. Working together to build a healthier community!


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