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Welcome to another edition of DocSmo.com, the pediatric blog dedicated to the well being of children and families. I’m your host, Dr. Paul Smolen, a board certified pediatrician with 32 years of practice… and counting. Today we are going to take on a topic that every parent unfortunately encounters needs to master, that of understanding and managing fever.
First, let me remind my new listeners about something we have talked a lot about on this blog, the fact that fever is not a disease, but rather a symptom, a sign that your child’s bodily defense has been turned on, most often because of a new infection. Fever certainly is an important thing for parents to recognize and pay attention to but it, in itself, is not a disease…just a sign of a problem, a symptom that usually signals the onset of an infectious disease. If you need to learn how to take a rectal temperature, check out my video on the subject, currently #1 on You tube for this subject. My mother is so proud. Anyway, back to fever. In the era of immunized children, a fever in your child is most likely being caused by a virally caused infectious disease, a disease that usually needs no treatment other than time and loving symptomatic care. Starting to relax a little about fever… I hope so.
I think it will be useful for you to learn some of the science behind temperature control? Just how does your child’s body control his or her temperature? For the answer to that we need to take a little detour down what I call, Science Lane. It goes without saying that having a normal body temperature is extremely important to the good health of your child. There is a very narrow range of temperature that your child’s body will function properly at…too cold, and the child’s metabolism slows down with terrible consequences. Too hot, and their brain malfunctions, again sometimes causing terrible problems. Your child’s body temperature is controlled by a part of the brain called the hypothalamus; the thermostat of your child’s body so to speak. For various reasons, this thermostat works on a day/night rhythm called a circadian rhythm, body temperature being slightly higher at night than during the day. Sickness alters this set point and exaggerates this day/night rhythm. A group of substances called pyrogens, released from white blood cells when a child is sick, can turn up a child’s body temperature in an instant, just like adrenaline that can raise their heart rate or insulin that can lower their blood sugar, almost instantly. Raising your child’s body temperature a little is useful when they are sick, speeding up their immune response. Raising their body temperature VERY quickly is a big stress on a child’s body as any parent with a child with febrile convulsions can attest.
How and when do you as a parent need to get your child’s temperature down? Well, actually the same ways you cool your house down… by either turning down the thermostat or by opening the windows and letting the heat out. Let me explain. When confronted with your feverish child, you can do the same things. Acetaminophen, ibuprofen, and similar medicines literally turn down the thermostat in your child’s brain. Their bodies temperature “set point” is lowered by these medicines just as you would do by lowering the thermostat program. Similarly, a tepid bath, cool drinks, and wet clothes transfers heat transfer from your feverish, hot child and thereby lowers you’re their body temp, just like opening the windows of your hot stuffy house. Grandma’s have known forever, that putting a feverish child in a bathtub of lukewarm water gets their temp down quickly. Think about it, when your child’s temp is 102 F and you put them in a bathtub of 75F water, heat is literally sucked out of them by the cooler bath water. The water will continue to cool the child until the bath water reaches their body temperature, 102F. You don’t have to use cold water simply any water temperature that is lower than your child’s high body temperature. This is a very quick and very effective way of lowering a child’s body temperature, just like Grandma told you. The only negative side effect of the bathtub method is you might need to get into the tub with them… that’s not so bad, is it.
-So, let’s summarize today’s pedcast and review the wisdom that Grandma has given us. Fever is not a disease, just a defense mechanism your child’s body uses to speed up recovery from an infection.
-Most childhood illness today, in immunized children, are viral illness and self -limiting thank goodness. This is why you put your children through the pain of getting shots. The serious, life threatening bacterial infections of the past have been mostly eliminated by routine childhood vaccines. What a blessing.
-There are two main reasons to lower a child’s temperature, to make them more comfortable and to try and distinguish serious from non-serious illness. If your child is hot but not uncomfortable, I prefer not to lower their bodies temperature because this may slow their recovery from the infection.
-Parents have two choices when they have decided to lower a child’s body temperature, pharmacologically turning down the thermostat with ibuprofen or acetaminophen or physically removing heat, usually with water baths.
You need to remember that fever can signal serious trouble such as when your child has the combination of fever and rash, or an extremely high fever (105 or greater), or when your very young infant has fever, especially those under 3 months of age, or when a child has fever for more than 3 days, or when fever occurs in combination with any localized symptoms such as chest pain, a swollen joint, a stiff neck etc. etc.. These are a few situations where fever can mean serious trouble and should not be ignored. for more advice about your child’s fever, call or visit that wonderful person you call your child’s pediatrician.
I hope this pedcast continues your pediatric education and makes you a little more confident the next time your little ones have an elevated body temperature. If you want to learn more on the topic of fever and children, take a few moments to read or listen to other pedcasts on the subject.:
As always, your comments are welcome at my blog, www.docsmo.com and on iTunes. This is Dr. Paul Smolen, recording in studio 1E, hoping you don’t go wild, the next time you have a sick child.
Good day and welcome to the DocSmo blog. I am your host and the creator of this blog, dedicated to parents and children. I am Dr. Paul Smolen, a board certified pediatrician with 32 years of experience in private practice and 36 years if you include residency and fellowship. All those years in practice has given me an interesting perspective on today’s children and families, and I hope to bring some of my insights to you today, in what I call a pedcast… that’s a podcast about pediatric subjects. Today we are going to talk about bread and butter pediatrics, a subject that gives both pediatricians and parents many sleepless worried nights; FEVER. A febrile child is what occupies more of a pediatrician’s life than anything else so I am about to share some of the things I have learned over the years about fever. Here we go.
I have spent my adult life with children who have fevers. Sweating through a high fever illness of a child with his or her parents is the essence of what pediatricians do. As I like to tell my patients, I am a professional worrier… worry is in my DNA. When a young child has a fever, it is my job to worry about everything. Does that rash part of this illness?, is that lack of response to Tylenol a meaningful sign of something bad?, or does fever on day 5 of a sickness really spell trouble? Fever is probably the number one symptom that brings parents to a pediatric visit. Parents fear fever… we were taught to fear fever by our mothers and grandmothers because in the pre-vaccine era, fever often meant something terrible was about to happen; meningitis leading to seizure and death, pneumonia leading to a child not being able to breath and dying, or a urinary tract infection with sepsis, shock, and death. Fortunately, in todays world where most children are immunized, these are much rarer events, but pediatricians and parents still fear fever!
It is important to highlight that a fever in and of itself is not usually a danger to an overall healthy child. Most fevers only last a few days and help to protect your child. Its your bodies way of making things happen faster, shortening an illness. Here is a DocSmo pearl “A fever is not an illness, usually just a shortcut to wellness.” It is a physiologic mechanism that fights infection by speeding up a child’s own natural defenses to bacteria and viruses. Therefore, the main objective of treating your fevered child is to improve his or her overall comfort, not to focus on normalizing his or her body temperature.
Many parents and doctors don’t like fever hence their obsession with lowering a febrile child’s temperature. Fever phobia only makes sense since children who are well don’t have fever, therefore, artificially lowering the temperature of a child with fever must make them well, right? NO, NO, NO. In most cases, it simply makes them more comfortable but can actually slow down the sick child’s recovery by a few hours. Yes, you heard me right…treating fever in most virally caused illnesses actually prolongs the illness. According to many pediatricians including this one, fever reducers, such as acetaminophen (Tylenol) and ibuprofen (Advil), should only be used for temperatures high enough to make your child uncomfortable, probably the 102 or higher range, especially at night when they need to get comfortable to sleep. Additionally, unless your child has some special health problem, you should not wake your sleeping ill child only to give him or her antipyretics. And remember, be aware that cough-and-cold medications may also contain acetaminophen and ibuprofen so be careful not to give your child a double dose of fever reducing medicine… that can be dangerous, especially when they are sick and dehydrated.
The take home message here is that fever is not the primary illness, and doesn’t have to be treated. A fever is a physiologic mechanism that helps your child’s body fight infection… it accelerates healing by enhancing their natural germ killing ability. This is not to say, however, that all fevers are harmless. Parents should be extra mindful of fever if:
A fever certainly can be a sign of a serious infection, but… it is usually not, especially if they have had all their shots. Your child’s fever may actually be of benefit to him or her, thus the goal of fever reducing medicine use is to improve your child’s comfort not to cure any disease.
I hope you found some practical advice in today’s pedcast. I thank you for joining us. If you think a friend or relative would benefit from this or any of my podcasts, just hit the send button at my website. Its easy. And, I would love to hear your comments and stories on iTunes, Facebook, or my blog docsmo.com. Go ahead, express yourself. Connect with the blogging community or simply ask a question. This is Doc Smo, broadcasting from my cutting edge studio 1E, hoping that the next time your little tot is hot, you hit the treatment, right on the dot. Until next time.
|Does a Failure to Respond to Antipyretics Predict Serious Illness in Children With a Fever?|
|Arch Dis Child. 2013;98(8):644-646. © 2013 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health|
I was catching up on some of my journals the other day when I came upon an article that caught my interest. Regular readers/listeners of my blog may remember a pedcast I did on teething last year. In that post, I tried to get to the facts of what we know and don’t know about the effect of teething on children. Many parents believe that tooth eruption causes high fever, diarrhea, and/or severe pain. When I made the teething pedcast, I had concluded from my reading and my own experience that teething does not cause a lot of physical symptoms. None of these things happen at the time of dental eruption but many parents attribute all sorts of symptoms to teething to this day.
So it was great interest that I read an article in the September 2011 journal Pediatrics about a study that was done in Brazil, of all places. There, the researchers sought to determine what, if any, symptoms are attributable to the eruption of primary teeth in children between five and fifteen months of age. They observed 231 teeth erupt in the 53 children that they observed. To my surprise, they discovered that Grandma was right, at least partly: teething causes fever, diarrhea, irritability, sleeplessness, and a runny nose. The researchers found that fever .17 degrees Celsius, irritability, diarrhea and sleeplessness were more frequent on the day of a tooth eruption as well as the following day. They did not find in any of the children they studied, however, that high fever, severe pain, or any severe symptom was associated with the teething process. Their findings confirm my opinions expressed in last year’s pedcast; it is nice to be right on occasion.
The next time you hear someone talking about teething causing severe symptoms of any sort, remember the facts that this study points out: Grandma was right to believe that a variety of physical symptoms do seem to accompany teething, but she was not correct to attribute any severe behavioral or bodily changes to teething. Now you know.
Until next time.
Ramos-Jorge et. al. :Pediatrics Volume 128, Number 3, September 2011