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:
- The fever is in a very young infant, especially in children less than 3 months of age.
- Or if the fever is 104°F or greater
- Or if the fever is accompanied by a rash
- Or if the child is acting particularly ill
- Or if the fever is accompanied by any localized pain, such as neck pain
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|