Tuesday, December 9, 2014

Fever, How high is too high?

When it comes to fever, how high is too high?

The journal Pediatrics did a follow up study in 2001 (http://www.ncbi.nlm.nih.gov/pubmed/11389237) to a similar study done in 1980 by Barton Schmitt, MD (http://www.ncbi.nlm.nih.gov/pubmed/7352443), who found that parents had numerous misconceptions about childhood fevers. These unrealistic concerns were termed "fever phobia." The most alarming finding of the more recent survey was that “fever phobia”, or the misconceptions about fevers were even more prevalent in 2001 than in 1980. This tells me that the education about fevers has been very inadequate, and in some cases even misleading. The important thing to realize about these misconceptions is that it leads parents to seek and even demand inappropriate treatments for what is truly a normal part of our body’s intelligent design to handle infections. Furthermore the inappropriate treatment and medical interventions negatively affect your future health. Life is cumulative and to assume that one round of unnecessary antibiotics or antipyretic (fever reducing medication) is harmless, totally misses the fact that this trend of fever phobia and unwarranted intervention is continually increasing, as these two studies demonstrate. If you and your pediatric doctor are not aware of the facts about fever then throughout a lifetime your child will have received numerous inappropriate interventions. 

To clear the air and help our parents here are some common myths about fever and the reality behind them from Dr. Barton Schmitt and John Hopkins All Children’s Hospital. http://www.allkids.org/PediatricSymptomChecker/housecalls3tab_english/peds/fever_myths.htm

MYTH: My child feels warm, so she has a fever.
FACT: Children can feel warm for a many reasons such as playing hard, crying, getting out of a warm bed or being outside on a hot day. They are “giving off heat”. Their skin temperature should return to normal in 10 to 20 minutes. Once these causes are excluded, about 80% of children who feel warm and act sick actually have a fever. If you want to be sure, take their temperature.  The following are the cutoffs for fever using different types of thermometers:
  • Rectal, ear or temporal artery thermometers: 100.4° F (38.0° C) or higher
  • Oral or pacifier thermometers: 100° F (37.8° C) or higher
  • Under the arm (Axillary or Armpit) temperatures: 99° F (37.2° C) or higher
MYTH:  All fevers are bad for children.
FACT:  Fevers turn on the body's immune system and help the body fight infection. Fevers are one of the body's protective mechanisms. Normal fevers between 100° and 104° F (37.8° - 40° C) are actually good for sick children. 

MYTH:  Fevers above 104° F (40° C) are dangerous and can cause brain damage.
FACT:  Fevers with infections don't cause brain damage.  Only body temperatures above 108° F (42° C) can cause brain damage.  The body temperature climbs this high only with extreme environmental temperatures (for example, if a child is confined to a closed car in hot weather).

MYTH:  Anyone can have a febrile seizure (seizure triggered by fever).
FACT:  Only 4% of children can have a febrile seizure.

MYTH:  Febrile seizures are harmful.
FACT:  Febrile seizures are scary to watch, but they usually stop within 5 minutes.  They cause no permanent harm. Children who have had febrile seizures do not have a greater risk for developmental delays, learning disabilities, or seizures without fever.

MYTH:  All fevers need to be treated with fever medicine.
FACT:  Fevers only need to be treated if they cause discomfort.  Usually fevers don't cause any discomfort until they go above 102° or 103° F (39° or 39.5° C).

MYTH:  Without treatment, fevers will keep going higher.
FACT:  Wrong.  Because the brain has a thermostat, fevers from infection usually don't go above 103° or 104° F (39.5°- 40° C). They rarely go to 105° or 106° F (40.6° or 41.1° C). While the latter are "high" fevers, they are harmless ones.

MYTH:  With treatment, fevers should come down to normal.
FACT:  With treatment, fevers usually come down 2° or 3° F (1° or 1.5° C).

MYTH:  If the fever doesn't come down (if you can't "break the fever"), the cause is serious.
FACT:  Fevers that don't respond to fever medicine can be caused by viruses or bacteria.  It doesn't relate to the seriousness of the infection.

MYTH: Once the fever comes down with medicines, it should stay down.
FACT: The fever will normally last for 2 or 3 days with most viral infections.  Therefore, when the fever medicine wears off, the fever will return and need to be treated again.  The fever will go away and not return once your child’s body overpowers the virus (usually by the fourth day).

MYTH: If the fever is high, the cause is serious.
FACT:  If the fever is high, the cause may or may not be serious. If your child looks very sick, the cause is more likely to be serious.

MYTH:  The exact number of the temperature is very important.
FACT:  How your child looks is what's important, not the exact temperature.

MYTH:  Oral temperatures between 98.7° and 100° F (37.1° to 37.8° C) are low-grade fevers.
FACT:  These temperatures are normal variations. The body's temperature normally changes throughout the day. It peaks in the late afternoon and evening. An actual low-grade fever is 100° F to 102° F (37.8° - 39° C) .

SUMMARY: Remember that fever is fighting off your child's infection. Fever is one of the good guys.