Don't fear a fever

Hello parents! This is your friendly pediatric nurse practitioner, Mary-Faith Fuller, from ABC Pediatrics, with your monthly “Did you know?” topic. Every month I will be discussing common pediatric topics and problems to keep you informed. If there is a topic that you are curious about, please let me know, I would be happy to feature it in a monthly installment.

Picture this: It's 3:00 am, you're three-year-old child, Johnny, is crying, you go to his room and he feels really warm. You take his temperature and it reads 102 degrees F. You end up giving Tylenol and he is able to fall back asleep. You check his temperature an hour later and it has dropped to 100 degrees F but by 10:00 am it's back up 102.1 degrees Fahrenheit. Besides the fever, he's otherwise acting okay. He is still playing happily with his toys and drinking and eating well, but you begin to panic that his temperature is not dropping much. You've been taught fevers are bad and need to be treated, otherwise, it could cause brain damage. So what do you do now? Well, let me help you.

First and foremost, fever is no reason to panic. A fever, in and of itself, is not harmful. It's actually the body’s normal way of fighting off an infection or illness and it is beneficial. Think of it as the body’s “check engine light” and a clue that something is going on. In my practice, I have found that there is a lot of confusion as to what temperature constitutes a fever. A fever is a temperature of 100.4 degrees F or above and any temperature below that is not a fever.

Second, a common saying in Pediatrics is “treat the kid, not the fever”. Always look at your child. How is he acting? Is he playful and happy? Or, is he whiny and not wanting to get out of bed and not acting like himself? Also it's important to remember that the number on the thermometer doesn't necessarily correlate with how sick the child is. One child could be running around with a temperature of 104 F and another child may be lethargic with temperature of 102 F. Again, it just depends on how the child looks. When deciding whether or not you need to give your child a fever-reducing medicine, don't base it upon the number you see on your thermometer, base it on how uncomfortable your child may be. How much should you give? Well, that’s easy! Just visit our ABC Pediatrics homepage and we have a Quick Links section with dosing information for Acetaminophen and Ibuprofen dosing based on your child’s weight.

Third, and perhaps most important, when do you need to be concerned? Of course, there are instances when a fever is not normal and you should seek out advice from your health care professional. These instances include:

• fever in a child less than 2 months of age
• fever that lasts longer than 5 days
• a child who is acting lethargic after the fever has resolved
• fever in a child with a chronic disease or lowered immune system
• fever in a child who is throwing-up non-stop and will not drink fluids
• fever in a child who has spent a long time in the heat
• fever in a child with stiff neck and headache

So, based on the following information presented, how would you counsel Johnny’s mother? Since Johnny is acting normally, despite having a fever, she is okay to monitor him. In addition, because Johnny appears comfortable, there is no reason to give him any fever-reducing medicine.
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In conclusion, don’t fear a fever! The goal should be to keep your child comfortable and treat based on how your child is acting, and not just the number on the thermometer. Finally, as always, if you’re worried that something is not right, just give us a call; that’s what we’re here for.
*Information presented adapted from the American Academy of Pediatrics “Clinical Report-Fever and Antipyretic Use in Children” http://pediatrics.aappublications.org/content/pediatrics/early/2011/02/28/peds.2010-3852.full.pdf