Fever by Mark B. Levin, M.D. and Timothy Patrick-Miller, M.D. The Pediatric Group, P.A., Princeton

This is the thirteenth article in a series written for Princeton Online. Click here for an archive of other articles.

During this season of influenza and strep throat, many parents worry about their children having high fevers, especially when acetaminophen or ibuprofen has failed to lower the temperature. Uncomplicated fever, when allowed to run its course, may be associated with some discomfort, but is not dangerous. It is actually part of the body's immune response that fights bacteria and viruses. This unwarranted fear of fever stems from the bygone practice of bundling a feverish (febrile) child to "sweat it out of him". Bundling a child inhibits the dissipation of warmth through the skin-- the body's natural fever-control mechanism. Fevers can then climb to extreme levels, causing damage. Equally problematic in the "old days", specific medical diagnosis and treatment were limited. Hence it was more difficult to discern the cause of the fever-- a much more important factor than the height of the fever. Although most fevers are due to self-limited benign viral illness, unrecognized or untreatable serious disease associated with fever lent fear to any febrile illness.

Fortunately for our children, medical knowledge has improved. The medical profession has greater knowledge, more accurate diagnoses and more effective therapies for specific diseases. Once a disease has been identified by the history of the illness, the child's physical findings or confirmatory laboratory studies and after any needed specific therapy has been instituted, doctors do not worry about the height of the fever, but rather use it as an indicator of whether the body is still fighting the illness. We know that as long as a child is not insulated with layers of clothing or blankets, the fever will not climb to excessive dangerous levels.

What, then, is a dangerous level of fever for a child? The answer relates not to a number, but to the child's functional state and associated symptoms. If a child with an identified condition has a fever at any level and responds to social interaction in a manner that is appropriate for the child's developmental stage, then concern is lessened. Well being is not tied to a number on a thermometer. We have all seen children who are cranky and uncomfortable in the absence of fever. We have also seen children with fever contentedly watching television and asking for juice without apparent discomfort. So it is the ability of the child to interact rather than the number on the thermometer that is more telling.

The timing of a fever can suggest whether a child needs more specific medical intervention. Fevers related to viral illness usually occur at the onset of the illness, oscillate for one to three days and disappear. Since viral disease generally resolves without specific treatment in children, the fever associated with it is not indicative of a worrisome event. When a child has a viral condition for several days and then develops fever, that may indicate a secondary bacterial infection which requires antibiotic treatment. This later appearance of a fever, though not dangerous, indicates the need for a physical examination. Once specific therapy for any complication is instituted, the fever usually dissipates without anti-fever treatment.

It follows from the preceding discussion that knowing the exact level of the fever is unimportant. Indeed, knowing whether fever is present helps identify that a child is ill and perhaps contagious, but it is the discomfort suffered by the child, not the level of fever, that guides the administration of medication. If the number of the temperature must be known with any precision, the old fashioned glass thermometer is the most reliable, most accurate and most economical tool. Newer digital thermometers can achieve a similar accuracy with far greater speed at greater cost, but if dropped or jostled, their reliability can be compromised. The popular ear thermometers are notorious for over-reading a temperature, especially for children under three or four years of age (when higher fevers are more likely).

When we recommend acetaminophen or ibuprofen, our goal is usually the comfort of your child, not reduction of the fever. The aches and crankiness that accompany an illness may be associated with a normal or elevated temperature. Unless your child has a known predisposition to problems from fevers, forget the fever and treat the discomfort. Bathing a child with a fever may help increase the child's comfort level after the bath. However, you can anticipate a moderate amount of complaining by a child placed in a tepid bath when his or her body is trying to generate a higher temperature. We recommend against alcohol bathing or rubs because the body is chilled too quickly, causing uncomfortable shivers and more fever. Also, alcohol accidentally splashed in the eyes of a struggling child can irritate. Taking a febrile child out of doors makes absolutely no difference in the course of the child's illness and is considered safe. Be careful not to bundle up the child outside any more than you would indoors. Caution regarding exposure of a febrile child to others is warranted, however, in order to prevent spread of the infection to others.

Fevers in childhood are common. They signify that a child is experiencing and fighting an inflammatory condition, usually an infection. The fever is not in itself a disease, but rather a helpful natural biologic mechanism for combating the disease. Fever need not be feared nor treated medicinally but for exceptional circumstances. If you have questions regarding the approach to fever, discuss it with your pediatrician. Hopefully the winter flu season will pass quickly and not force you to face the prospect of dealing with an ill child. Spring is just around the corner!

All Rights Reserved 3/99 The Pediatric Group, P.A.

Dr. Levin has been a member of the staff at The Pediatric Group since 1977. Currently an attending Pediatrician at the Medical Center at Princeton, he has been Chairman, Department of Pediatrics, Medical Center at Princeton, 1984 to 1986, 1989 to 1992, and past President, Medical and Dental Staff, Medical Center at Princeton, 1987 to 1988. Dr. Levin has served on numerous Departmental and hospital committees. He has published original articles both while at Upstate Medical Center in Syracuse and at The Pediatric Group. He has a wife and three children. Dr. Levin enjoys alpine skiing, jogging, hiking and camping, travel, computers and racquetball.

Dr. Timothy Patrick-Miller

Dr. Patrick-Miller has been a member of the staff at The Pediatric Group since 1985. Dr. Patrick-Miller has served on several Departmental and hospital committees. He has published original work while at The Pediatric Group. He and his wife enjoy travel. He also likes hiking, biking, gardening and reading.