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Fever

ONE DOCTOR'S OPINION:

Fever is probably one of the most feared and most misunderstood symptoms of childhood. Every child gets a fever at some point in their lives, and most will get fever multiple times. Parents see that their children are fine after they recover from the illness causing the fever, so why is fever feared so much? Why do parents want so badly to get the temperature into the normal range, and most importantly, why do people think that fever causes brain damage?

First, let's start out with the definition of fever. Fever is an elevation of temperature out of the normal range. A normal temperature is 98.6 degrees Fahrenheit, but a normal range can be from 97 degrees Fahrenheit to 100.5 degrees Fahrenheit. Is a temperature of 100.3 degrees a fever - that's debatable, but as you'll see it doesn't really matter. A fever is the response of the body to infection, inflammation or injury. Most commonly we see fever with infection. The body will elevate its temperature to combat the infection. A higher temperature allows the body's own immune system to combat the illness better, and nothing is better than our own immune system. All the antibiotics in the world won't cure an illness if our immune system is not functioning. That's why people with immune deficiency disorders do so poorly. So if a fever is helping the immune system and the immune system is the best way to combat infection, then why do we try to stop the fever? In order to answer this question, it is important to understand the history of fever.

Until the middle 1800's, the medical field did not know about organisms causing illness. No one knew about viruses or bacteria. So when a child got sick and got a fever, there was no way to know exactly what was causing the fever. A doctor would look at the symptoms and name the illness, but no one knew that the underlying cause was a microscopic organism. So children got fever and the illness would run its course. There were no antibiotics for bacteria. Almost every child, as is the same today, would recover with no problems - the fever would break, the illness would pass and the child would be fine. However, an extremely low number of children would have long-term complications. Was this because of the fever? Of course not. But fever was the only thing these people knew, so it was blamed on the fever. The complications actually came from the underlying illness that caused the fever. The child may have had a serious bacterial illness, such as bacterial meningitis or bacteremia, which is bacteria in the blood stream. The illness would cause the complications, not the fever. Fever was blamed, and this fear of fever became entrenched in society.

So why do we stop the fever? The answer is really for no good reason. If a child is comfortable, looks well, is eating and drinking, and has normal activity, then the best thing is to leave the fever alone and let it do its job. The only reason to bring a fever down is if the fever is causing discomfort in the child. Fever is not dangerous. It does not cause brain damage. It is not something to be feared. When a child is ill, fever is not the most important symptom. It's not as simple as a child with 98.6 temperature is healthy, one with 100.1 temperature is worse, a child with 102 degrees fever is sicker and one with 104 temperature is dangerously ill. It just doesn't work that way. A child with a 98.6 temperature could be seriously ill, and one 104 temperature could have a mild virus. The best way to determine how sick a child is is to look at how they are acting. If a child is vigorous, full of activity, eating and drinking and even actively fussy - then they are healthy but may have a minor illness. If the child is lethargic, not responding well, not able to show good eye contact, has a stiff unmovable neck, or is floppy, then you have an ill child. The height of the fever doesn't matter. So what's the worse thing a fever can do to someone? The worse thing a fever can do is to cause a febrile seizure. This is a short seizure induced by fever. Some children are prone to this, and in these children, a small elevation of temperature can initiate it. Most will never get one, no matter how high their temperature gets. A febrile seizure is not dangerous and does not cause brain damage. Sure, it's scary to see, but it is not a dangerous event. It happens, it is over quickly, and there are no sequelae to the event. We should not look at fever as the enemy. We should look at fever as our friend. The fever is helping us to combat infection. Find the cause of the infection and treat that but leave the fever alone.