Health Update from Your Nurses
Drs. Gordon, Nussbaum, and Lappin

February 26, 2011
Hot and Bothered: the Story of Fever 

Fevers are definitely a "hot topic" right now. We're seeing

lots of fevers averaging about 104-105 degrees Fahrenheit for days. It's scary, but it's a normal part of many common illnesses.  


In this newsletter we have what we hope is some helpful information about fevers. But here's the bottom line: if your child with a fever is drinking, playful, smiling, and engaged, she's probably doing just fine.  


So, What Exactly is Fever:   

The technical definition of fever is a body temperature greater than 100 degrees Fahrenheit orally (37.8 degrees Celsius), or 100.8 degrees F rectally (38.2 C).

The body's thermostat, the hypothalamus, controls our daily body temperature through skin circulation, sweating, and involuntary shivering. During some illnesses, infectious agents such as viruses and bacteria produce chemicals that cause the hypothalamus to respond by raising the body temperature and producing a fever. Chills come into play, ironically, when our body is heating up with fever because the little muscle contractions in chills and shivering actually produce warmth and help the body to get hotter!


But high fevers do not necessarily correlate with a more severe degree of illness. Just because your little one has 104 degree temperature, doesn't necessarily mean that he's more sick than when he has a 101 degrees. And fevers naturally go up and down in the course of a day, with them often spiking in the evening.  


It's really about looking at the whole child, his behavior, eye contact, interest in toys, etc.--not just the number on the thermometer.  


Fever: One of Our Immune System's Defenses:


This fever-inducing system is primal, and beyond our conscious control, so might it serve an important survival purpose? Absolutely! Fever is one of our immune system's methods for fighting infection (and for keeping parents awake all night!).

Our bloodstream's white blood cells, those brave little warriors who engulf and devour germs, move faster and are more effective at higher body temperatures--go WBC's! Viruses and bacteria do not thrive at these higher body temperatures, so fever makes us a very inhospitable host. 

So, if fever is actually nature's way of helping us, and in fact is not harmful to children, can't we all just shake hands and be friends? Should we really try to bring a fever down if it's really all that?

When to Bring a Fever Down:

1. Your child is too miserably uncomfortable to rest or sleep

2. Your child is too lethargic to drink and stay well hydrated

3. Your child is too miserably uncomfortable for you to assess just how sick she really is. Sometimes, a fever can make your child appear very ill, indeed. If reducing the fever perks her up nicely, it can be very reassuring to you and helpful information for your doctor.


4. Your child is too miserably uncomfortable. Period!


In other words, the reasons for reducing a fever are more practical than medical. Your child will not be harmed by running even as high as a 105 degree F. fever*. Fevers themselves are not dangerous. But your child may very well look and act quite worrisome to you during any fever and may feel a whole lot better when you bring that fever down.


Doing nothing to reduce a fever, then, may not always make much sense, especially given the risks of dehydration and the discomforts a high fever can bring.  


*If your infant is 2 months or younger and has a fever of 101 degrees or higher, we need to hear from you right away.  


*If your child remains lethargic (limp, unresponsive, no eye contact, or smiles) or inconsolable after you've attempted to bring the fever down, we need to hear from you right away.  


How to Get Cool, Man:

1. Off with the blankets, clothes, and diapers.


2. Into a lukewarm (but definitely not too cool) bath. Lounge a while, but don't get chilled. Getting the hair and head wet can help the evaporation process and cool your little one down, too. 


3. Re-dress lightly.


4. Lots to drink, breastmilk for babies, cool water and herbal teas best for the rest.


5. Quiet activities.


6. Tylenol or Advil/Motrin as fever reducers. Generics of these are still what's on shelves (acetaminophen and ibuprofen respectively). Ibuprofen can be harder on the stomach, so acetaminophen or FeverAll (suppository) may be better choices for an upset or empty tummy. 


*Never wake a sleeping child to give a dose unless otherwise directed.*


7. Repeat baths as often as you like, cool compresses or sponging off with water (NO alcohol rubs which are toxic and also reduce body temperature too quickly).

And remember, sometimes fevers won't budge no matter what you try--very annoying and frustrating, but not to worry. Call us and we'll guide you through.

Also, please reduce your child's fever at home if she's uncomfortable before your office visit. We simply need your report of the fever to help us during the exam. We don't need to see the fever itself.


Fever Patterns and Scenarios:

#1: At the onset of a new viral illness, fever may be the only symptom to appear. If your child begins a fever "out of the blue" with no previous days of illness and no other symptoms, it is likely viral and could last for an hour or up to several days.

Note: Because fevers may come and go within the same day, your child is not officially "fever free" and ready for playdates or school until his temperature is normal for a full 24 hours.

Guidelines for this scenario: You can do home care for this fever for up to three days. Call us if during these three days other symptoms (heavy coughing, vomiting, sore throat, ear pain) appear. Also, call us if the fever persists more than three days, even if there are no other symptoms.

#2: Frequently, your child will only have the other viral symptoms (congestion, upset stomach, sore throat, etc.) with no fever at all. However, if a fever then begins AFTER those first three days of illness, it could mean a developing bacterial infection, secondary to the original virus.

Guidelines for this scenario:  Please schedule an office visit with us.

How to Take a Temperature:

It is more important to establish whether or not there is a fever than to very accurately measure what it is. (Remember, your child will not necessarily be more sick at 103 degrees than he is at 101). But verifying a fever is there is useful and some measurement will help.

1. Low tech but useful:  touch your child's skin--your hand or lips to forehead or cheeks. It may not feel equally hot all over, but it will feel warmer than usual. Your child may also get very tired, cranky, may stop eating, or generally not look or act like himself.

2. For an infant, a rectal temperature with a well-lubricated (KY Jelly is preferable to Vaseline) digital rectal thermometer, or alternatively an underarm temperature with a digital thermometer. (A glass thermometer is fine, but the digital has the added benefits of speed, ease, and not shattering on your bathroom floor).

3. You can use an ear thermometer, forehead scan, or oral thermometer for older children who can cooperate well and safely.

In Closing:

This time of year it's normal and expected for children to run fevers which can vary greatly from low to high and how long they last. While it's hard to chill out in the midst of a heat wave, rest assured all will be well again soon enough.

Please feel free to call us with any of your questions or concerns. And, as always, lots of hydration, rest and hand washing to get you and yours through this season.


Your Nurses