Fever… Facts & Fiction
By medical definition, fever is defined as temperature greater than 100.4º. While there may be slight variation in an individual’s normal body temperature, this definition of fever is universally accepted by most medical professionals.
It is important to note that fever in itself is not an illness but a beneficial reaction of the body usually in response to an infection. The rising body temperature decreases the ability of the infection, virus, or bacteria, to complete its normal function, and it improves the body’s inflammatory process to help clear the infection and prepare the body for healing. While it is true that fever may result in discomfort and a slight increased risk of dehydration; most fevers are limited in duration, harmless, and studies indicate may be beneficial in accelerating recovery. Despite the physiological origin and benefits of fever, it remains misunderstood and a subject of concern for patients and those with children, so let’s compare the fiction and facts.
Fiction: Fever is an indication of severe illness.
Fact: Anything that triggers the body’s immune system may result in a fever. In pediatric patients, viral illnesses often result in significant elevation in temperature. It is not uncommon for a patient with a cold-like illness to experience a temperature of 104º in the first 24 hours of the illness. Teething infants may have a temperature from 99-101º. While your child’s physician may use the level of fever in determining the illness cause and treatment, the degree of fever is not directly related to the illness severity. In addition to the level of fever, illness duration and symptoms are all important in identifying its origin. Viral illnesses usually result in fever for 48-72 hours, longer durations justify evaluation by a physician, but may still be self-limited.
Fiction: Fever can result in brain damage.
Fact: Multiple studies indicated children with fever are not at increased risk of brain damage. Fever is a process that is regulated and controlled. In contrast, hyperthermia is a rare condition that results in the inability to control elevated external temperature.
Fiction: High fever results in seizures.
Fact: Febrile seizures may occur with fever. However, they are not directly related to the level of fever but are more directly related to how rapidly the temperature rises. Simple febrile seizures occur most commonly in pediatric patients ages 15 months – 5 years of age and are not associated with seizure disorders. Febrile seizures outside of this age group should prompt evaluation by a physician for an underlying neurological process.
Fiction: Treatment of fever should result in “normal” temperature during illness.
Fact: The goal of treating a fever should be increased comfort for the individual. Adults and children usually do not feel well during a fever and so Tylenol and Motrin can help with discomfort. Cool liquids, compresses, and adequate airflow may improve comfort as well. It is important to remember the physiologic and beneficial effects of fever as it relates to combating the infection. Remember, fever is a response to the illness and not the illness.
TREATING A FEVER
Non-medical measures should be undertaken first. Cool cotton clothing improves airflow and temperature regulation. Chilled liquids help bring soothing relief to the throat and may help lower the body temperature. Cool compresses also help dissipate heat at the skin’s surface. Overuse of Tylenol and Motrin may inhibit recovery from illness. In my practice, I recommend treating the patient and not the number. In a playful happy child with a temperature of 102 º, cool clothing and liquids may be all that is necessary. However, if a child is fussy or uncomfortable, medication treatment may be considered. With febrile seizures, when attempting to prevent the rapid rise of fever, providers may employ the early use of fever-reducing medications. These special circumstances should always be discussed with your or your child’s physician.
While skin surface temperature can provide an estimate of body temperature, factors such as environmental temperature, sweating, or the presence of an ear infection can all affect the reading. Rectal temperature remains the gold standard for temperature evaluation in pediatric patients under 2 years of age. Oral temperatures are standardly used for evaluation of fever in children 3+ through adulthood. Keep in mind, the presence of fever may be an indication of a contagious illness and treatment should never be used to mask a temperature for returning to daycare, school, or work as it only serves to spread infection.
Kendall Wagner, M.D. is a regular healthcare contributor to Do South Magazine.
Chaffee Crossing Clinic
11300 Roberts Boulevard, Fort Smith, Arkansas