Concerns about childhood fever arise in part, from the belief that fever is a disease rather than a sign of illness. Viewing fever in this way leads to misconceptions on the part of caregivers regarding its role in illness, which may foster anxiety about its potential harmful effects. Ultimately, concern about fever can lead to excessive monitoring and treatment by both parents and pediatric health-care providers.
What is a fever?
Fever is typically defined as:
Rectal temperature greater than 38° C (100.4° F)
Tympanic temperature greater than 38° C (100.4° F)
Oral temperature greater than 37.8° C (100° F)
Auxillary (armpit) temperature greater than 37.2° C (99° F)
Reasons to not treat fever:
The two main arguments against treating fever are its protective effect and the risk that treatment may obscure diagnostic signs of serious illness.
Fever is a protective mechanism. Research has shown that fever is an adaptive response that has evolved as one of the body’s many mechanisms for fighting infection. Evidence suggests that elevated body temperature enhances various components of the immune system. Fever can retard the growth of bacteria and viruses, increase neutrophil production and T-cell proliferation, and aid the body’s acute phase reaction. Many investigators have found that temperature elevation confers a survival benefit in animals in response to challenges by bacteria, fungi, and viruses. Cold-blooded animals, like lizards, show an increased rate of survival after bacterial challenge when they are allowed to seek out a heat source and raise their body temperature.
Fever reduction may obscure diagnostic signs of severe illness. It was once thought that a poor response to antipyretics (fever reducing agents such as ibuprofen and acetaminophen) predicted serious illness in febrile infants. However, antipyretics can reduce fever in children with a viral illness as effectively as they do in children with a bacterial illness. Concern has also been raised that reducing fever may hide signs of a serious bacterial illness and delay diagnosis.
Serious bacterial illness such as bacterial meningitis and septicaemia necessitates urgent medical care, as these infections can be fatal within hours.
In addition to fever, children with meningococcal may present with the following symptoms: severe headache, vomiting, rash, sensitivity to light, stiff neck, confusion and lethargy.
Signs in babies include a bulging or tense softspot on their head, a refusal to feed, a high pitched moaning cry when handled, stiff jerky movements, or floppy, lifeless and lethargic in nature. Babies younger than 3 months often present without fever, so recognizing these signs as early as possible may be lifesaving.
Reasons to treat a fever:
When children are febrile they may complain of pain or appear to be in discomfort. It is not clear whether discomfort such as headache or generalized muscle ache results from fever or the underlying illness. In either case, giving acetaminophen or ibuprofen provides both antipyretic and analgesic effects and helps the child feel better.
An antipyretic may be beneficial in certain disease states. During a febrile illness, a child with cardiovascular disease may increase his oxygen consumption and a child with pulmonary disease may have an increase in carbon dioxide production. Fluid requirements increase during febrile illness, putting some children at risk of dehydration. Lessening body temperature with an antipyretic helps decrease the fluid requirement to more normal levels and, possibly, reduces the threat of dehydration. Last, it is often recommended that parents give an antipyretic to a child with a history of febrile seizures at the first sign of illness to prevent a rise in temperature, and therefore a seizure. No evidence supports this practice, however. One study of hospitalized children with febrile seizures found that children who were given acetaminophen every four hours were just as likely to have a second seizure as children who received acetaminophen sporadically.
In healthy children, fever usually develops in response to a viral infection and is generally short-lived and benign. Fever lasting longer than three to five days and fever in children under 3 months of age or children who are immunocompromised by conditions such as sickle cell disease, cancer, or HIV infection are some of the situations that may indicate a more serious bacterial illness necessitating further evaluation and treatment. Keeping a child calm, comfortable and well hydrated while their body goes through the natural febrile process is the best treatment.
Have a great day,
The Vitality Team