Kids Love Dr. Barton

Fever Doesn't Hurt Children

by Dr. Douglas Barton, M.D., Pediatrician 07/12/2011



Fever!  A middle of the night scare for any concerned, caring parent.  Easily, the most common concern I hear on the phone when I'm on call.  Fever is a scary thing.  Parents have been trained by their parents to become very concerned about high temperatures.  Let's take a few moments to look at fevers.  When should you be concerned?  When can you let it be?  What are the myths that surround fever?

The first and most important myth regarding fever is that fever causes brain damage.  When the parents of my patients were kids, life was a little different.  We didn't have the abundance of vaccines available now to protect us from a wide variety of bacterial and viral illnesses that we have now.  Fifty and seventy-five years ago, a fever often heralded a serious illness. Most often, these illnesses were colds and minor infections, just like today.  In many circumstances, however, fever heralded an illness associated with bad outcomes such as pneumonia, urinary tract infections, meningitis, or epiglotitis, just to name a few.  When there is a serious bacterial infection, the risk of brain injury goes up, but it is NOT the fever that causes that risk!  It is the infection.  With today's vaccines, these infections have gone down in frequency markedly.  We see FAR less pneumonia or meningitis than we did fifty years ago.  Without a serious infection underlying the fever, fever, by itself, cannot cause brain damage. 

But what about febrile seizures?  About five to ten percent of children will have a seizure with a fever.  These seizures generally involve the whole body shaking or jerking for one minute to as long as fifteen minutes.  Immediately before or immediately after these "simple" seizures, the patient is noted to have a fever, often quite high!  What is far less clear, as these seizures are better studied, is whether or not the fever caused the seizure or if it was a combination of genetics and the specific infection involved.  New studies show that most children with a febrile seizure have a family member who has had a febrile seizure. These children are rarely the first one in the family.  Also, certain viruses seem to be far more associated with febrile seizures than other viruses.   Roseala (Human Herpes Virus-6) has recently been shown to be very commonly associated with febrile seizures.  Simple febrile seizures are not associated with any brain damage.  Children with simple febrile seizures do not have a higher risk of epilepsy than the general population.

Some seizures with fever are NOT normal.  Seizures involving only a limited portion of the body (so called "focal seizures"), seizures lasting longer than a half hour and multiple seizures over the course of several hours are not normal.  Febrile seizures in a child with an underlying neurological problem or seizures in a child who has a family history of epilepsy may also indicate a higher risk of seizure disorder in the child.  Furthermore, children with a simple febrile seizure rarely have symptoms other than the fever and maybe some cold symptoms.  Seizure with fever and a rash or severe headache probably indicates meningitis.  A child who has a febrile seizure who is not acting nearly normally within a very short time after the seizure may have something more ominous going on.

So what DOES fever do?  Fever is our body's way of increasing its ability to fight off infections.   Many viruses reproduce much more slowly in a warm environment.  Imagine two different bodies, one at normal temperature and one running a fever.  Infect them both with a virus and the feverish body keeps these little viruses from making as many baby viruses.  Secondly, many of our body's defenses against infection, such as interleukins, work better at a slightly higher temperature.  Also, we don't feel nearly as energetic when our temperature is up, so we tend to rest more, allowing the body to fight off the infection more easily.  Clearly, low grade fever works in our favor. 

"But, it's 2:00 a.m.!  My son has a 102 temperature and I'm worried!  What now?!?!?"  First, take a look at the whole picture.  What was he like earlier in the day?  Was he acting normal?  What other symptoms does he have now?  Some cough and congestion? Fine.  Bad headache and trouble bending his neck?  NOT FINE!!  Severe stomach ache?  NOT FINE!!  How is he responding to Tylenol or Motrin (remember, no Motrin before six months old)?  Is he acting nearly normal after fever reducer or is he still listless or in pain?  You see, it's these bigger picture things that become desperately important when your child has a fever.  If the fever comes down a couple of degrees with acetominophen (Tylenol) or ibuprofen (Motrin) and he acts nearly well for 3-6 hours until the fever returns, he's probably okay.  If not, or if other symptoms seem to be dogging him, then he probably should be seen.  If he really has no good response to fever-reducing medications, then he should probably be in the emergency room.  Call your pediatrician if you have these concerns to get further guidance.

   
 

 

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