Last year a friend of mine was taking her daughter to a weekly community play group. The organizer arranged guest speakers to educate parents on various child-related topics. One week a pediatric chiropractor was invited. During her presentation she told parents they should never medicate a fever unless it’s reached 40C/104F.
What do you think – was she right or wrong?
Our family is just coming off of a week of illness and high temperatures so I thought this would be a great time to look at the current fever guidelines and see if they align with this chiropractor’s recommendations.
What Is a Fever?
Normal body temperature is 37C/98.6F but may vary slightly from person to person. A fever is the elevation of a person’s core temperature above 38C/100.4F. Fevers can develop for a variety of reasons but are mainly the body’s natural response to fighting an illness (less commonly a fever can indicate an adverse reaction to a medication, cancer, or thyroid conditions). There is evidence that a fever is beneficial to the body in fighting infections as some bacteria and viruses have trouble replicating in hot conditions. In nature there are a few examples of this:
Lizards have been observed staying in the sun longer and fish seeking out warmer water when ill… This implies at least that there is some degree of survival advantage in being able to develop a fever.
-Science & Evidence Based Medicine
Pretty cool, hey?
Not all high body temperatures are fevers. Hyperthermia (the opposite of hypothermia) is when the body is exposed to an external heat source and cannot cool itself down. Leaving a child in a hot car or heat stroke can cause hyperthermia.
Do You Have Fever Phobia?
On the other end of the spectrum from the chiropractor, we have those with “fever phobia.” Fevers can be frightening for parents. They’re also responsible for one-third of children’s visits to their doctor.
Fever phobia exists because of a few misconceptions about body temperature. Some people believe that the higher the fever, the more severe the illness. This is not always true.
Another misconception is that fevers can cause brain damage in children. Every normal brain has an internal thermostat that will keep a temperature from getting high enough to cause brain damage. In short, your child’s body temperature will never rise above what it is capable of handling.
The body temperatures that can cause brain damage can be attributed to hyperthermia, not fevers from illness.
A hundred years ago a fever was a huge cause for concern. But since the introduction of better sanitation and vaccines, there are very few life-threatening illnesses related to fevers. The fever phobia pediatricians see today is not necessary.
When to Treat a Child’s Fever
From the American Academy of Pediatrics:
There is no evidence that fever itself worsens the course of an illness or that it causes long-term neurologic complications. Thus, the primary goal of treating the febrile child should be to improve the child’s overall comfort rather than focus on the normalization of body temperature. When counseling the parents or caregivers of a febrile child, the general well-being of the child, the importance of monitoring activity, observing for signs of serious illness, encouraging appropriate fluid intake, and the safe storage of antipyretics should be emphasized.
In short, you treat a child for their symptoms, not for the number on the thermostat.
Even though fevers can be beneficial in fighting an illness, there are a few good reasons for trying to reduce a child’s fever. If a child is achy and miserable, is refusing to eat or drink, or is having trouble sleeping then you may want to consider a fever-reducing medicine. Remember, the goal is to make a sick child more comfortable, not return their body temperature to normal.
How to Reduce a Fever
Studies have shown approximately one-half of parents aren’t dosing children’s fever medications correctly. Always dose according to the manufacturer’s guidelines on weight, not age. Under dosing will do nothing for your child.
Acetimonphen (Tylenol and Panadol) or Ibuprofen (Advil) can be used to reduce pain or fevers in our children. Because of the risk of overdosing the American Academy of Pediatrics does not recommend alternating these medicines anymore. See this dosing chart for more information.
Other methods we use to help reduce body temperatures are:
– Dress in light clothing
– Plenty of fluids
– Lukewarm baths
– Cool (not cold) packs on necks and foreheads
Also worth mentioning – you should never wake a sleeping child to administer medicine. If a child is sleeping then he or she is comfortable. ☺
When a Fever Requires Medical Attention
Here are a few red flags to watch for when your child is sick:
– When a baby younger than three months has a fever, seek medical attention immediately.
– If your child is unresponsive, having trouble breathing, or has had a febrile seizure.
– When you’ve brought your child’s fever down with medication and they still seem seriously unwell.
– When your child has had a fever longer than five days.
– If your child has not been immunized keep in mind that he or she is at a higher risk for catching life-threatening bacterial infections.
Now we know there is nothing to fear about a fever. It’s a natural physiological response and is helpful in fighting illness. The chiropractor had good intentions but I think she missed the mark with her medical advice. Remember, a higher fever does not always mean a more severe illness. The American Academy of Pediatrics recommends treating the symptoms of a disease, not the number on the thermometer. Treating a child’s fever should be assessed on a case-by-case basis. Knowing when to take your child to the doctor requires a little intuition and common sense.