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When to Treat a Child's Fever

Posted Mar 09 2011 2:45pm


There's nothing like fever in a small child to send a parent into panic: Run to the medicine cabinet, call the pediatrician, head to the emergency room. I know because--as the parent of two girls--I've been there and I've done that.

But it turns out that fevers may not be all evil all the time, according to a clinical report from the American Academy of Pediatrics. The report points out that the number on a thermometer is just a number and not necessarily indicative of the severity of a child's illness. The goal of treating a fever should be to make the child comfortable rather than getting body temperature down to a certain number, the report concluded.

The take-home message for parents: Don't worry so much about the temperature, says Robert Harrison, M.D., MPH, Ph.D. "It's not the fever--it's what the child looks like." Harrison, who was not involved in the report, is an infectious disease specialist at Children's Healthcare of Atlanta and a pediatrician at Sandy Springs Pediatrics.

The report, published in the March 2011 issue of the journal Pediatrics [PDF], notes that fevers are responsible for up to a third of all doctor visits and that many parents are "concerned with the need to maintain a 'normal' temperature in their ill child."

But there are several problems with that approach. The first is that there is no "normal" - the body's temperature can fluctuate throughout the day. Harrison says he's seen perfectly healthy kids with temperatures over 100 degrees after they've been running around on a warm day. Also, some parents start giving the child medicine when there is a minimal fever (under 100.4 degrees).

"It is very variable what people consider a fever," Harrison says. "Everyone has their own threshold. Anything over 102 degrees--you should pay attention to that."

Fever--which is a symptom of illness, not an illness in and of itself--can actually help the child fight off infection. And contrary to many parents' fears, there's no evidence that fevers worsen the course of an illness or lead to long-term neurological complications in otherwise healthy kids.

Finally, in their efforts to reduce body temperature to a "normal" level, parents often do the wrong things. As many as half of parents give kids the wrong dose of fever-reducing medicine. Doses should be determined by weight not age, and medicine should be measured with a proper measuring device and not any old spoon.

Parents also wake sleep children up to give them more medicine--but most pediatricians surveyed believe that a sick child who is sleeping should not be awakened solely to be given a fever-reducer.

The most common fever-reducers are acetaminophen and ibuprofen, which when used as directed are considered safe for otherwise healthy children. Some pediatricians recommend alternating between the two, but the report notes that even though combination therapy can be more effective, it could put children at risk for dosing and timing errors.

In addition to making sure their child is comfortable, parents should also make sure that child is well hydrated. And parents also need to look out for serious illness. "You're looking for lethargy, a child who is not as responsive as normal, not making eye contact, a child who is really sick (with symptoms) like severe vomiting," said Harrison.

There are times of course when a fever is cause for alarm. An infant younger than three months with a fever of 100.4 degrees or higher should be seen by a pediatrician. And a parent should also trust his or her gut. If you feel something is not right, get it checked out.

The only time I hustled my child to the ER was when she spiked a fever of 104 degrees (inching towards 105 degrees!) that would not go down with medicine. She also looked and acted like a soggy mop. Turns out she had a double ear infection. Mommy felt vindicated and not crazy over-protective.

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