Fevers in Children: Common Misconceptions
Crystal Run Healthcare Pediatrician, Dr. Daniel Sinyor, discusses shared misconceptions surrounding fevers in children, along with why they occur.
A fever, defined as a body temperature higher than 100.4º F, is one of the most prevalent clinical symptoms managed by pediatricians today. And, it is one of the foremost causes of urgent care and emergency room visits, as well as a frequent cause of parental concern.
Measuring a Fever in Children
For young children and infants, a rectal thermometer gives the most precise temperature reading – often more accurate than ear or forehead thermometers. Digital thermometers, used in the mouth or under the armpit, are other ways to measure a temperature in older children.
Common Causes of Fevers
A fever alone is not an illness, but is a symptom of an underlying infection or illness and is a standard body mechanism that has helpful effects in combatting infection. When a child has a fever, the body’s internal thermostat, the hypothalamus, raises the “set point” body temperature to 100.4º F or higher in order to fight the infection or illness. By the time the illness resolves, the hypothalamus resets the internal temperature to standard levels, typically around 98.6º F.
When treating a child with a fever, pediatricians will often take into consideration the duration of the fever, overall condition of the child, as well as any other signs and symptoms that may lead to an underlying diagnosis. It is important to be aware that a fever indicates that a child has a working immune system and is in combat mode, fighting the infection.
With regards to infection and illness, the most widespread causes of fever in healthy children are viruses, which typically resolve with time and supportive care and not with antibiotics, since they are never indicated for viral infections. On average, fevers caused by viral illnesses will not last longer than four or five days.
During immunizations, it’s important to note that they can occasionally cause a low-grade fever within 24 hours post-injection. For infants younger than 2 months old, a fever (higher than 100.4º F measured rectally) may indicate a more serious infection and warrants an immediate call to your pediatrician or a trip to the emergency department.
Guidelines on Anti-Fever Medication
Typically, parents are concerned with the need to maintain a “normal” temperature when their child is sick. However, a fever is not known to compromise a generally healthy child. One of the main reasons to give a sick child an anti-fever medication should be to improve their comfort during the illness. An uncomfortable child may not be as interested in eating or drinking, leading to more serious complications, such as dehydration. And, most pediatricians would agree that an ill child who is sleeping and who has a fever should not be woken to receive anti-fever medications.
The two most common antipyretic (anti-fever) medications used to lower the body’s temperature and ease discomfort are ibuprofen (Motrin) and acetaminophen (Tylenol). While there is no major difference between the two in lowering a child’s temperature, Ibuprofen is generally not recommended for children younger than 6 months of age. Both, however, can have serious side effects if a child is given more than the recommended dose. It is critical that parents understand that the dosages for acetaminophen or ibuprofen are based on the child’s weight and should check with their pediatrician or refer to the back of the medication box to determine the appropriate dose for their child. Lastly, it cannot be stressed enough: remember to keep all medications in the household in a locked cabinet out of reach of the child. Acetaminophen (Tylenol) is the single most common ingredient implicated in ER visits for medication overdoses in children.
There is no evidence that fever itself deteriorates the course of an illness, or that it causes long-term neurologic complications. Additionally, there is a misconception that high fevers, if left untreated, are associated with seizures, brain damage, and death. Febrile seizures are caused by a rapid rise in temperature—anti-fever medications do not prevent seizures in a child with a fever.
With a greater understanding of fevers, including causes, parents should feel more at ease when working with their pediatrician to provide quality care for their child during a feverish illness.
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