Get away from fever phobia

I would like to spend some time talking about fever, a topic that is extremely common and brings so much concern. I can’t tell you the number of times I have received calls not only from concerned parents with febrile children, but from concerned adults worried about their own temperature! So, lets break down some myths that leads us to fever phobia and start to feel a little more comfortable with the “heat.”

Why does fever happen in the first place?

Let’s start with basics first. Most often, in people with normal, healthy brains, a fever is a NORMAL physiologic response our bodies have to a breach in our immune system. Viruses and bacteria are very sensitive to temperatures. When our bodies notice there is an intruder in our system, it raises our normal body temperature. In this way, it supports our immune system by making our environment less hospitable. This means that viral/bacterial replication are affected by interfering with their growing and multiplying. 

Certain drugs or being exposed to extreme heat (as is the case of heat stroke) can also elevate our normal body temperature. However, for purposes of this post, we will concentrate on infectious reasons for a fever.  

As mentioned above, some types of brain injury can affect our ability to control our body temperature, or thermoregulation. The hypothalamusis the brain region that controls our temperature. If this area is damaged, body temperature may drop too low or rise too high without any reason. 

What is the normal body temperature?

Our bodies are usually held around 97.7 to 99.5 °F or 36.5 to 37.5 °C. A true fever starts when we get to 100.4 °F or 38.0 °C and we call this a low-grade fever, up until you get to 101.5 °F or 38.5 °C. I have gotten many calls from concerned parents that their child has a fever of 99.5°F. Guys, this is NOT a fever. 

How do you measure it?

The most reliable way to measure a fever is to get a core temperature. If the patient is able to cooperate and hold a thermometer in their mouths, then you can get an oral temperature. If they are very young, then you should get a rectal temperature. Either one are considered true core temperatures. 

Skin is easily affected by environmental temperature, so temporal, ear or axillary temperatures tend to be less reliable, although you can certainly use it to trend temperature and get a general idea. Unless you are in a really hot room, it would be unusual for a skin temperature to be higher than the core temp. So, if your skin temperature shows a fever, it is quite possible and likely that your core temperature is higher. 

When should you worry about a fever?

In the vast majority of the cases, as we previously mentioned, fever is a normal response to infection. There is no reason to have fever phobia. Furthermore, in most cases, the culprit will be a virus. For any virus, the only thing you can do is let it run its course. As we have discussed previously here, antibiotics work only for bacteria.

For most viruses, you should start seeing an improvement in the fever by day 2 to 3 of illness. If you see no improvement, then you should seek a medical evaluation to ensure there is nothing more serious going on. 

When should go see your doctor fast?

In a baby less than 6 weeks of age, ANY fever merits a visit to the doctor or the urgent care center. Babies don’t have well developed immune systems and they are at risk for overwhelming bacterial infection. It will most often still be a virus, but with this particular population, you just never know and they will need a full evaluation. 

Anybody feels terrible with a fever, but as the fever decreases, the patient should perk up and look better. If the patient is hard to wake up, is acting weird, seems to be having a hard time breathing or is unable to take liquids, you should seek medical assistance immediately. 

I’ve heard people seize with fever, so shouldn’t I be worried?

Let’s talk about seizures for a minute because I think a lot people worry about febrile seizures. This may very well be the biggest factor surrounding fever phobia. According to the national institute of health, febrile seizures occur in about 2-5% of the pediatric population, the majority between the ages of 6 months and 5 years. They usually last a few minutes and self-resolve without any intervention. About 40% of children who have a febrile seizure may experience another one. Who is at highest risk of having another seizure? Having a febrile seizure at an age younger than 18 months, having a family history of febrile seizures, having a febrile seizure as the first sign of an illness or those who have a seizure at a relatively low temperature increases.

Obviously seeing your child seize is very frightening, however, rest assured that there is no evidence that short febrile seizures cause brain damage.  Large studies have found that even children with prolonged febrile seizures have normal school achievement and perform as well on intellectual tests as their siblings who do not have seizures.

What about recurring seizure condition like epilepsy? 

Many people worry that a febrile seizure places their child at an increased risk for epilepsy. If your child experiences multiple or prolonged seizures, this can be a risk factor for epilepsy. However, most children who experience febrile seizures do not go on to develop epilepsy.

So, should I always treat fever?

There are a few reasons to treat a fever. First of all, most of us will feel quite terrible with a fever. So, if the person is complaining of headache and generalized body aches with fever, absolutely treat it. 

The other day my daughter was sick with a fever of 38.7 °C, but surprisingly, she was running around and playing in spite of it. That fever I did not treat. Had she been plopped in bed and feeling ill, of course I would have given her something. 

So, if the patient is uncomfortable because of the fever, treat. If your child has a history of febrile seizures, treat. Also, if the patient has epilepsy, treat because we know fever will “irritate” the brain and potentially bring on seizures. 

If the patient is comfortable and tolerating the fever, then you can totally wait it out.

How should I treat it?

Cold compresses around the neck, underarms or groin area will help. Also, lowering your environmental temperature will help. Do not over bundle or put on too many layers, even though that is what we often feel like doing with a fever. This will only bring your temperature even higher. 

You can also give medications, including acetaminophen, paracetamol and ibuprofen. Just make sure you read dosing recommendations before administering any if these.

And there you have it

Fever is most often a normal physiologic process and we don’t have to be stressed out over it. I hope this will help you keep fever phobia at bay. Just make sure you look out for any of the warning signs we discussed, stay hydrated and rest. 

Till next time,