Dr. Eisenbergs’s words:

WHAT FEVER MEANS IN CHILDREN AND WHAT TO DO WITH IT:

Fever is a symptom of an illness and often frightens parents due to misconceptions and controversy surrounding it.  The anxiety is also heightened when parents are unsure about what to do with it.  In this article, I will try to allay any fears and straighten out what fever is and what to do about it in as simple of a way as possible.

What is fever?

Most people have normal temps between 97 F and 99.4 F degrees although most people run 98.6 degrees.  Kids though tend to run slightly warmer than adults. If they have been running around, drinking hot fluids, overwrapped, or in a warm room the temps can also be affected. The late afternoons tend to have higher temps and early morning the lowest temps.

Fever is only one indicator of the illness so don’t just rely on the fever to see what is happening with your child. Kids less than 8 and especially with infants , the fever is not an accurate indicator of how severe the illness is in your child.  An infant can actually be very ill with subnormal temps ie less than 97 or a 6 year old with a 104 and running around and active can be with just a mild illness. I always ask my parents to see how they are acting , eating  and what their activity level is. If that is out of the ordinary for them then it is recommended to call us.

What causes fever?

Infections from bacteria, viruses and parasites are the most common causes of fevers. But, there are many causes of fevers besides from an infection. Other possibilities include allergies, JRA(arthritis), vaccines, medications, dehydration, cancer and tumors and teething.

During an infection, the organisms cause the body to release white blood cells which then secrete endogenous pyrogens into the bloodstream. The pyrogens then stimulate the hypothalamus in the brain to re-set the thermostat of the body to higher temperatures.  The body begins to shiver and increase its metabolism to heat up the body. The fever also gets the child to finally rest by making them fatigues so again the body can use the rest to help healing.   To prevent heat loss the pores and capillaries on the skin’s surface shut down causing a cold pale surface.

Why fevers ?

The body needs the higher temperatures in order to help fight off the infection.  The body uses the fever to increase the White blood cell release and a natural anti-viral and anti-cancer substance called interferon.  The fever in itself also helps to keep the number of viruses and bacteria down by interfering with their replication.

What to do now ??

First , don’t panic !! Remember that a moderate fever is there to help your child. Suppressing the mild  fevers with drugs like acetaminophen or ibuprofen  will be actually making it harder for your child’s body to fight off the infections by it’s natural mechanism of fever.   As long as it is mild and last less than 4-5 days and your child is looking well and active with a good appetite and urinating well then push fluids and rest. Call our practice to speak to the nurse or doctor if you are unsure what to do but I will explain more below.

Remember that the fever reducing drugs such as acetaminophen, ibuprofen and aspirin may make the infections worse by weakening the fever.  But, at times the child is listless and complains of symptoms like a headache and you may want to give the child some relief.

Initially , I will try a home or natural approach with bathing, pushing fluids by mouth and rest. Put the child in a  tepid (warm) bath  for 5-10 minutes.  The warm bath will help the pores and blood vessels of the skin to open and allow the warmth out  to lower the temp. This will help the temp even out and make the child more comfortable.  Do not use ice or cold baths. This only will  further close the capillaries of the skin and bring the bodies core or central temp higher while making your child even more uncomfortable.  Also push fluids frequently. The smaller the sips the most frequently to give because the fevers will often cause the child to refuse fluids. They need fluids though so they don’t get dehydrated. If your child is not hungry for food then don’t worry because the body mostly just needs plenty of fluids.  If your child complains of being too hot then let them dress lightly and throw off the sheets and covers. If they are cold with the chills , give warm fluids and bundle with breathable blankets. Again , let them be the judge of the number of layers over them.

Over the counter remedies ?

If your child has mild to moderate fevers and appears well hydrated and active then you may try over the counter or OTC medications on the form of herbs , homeopathics or drugs. We still recommend the bathing and fluids first  but if the fever is interfering with the sleep, feedings  or activity you may try OTC’s first before calling your pediatrician.   The child can get herbal or homeopathic supplements at the health food store or prescribed by our practitioners after your child has been seen. Other initial options are OTC antipyretics. These include acetaminophen and ibuprofen. They are found over the counter at most pharmacies. The dosage is indicated on the bottles. We do not recommend any Aspirin  for any children or teenagers though.  The acetaminophen or ibuprofen will help to bring down the temps in order for your child to feel better and drink or sleep. Your child will then need to be followed up soon by a medical practitioner depending on the severity o  I always recommend these above home options first for mild to moderate fevers and the children look well. Some fevers can do harm. During high or prolonged fevers, the body loses water and sweat along with burning up of  Vitamins such as Vitamin C. Your child is prone towards dehydration and vitamin loss. If the temp goes up or down too quickly a febrile seizure can occur. Fevers over 106 can be harmful to the tissues of the brain or heart if prolonged.  If the child’s temp still does not come down or is over 104 and the child is irritable or won’t drink or sleep or has a headache then more aggressive therapy and medical intervention may be needed. If your child is less than 3 months with any temp over 100 degrees or less than 97 degrees then seek immediate medical help. This could be a sign of a severe medical illness such as sepsis or meningitis.

I always recommend these above home options first for mild to moderate fevers and the children look well. Some fevers can do harm. During high or prolonged fevers, the body loses water and sweat along with burning up of  Vitamins such as Vitamin C . Your child is prone towards dehydration and vitamin loss. If the temp goes up or down too quickly a febrile seizure can occur. Fevers over 106 can be harmful to the tissues of the brain or heart if prolonged.  If the child’s temp still does not come down or is over 104 and the child is irritable or won’t drink or sleep or has a headache then more aggressive therapy and medical intervention may be needed. If your child is less than 3 months with any temp over 100 degrees or less than 97 degrees then seek immediate medical help. This could be a sign of a severe medical illness such as sepsis or meningitis.

So, Fever is good and usually can be treated with mild means:

Observe your children well. If they are active, playful , drinking well and urinating at least every 6-8 hours then that is a good sign. If they can be consoled when irritable then good too.  If they deviate from this after getting  the fever down and still don’t look good then notify your pediatrician.

When home remedies won’t cut it-

I always recommend these above home options first for mild to moderate fevers and the children look well. Some fevers can do harm or be a sign of a more serious illness. During high or prolonged fevers, the body loses water and sweat along with burning up of  Vitamins such as Vitamin C . Your child is prone towards dehydration and vitamin loss. If the temp goes up or down too quickly a febrile seizure can occur. Fevers over 106 can be harmful to the tissues of the brain or heart if prolonged.  If the child’s temp still does not come down or is over 104 and the child is irritable or won’t drink or sleep or has a headache then more aggressive therapy and medical intervention may be needed. If your child is less than 3 months with any temp over 100 degrees or less than 97 degrees then seek immediate medical help. This could be a sign of a severe medical illness such as sepsis or meningitis.   Whenever the fevers are prolonged over 5 days ,   associated with any aged child with symptoms such as  severe headaches, stiff neck, severe abdominal pains, vomiting, poor intake of fluids  or output of urine, irritability that can’t be consoled or severe weakness and fatique then immediately consult your pediatrician.

This explanation is meant to  summarize but not treat your child’s fevers. Please feel free to consult us with any questions.

Dr. Perlman’s words: