Chapter 3: Fever

BABY HAS FEVER

Infant FeverI’ll never forget one late night phone call. Barely able to contain herself, Mrs. X blurted out that Anthony’s rectal temperature was 99! Perplexed, I asked what Anthony, six years old, was doing while we were on the phone. “He’s watching TV,” she said. When I asked why she even took his temperature, Mrs. X explained “Why, I take his temperature every night!” Needless to say, Mrs. X’s fear of fever was extraordinary. However, many parents, while more relaxed than Mrs. X, still share, to a small degree, that same dread of fever. Physicians sometimes contribute to this anxiety by encouraging fever therapy around-the-clock, often involving more than one medicine every two to three hours. This fever phobia is unwarranted and can lead to harmful side effects.

Where in the world did you hear?

Fever can cause brain damage. Keep both ibuprofen (Advil) and Tylenol handy. It’s a good idea to give both. Get that fever down, fast!

Sound Advice

Relax! By the time your baby becomes a teenager, you will have dealt with more than twenty febrile (feverish) episodes, almost all without incident. The fear of brain damage from fever is unfounded. Only lack of oxygen or the most severe, life-threatening infections can damage the central nervous system, not fever.

Fever is a natural mechanism to fight infection: increased body temperature helps the body kill germs. Studies have shown that without fever, some laboratory animals are unable to survive even mild infections. It follows that excessive dosing with acetaminophen and ibuprofen may diminish the body’s natural response to fight infection. These medicines have potential side effects: acetaminophen can produce liver toxicity, ibuprofen can result in ulcerations in the intestinal tract and kidney toxicity, and using both by alternating actually increases the risk of damaging the kidneys.

Despite such dangers, many parents, and even some physicians, routinely alternate ibuprofen and acetaminophen every two to three hours no matter how high the fever. This is unwise and not in the best interests of the child. Temperature control is easily and safely accomplished using a single medication, either acetaminophen or ibuprofen, following the schedule advised on the label, along with hydration and sponging, when needed. Always keep in mind that in all cases of fever, the single most important therapy is an adequate fluid intake, since heat increases fluid loss

The Conclusion

There’s no reason to panic when your child has fever. This is the natural way his body fights germs and it won’t cause brain damage. It is important, however, to always determine the cause of the fever. While the fever, in itself, does not damage vital organs, the germs responsible for the fever may, in fact, be dangerous. The cause of all fevers should be investigated so that serious illnesses are detected and treated.

Where in the world did you hear?

Fever is dangerous because it causes convulsions.

Sound Advice

This fear is generally unfounded. Fever convulsions, called febrile seizures, occur almost exclusively in families with a genetic predisposition for this condition. In other words, if there is no family history of fever convulsions, it is less likely, no matter how high the fever, that an infant will experience such an event. As frightening as the word “seizure” sounds, the good news is that these febrile episodes are generally harmless, last less than a minute or two, and only occur between the ages of six months and six years. A myth surrounding febrile seizures is that they are brought about by very high temperatures. This is not true. Although the mechanism is not well understood, convulsions seem to be triggered by sudden shifts of temperature, often occurring at fevers no more than 101 F and rarely occurring more than once in an illness, no matter how high the fever. Some parents discover that their child is running fever only after they witness a brief convulsion.  Since these events usually occur when there is a positive family history and usually present without warning, it is futile to be a fever watch guard.

The Conclusion

Fever convulsions rarely occur unless there is a family history of such occurrences.  Children who do experience these episodes are generally none the worse for them, they are brief and cause no damage (except to the poor parents who witness these events.)  High fever, in itself, will not cause a fever convulsion.

Where in the world did you hear?

Use an alcohol rub to get the fever down.

Sound Advice

Alcohol rubs have been used for generations to attempt to cool feverish patients. This method should be abandoned. Studies have shown that alcohol cools the skin so rapidly that it causes blood vessels to constrict, diminishing heat loss and actually causing the temperature to rise! In addition, the alcohol fumes have actually contributed to temporary central nervous system disturbance in some children. Therefore, use of alcohol is a no-no. Cooling is best accomplished by evaporation of water from the skin, the larger the surface area used, the better. When a child is immersed in a tepid bath, most evaporation occurs from the shoulders on up, not a very efficient method to obtain effective cooling.

Most important, fluid intake should be adequate. No matter how difficult the task, infants should be made to drink enough fluid to ensure regular urination. If the urine is dark yellow rather than clear, it indicates inadequate hydration: more fluids should be administered.

If, after administering either acetaminophen or ibuprofen, the fever remains high, the towel wrap method should be used. This technique is very effective. Approximately 30 minutes after taking the fever medicine, the infant or child should be completely undressed. A very large towel is soaked in room temperature water and then wrung partially dry. The child is wrapped, mummy style, from neck to toes and held for several minutes until the towel feels much warmer. This evaporative method rapidly removes a great deal of heat from the patient and will usually cause the fever to drop a few degrees. It is more effective and less traumatic than using a cold bath. The towel is then removed and the patient rubbed with a dry towel and put into light clothing.

The Conclusion

Never use alcohol to lower the temperature of a feverish child. Immersing in a cold tub will help but is uncomfortable and not very efficient. The best method is the towel-wrap, as described.

Have any questions? Please contact Dr. Mesibov

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