Fevers: Why I Usually Don't Treat Them, and What to do Instead
Fevers are a hot topic to parents who call for advice at my clinic. I remember when my kids were babies and they got their first fevers. I was, admittedly, alarmed! So as you read on, please know that I completely empathize with any fears parents have about fevers.
Once you understand more about fevers, however, you realize they are usually not all that scary. It's true, your child will feel bad, and that always difficult to see. We, as parents, are there to make our kids feel better. It's our job! But, there are times when letting them ride a fever out (within reason), may be better for our child than using the quick fix and reducing the fever.
This is how a conversation often goes when a parent calls about a fever:
"Little Johnny, age 3, got a fever last night! He woke up crying, and was burning hot to the touch. His temperature was 101, so I gave him Tylenol. He felt better and went back to sleep, but then the fever came right back when the Tylenol wore off! Every time I give the Tylenol, the fever comes down, but then it just keeps coming right back. What should I do?"
Note that the parent has a tool to use to make their child feel better, so, naturally they use it. But, the parent has a misguided belief that the tool (the Acetaminophen) is going to somehow "cure" the fever, so they get upset and think there is something wrong when the fever comes back after the Acetaminophen (or Ibuprofen) wears off.
If this is you as a parent, don't feel badly at all. It certainly was me when my kids were younger! My job, as the RN, is to educate the parents I talk to about fevers, and I want to do the same for you. By the way, the same information applies to adults when they get fevers!
What is a Fever?
A fever, quite simply put, is the body's immune response to an illness. The fever is not the illness itself. Most commonly, it is in response to a new virus coming on. I like to think of the fever as the body "cooking" the virus; that is, making conditions less favorable for the virus. There is more to the immune response, of course, including the body's immune cells going to work and the production of antibodies, when a virus (or bacteria) is present, but the fever can be a part of that immune response.
More specifically, a fever enables the body to increase its production of interferon, which is an antiviral substance that is so vital in fighting infection. In addition, fevers increase production and activity of white blood cells, which are a huge part of the immune system, and, the body's ability to fight infection.
When we shut the fever down, in essence, we are shutting down part of the body's immune response to the virus! Shutting the fever down can actually extend the length of the illness, and, even worse, leave the body open to additional complications of illness. Of course, there are times when fevers should be treated, and we will get to that.
Also, when we give Acetaminophen or Ibuprofen, the body has to metabolize them, which takes up energy that should be used to fight the illness. Remember that with Acetaminophen and Ibuprofen, there is always risk of liver and/or kidney damage!
Fevers DO make people feel pretty uncomfortable, sometimes even downright miserable. Keep in mind, though, the child is sick, and if we mask the fever and the child feels much better, they may not want to rest like they should!
So, to recap:
Fevers are a beneficial, and even vital, immune response to an illness.
Fever reducers are not without risk.
Fevers help the sick person to slow down and rest, as they should, during illness.
When the Fever is Usually Safe to Watch At Home
Fevers in a specific range are usually OK to watch, as long as the following conditions are being met:
Your child is over 12 weeks old. Any infant under 12 weeks, with a fever of 100.4 or higher, needs immediate evaluation! Call your doctor. They will either recommend an immediate office visit in this situation, or recommend the ER.
The child is alert and responsive. It is normal for a child to be tired and less energetic when a fever is present. They may take extra naps, even. As long as your child is responding appropriately to you, and able to get up and go to the bathroom, for example, then being more tired is OK.
The child is not inconsolable. It is normal for a child to be more fussy or irritable when a fever is present. But if your child is completely inconsolable for 2 hours or longer, then he or she should be evaluated by a medical professional right away.
The child is well hydrated. Hydration helps the body fight off illness as it should, and fevers can cause the body to lose fluid more quickly. Encourage lots of clear fluids (for an infant, breastfeed or bottle feed on demand). Your child should urinate at least every 8 hours, and if they cry, they should have tears. The inside of the mouth should be moist, not dry. If your child starts to become dehydrated, he or she should be evaluated right away.
The fever is below 105. If a fever is 105 or higher, seek medical attention, as the risk for bacterial infection is higher at this point.
Your child is not having difficulty breathing. This should go without saying, but actually, there is some confusion about breathing and fevers. It is somewhat normal for the rate of breathing to increase a bit with a fever, but significantly increased breathing rate and/or any difficulty breathing should be evaluated immediately. If in doubt, always call your health care provider!
Isn't a High Fever Dangerous?
In my clinic, we recommend watching a fever (without reducing it) from 100-102. Our protocol states that fevers 102-104 can be monitored without reducing, unless the child is very uncomfortable.
I am comfortable monitoring a fever without reducing it from 100-103. From 103-104, I would ideally monitor it without reducing it, unless in the case of bacterial infection, heat stroke, or poisoning/exposure to toxins. If any of these issues were suspected, I would just recommend the child be immediately evaluated by a qualified medical professional.
There is some concern about Febrile Seizures, and rightfully so. Always follow your doctor's recommendations if your child has had a Febrile Seizure, but rest assured that febrile seizures do not mean your child has epilepsy, nor do they typically cause brain damage.
As previously mentioned, a child with a fever of 105 or greater should be evaluated by a medical professional right away. I would, personally, definitely treat a fever that high (or higher) with a fever reducer. Fevers over 107 are concerning for causing brain damage, so never allow a fever that high to go untreated and/or unevaluated.
What CAN We Do for Fevers?
We want the immune system to respond properly to an illness, and we want a child to rest when he or she is sick. But, there are things we can do to keep them more comfortable.
Push fluids. As previously mentioned, fevers can cause more rapid fluid loss, and good hydration helps the body to fight illness off. Make sure your child sips on clear fluids often throughout an illness. My favorites are water and coconut water. I like to add a pinch of sea salt to an 8 oz glass of coconut water, as well.
Apply a cool cloth to the forehead. Get a clean washcloth wet with cold water, squeeze it out, and apply it to the child's head/forehead. This really does offer relief and helps to bring a fever down a little bit. If your child complains of being too cold, simply remove the cloth.
Lukewarm baths. It's OK for your child to take a lukewarm bath, and it can be very effective at reducing a fever to a more comfortable level, without suppressing it. If your child starts to shiver, it's time to get out of the bath.
Peppermint Essential Oil. Applying diluted peppermint essential oil to the forehead, temples and back of the neck provides a cooling effect.
When to Have Your Child Seen
ANY fever 100.4 or higher in infant less 12 weeks old or less. In this case, our clinic recommends taking your baby to the Emergency Department of the hospital (or at the very least, an immediate appointment in the primary care provider's office).
For a child age 3-6 months, it is recommended they be seen by a primary care provider for a fever 102 or higher.
A child age 6-24 months with a fever 102 or higher for greater than 24 hours, AND with no other symptoms (such as cough, cold, vomiting, diarrhea, or other), should be seen by his or her primary care provider.
The fever, 100.4 or higher, has been present for more than 72 hours. Some viral illnesses can cause fevers for longer than 72 hours, but there is an increased chance that the fever could be caused by a bacterial illness if it has been present for greater than 72 hours.
The fever (100.4 or higher) returns after being gone for 24 hours or more. This is another instance in which there is an increased concern for a possible bacterial infection.
Fever 105 or greater. I recommend calling your medical provider in this situation and getting a recommendation as to whether your child should be seen in the office, or go to the Emergency Department of the Hospital.
Difficulty Breathing. In this case, I also recommend calling your child's primary care provider to be seen in the office right away, or just taking your child to the Emergency Department of the Hospital, depending on the severity of the issue.
Fever with Stiff Neck, and/or Severe Headache. These are concerning symptoms that need immediate evaluation.
Suspect Poisoning or Toxicity. Again, immediate evaluation is necessary in this situation, likely in the Emergency Department. Poison Control is a great resource, as well, for suspected toxin ingestion or exposure.
Reassurance. As a pediatric RN, I tell parents all the time: If you think something is off, schedule an appointment so we can evaluate. This can be so reassuring for parents!
Strengthening the Immune System
Getting sick is always a bummer. And, I am so aware of how helpless we feel, as parents, when our children are sick! I think of the immune system as something that needs to be utilized in order to become stronger. Like lifting weights for the muscles to get stronger! All of this, of course, is within reason. I do not expect anyone to constantly be sick, but, once in awhile is normal.
If no immediate concerns have been identified with your child's immune system, but you are interested in taking measures to strengthen it, check out this post on Building Strong Immune Health.
I hope some of your fears about fevers have been alleviated! What has been your experience with fevers in yourself or your children?
Disclaimer: I am not a doctor. Always be sure to call your primary care provider, or other medical professional, if you have concerns. Proceed with caution, and do your own research!