Fever gets the attention of moth- ers. Most moms know it the moment it starts in their infant. It’s a generally little known fact that women can identify temperature change much quicker than men. When it’s measured by their kiss on the cheek of the baby, it can be less than a degree from normal but it is picked up as sure and fast as any high tech thermometer. Fever generates pa- rental fear. As an indicator of illness it is a pretty good sign, but as a measure of how severe the illness causing the fever, it is just not very accurate.
For example, I have seen children who were extremely ill and in septic shock with very little temperature elevation. I’ve also seen many more that were not really very sick but had very high fevers. I consider 104 a high fever but that doesn’t always mean that a child has a dangerous illness. The virus that causes Roseola is pretty innocuous and gives babies temperatures in that range for three full days! Fever in an infant less than two months however, no matter how high, can be a sign of a life-threatening illness. That situation really qualifies as an emergency. Fever, in children can actually be a good thing; it turns out that the fever associ- ated with the first few days of influenza can actually slow the replication of that virus and may even improve the course of the illness. Still, I get concerned when fever returns after it was normal- ized and the family thought the child was getting better. This can be a sign of pneumonia that so often follows a few days of Influenza.
Fever in children can cause abnormal changes, like delirium and con- fusion. As a rule, for every degree of temperature elevation, the child’s fluid requirements will rise by almost 15 %; that can be a problem if they have a vomiting and diarrheal illness. Some- times it takes a liter or two of IV fluids in the Emergency Department, to get control of fever. We don’t treat fever as aggressively as we used to, the goal is to make the child more comfortable, not to get the temp back down to 98.6.
Ibuprofen seems more effective as a fever reducer than acetaminophen, it acts quicker and lasts longer but it’s hard on the infant kidney and is therefore never used under 6 months of age or in chil- dren with kidney disease or high blood pressure. Acetaminophen only lasts 4 hours and it is much easier on the stom- ach than Ibuprofen. After a day or two on a steady diet of ibuprofen, the child will sometimes develop stomach lining irritation and may even vomit blood, so I prefer alternating the two fever re- ducing medications as often as every 3 hours if necessary.
Dosage is sometimes tricky since the amount is based on the child’s weight and is slightly different for each drug, but fortunately with the standardiza- tion of the liquid concentration the liquid volumes of each drug are roughly the same. In this digital age the correct dose is only one or two Google clicks away but it still my experience that most mothers under dose. Many nights it’s simply just giving the correct dose that lets everyone can get back to sleep.
One of parent’s greatest fears is Fe- brile Seizures; this effect of fever is common and will be covered in depth in another edition. Two things to con- sider, it often happens at the very be- ginning of an illness, even before the temperature is but one degree above normal and, as frightening as it looks to parents, it usually is not causing any injury. It will be brief and the child will outgrow this tendency. Still it is another good reason for a professional evaluation that same day.
Fever going up causes chills and fever going down brings on sweats in both adults and children. Even after the effective treatment is started, fever can stay high for another 12 hours, so there is often is a 12 delay before we know that the treatment is effective. Fever is a sign of illness, like loss of appetite or nausea or unusual fatigue. The real question we need to answer is, “what could be the cause”?
Michael R. Jordan, MD, CPE, FAAP, chief of Pediatrics of Newark-Wayne Community Hos- pital is board-certified in Pediatric Medicine. He attended the College of Human Medicine at Michigan State University and completed his residency training at the University of Roches- ter. In addition to his leadership role as chief of Pediatrics at Newark-Wayne, he is the medical director of Rochester Regional Medical Group (RRMG) and is also chair of RGMG’s Quality Committee. He works in the Sodus Rochester General Medical Group Pediatric office. To send questions on children’s health, please email Wendy Fisher, Pediatrics’ Practice Man- ager at wendy.fisher@rochestergeneral.org and write “Ask a Doc” in the subject line. To schedule an appointment, call (315) 483-3214
