April 30, 2018

Fever - the dreaded word that makes many a mother panic. When to worry is the question?

Fever is the body's natural response to an infection and is critically important in helping the body rid itself of the virus or bacterium. Warm blooded mammals have developed the ability to raise their core body temperature in times of infectious stress in an effort to kill the organism by making the host environment inhospitable through heat and also by activating the immune system.

Fever is produced when the brain's thermostat called the hypothalamus tells the body to increase the core temperature. This is achieved by releasing heat from brown adipose fat and muscle movement like shivering coupled with peripheral blood vessel constriction which keeps warm blood centrally in the core. Producing a fever comes at a great metabolic cost and is unlikely to be an evolutionary mistake.

In a nice article by Dr. Gonzalez Piaza, we see a tour through the research on fever. As quoted, "have found that suppression of fever in normal clinical settings can potentially lead to negative effects at the population-level, due to a possible increase in the spread of associated infections."

Fever is known to help shorten the length of an infectious illness. I reserve treatment of fever when my child is miserable which usually occurs around 103-104 degrees Fahrenheit. Even at 103F, if he or she is not miserable, I will let it burn helping to kill the infection. Super high fever, greater than 104F, is a marker of a potentially serious infection or cancer and requires medical evaluation immediately.

Myth - infectious fevers can cause brain damage.

The body will naturally reduce fever through sweating and blood vessel dilation when it decides that the temperature needs to go down. Hyperpyrexia, high fever, that causes brain damage is generally thought to only occur in normal individuals when they are exposed to a hot environment like a closed car in the summer where the body cannot reduce the core temperature through normal means. Infections that a typical child will contract do not cause hyperpyrexia.

Treatment is usually with cool compresses on the forehead and armpits or medically with ibuprofen primarily. I do not recommend the recurrent use of Tylenol/acetaminophen because of recent research showing adverse effects on different humans systems especially in pregnant women. Aspirin is not recommended for children under 12 years of age because of the rare case of liver disease that occurs when the flu is treated with aspirin.

My take home point today: Think of fever as a friend in the fight against infection. Read below if you want more details.

Dr. M

Fever Article Fever Article
Fever Article 2
Mayo Clinic Fever Info
Fever Article 3
Seattle Children's Hospital Myths Debunked