Fever: Treat the Kid Not the Number

Fever phobia is one of the most challenging “medical misunderstandings” we encounter. A seminal paper published in 1980 found that parents thought fever could harm their children. Parents believed fever caused brain damage, convulsions (which, we assume, means seizures…), hearing loss, and even blindness. 

Parents don’t still believe today, right? Wrong. We still get questions like:

• “At what temperature should we go to the ER?” 
• “What temperature causes brain damage/seizures/etc.?” 
• “At what temperature does the brain boil?”

The medical community as a whole may be partially responsible for this phobia. One of the first questions we ask parents is, “Does your child have a fever?” Discharge instructions nearly always say to contact someone if a fever develops. One of the first vital signs we check is temperature, and then we immediately medicate it. So, we get it. We put a lot of importance on body temperature. However, at KidMed, we make an effort to spend time during visits to educate parents and caregivers about fever and to help reduce fear.

Let’s shed some light on the subject.

What is normal body temperature?

The muscles and liver generate most body heat, and the lungs and skin release most heat. And the hypothalamus (part of the brain) is the overseer of the process. 

The average normal body temperature is 99.9 degrees. Not 98.6, which is from an outdated study from the 19th century. Normal body temperature varies with age, time of the day, activity level, and menstrual cycle phase, among other factors. Infants and young children generally have higher temperatures than older children and adults. The lowest body temperature is usually in the morning, and the highest is at night. This temperature cycle exists when you have a fever.

What is fever?

Fever is an abnormal body temperature elevation that happens in response to infection. It is controlled by the central nervous system. Germs and immune system cells release chemicals that tell the brain to raise its “set point.” As a result, the hypothalamus goes from being comfortable at 99.9 (previously known as 98.6) to something higher than 100.4. At this new, hotter brain set point, the rest of the body is tricked into thinking it’s cold. So, blood vessels get smaller to prevent heat loss, and muscles shiver to generate heat. Eventually, all of this heat saving and generating heats the body up.

The Pros:

Fever slows germs down and boosts the immune system. This is because viruses and bacteria don’t grow and reproduce well at elevated body temperatures. The immune system fighter cells function better at elevated body temperatures.

The Cons:

The tipping point seems to be 104 degrees. Fever is uncomfortable and increases the demands on the respiratory and cardiovascular systems. At 104 or higher, the benefits no longer outweigh the stressors.

The Takeaways (for otherwise healthy children):

1. Fever is a normal response of the immune system to infection. It is defined as 100.4 degrees or higher. Even if you feel your body temperature is lower than average, 100.4 is still the cutoff.
2. Fever is a sign of an underlying illness, is not harmful, and is not cause for alarm. Fever is just one piece of the whole puzzle.
3. Not every fever requires acetaminophen and/or ibuprofen. It is more important to treat a behavior than to treat a number on a thermometer. If your child is uncomfortable, treat the discomfort. If your child is slower than usual but otherwise fine, please don’t give them medications just because a thermometer says they have a fever.
4. Sharing how high the fever got or whether the temperature went down after giving medications does not tell us if a virus or bacteria caused the illness.
5. You do not need to wake your child to give them medications, and you definitely don’t need to check their temperature every hour. Just observe. If they’re uncomfortable, then do something.

We know fever is scary when it’s your own child. We get it! Many of us at KidMed are parents and can still worry when one of our little ones has a fever. Sometimes just reframing something scary like a fever makes it more manageable. 

If you do need to give your child acetaminophen and/or ibuprofen, use our dosing chart to be sure you give your child the correct dose for the their age and weight. 

Remember, KidMed is here if you need us!