I have written about fever in the past. It is such a common symptom yet there seems to be misunderstanding, so I wanted to talk about it again. To review, fever is not an illness; it is an indication that something is not right in the body. It is the body’s response to some problem, most commonly an infection.
Fever can be treated for comfort and monitored. It is not necessarily an emergency. However, a fever that is persistent and associated with trouble breathing, persistent vomiting, or decreased responsiveness should be evaluated promptly. Also, a fever in an infant less than 3 months old should be immediately evaluated. In addition a fever in an elderly individual or someone with chronic medical problems is more likely to be serious.
The body temperature is regulated by the central nervous system to a fairly narrow range. Normal temperature is considered to be 98.6. A fever is a temperature over 99.9 degrees Fahrenheit. Chills and shaking is usually a sign the temperature is going up and sweating is often a sign the temperature is decreasing. During an illness the temperature can vary several degrees within hours so measuring more than once is advisable.
It is important to keep a device at home for measuring temperature. A thermometer to measure rectal temperature in children is considered most accurate. But temperatures can be measured in the mouth or under the arm. In addition devices measure the temperature on the skin of the forehead or in the ear. It will help your provider and it will help improve the patient’s care if the temperature is measured rather than just feeling to see if they seem hot. It is best to report the exact reading and how and where the temperature was measured.
Fever in children is due to a viral illness the of the time. Children can tolerate high temperatures (it is not uncommon to see temperatures up to 105 in children) since they can compensate for rapid heart rates and the relative dehydration that accompanies fever. Children who have had their vaccinations are much less likely to have a serious bacterial infection.
Fevers can be treated to relieve the associated symptoms but the elevated temperature is not dangerous and does not have to be treated. Tylenol (generic is acetaminophen) and or ibuprofen are generally effective. Ibuprofen may be a little more effective but Tylenol is easier on the stomach. Tylenol does come in a suppository form if the child cannot take it by mouth. Tylenol is dosed at 10-15 mg/kg and ibuprofen 10 mg/kg and they can be used together or alternated if the fever is causing significant symptoms.
The old saying “starve a fever and feed a cold” is generally good advice. Fever produces an uncomfortable feeling because the body does not function as well when it is too hot. This is often associated with nausea and vomiting so eating is not advised. However, hydration is important since the body loses more fluid when the temperature is elevated. The best way to maintain hydration is to take small amounts (1-2 ounces) of easily absorbed liquid (like Gatorade or Pedialyte) every 1-2 hours.
Fever is a sign that something is not right. Children with fever should stay home from school or day care, rest, take liquids and use Tylenol or ibuprofen if needed for symptoms. Persistent fever especially associated with lethargy or difficulty breathing should be evaluated. Stay healthy my friends.
By: P. Michael Shattuck, M.D. – Community Health Network Family Physician
