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Most Child Fevers Not Dangerous, Studies Say

THE WASHINGTON POST

A feverish child languishes beneath the covers. Anxious family members huddle around the bed. The cold sponge bath is ready. Liquid cherry Children’s Tylenol has been poured.

It could be a Norman Rockwell portrait of human compassion, family ties and feelings of helplessness.

It’s also needless. Childhood fevers, for the most part, are not dangerous, according to dozens of medical studies conducted in the last 20 years. Most doctors now believe that fevers don’t even need to be treated. In fact, there is growing evidence that fever may actually speed recovery.

“We have a fever phobia in this country,” says Patricia D. Fosarelli, a pediatrician at Johns Hopkins University School of Medicine. “Anytime a child has a fever, parents want to treat it immediately. I just wish parents would not get so excited over low-grade fevers.”

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Fevers are ubiquitous. Every man, woman and child gets them--though fevers strike adults less frequently. They are most scary in children; sometimes they can signal a serious underlying disease, and in a child younger than 3 months, a doctor should be called immediately. But most fevers that affect children come from garden-variety viral infections that go away by themselves. Their temperatures range from 101 Fahrenheit to 104 and persist for two to three days. Doctors do not consider a fever “high” until it reaches 105 degrees.

Attitudes about fever are changing for a number of reasons. To begin with, studies of hundreds of feverish kids have shown few to be seriously ill. William A. Tomlinson, a pediatrician from the Children’s Memorial Hospital in Chicago, reviewed the records of 1,500 children with fevers and found that only 108 had fevers of 104 degrees or above. These children also had sore throats, ear infections, bronchitis, pneumonia and urinary tract infections that were treated with antibiotics. The rest of the patients had minor viral infections for which there is no treatment.

In addition, certain treatments have been linked to potentially dangerous complications. In the past, overeagerness to reduce fever with aspirin led to the side effect of Reye’s syndrome, a sometimes fatal swelling of the brain. Now, most physicians recommend against using aspirin for children, and if drug therapy is needed, order acetaminophen, the active ingredient in Tylenol, which has not been associated with Reye’s syndrome.

Yet physicians who do treat fever may be more likely responding to parental fears than to scientific studies. “In the short term, (treating the child) avoids the problems of parental distress,” says Paul J. Mankus, an assistant professor of family medicine at the Medical College of Wisconsin in Milwaukee. “It makes the patient more comfortable while (the physician is) sorting out the cause for the fever.”

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Fever phobia runs deep. More than half of the parents in an often quoted survey from 1980 erroneously believed that a fever of 104 or less could cause permanent brain damage. Some 85% gave fever-reducing drugs before temperatures reached 102, and 68% gave their children sponge baths before the fever reached 103.

But fevers only become harmful when they start reaching 107 degrees. Unless the child has severe brain damage from a trauma or a serious brain infection such as meningitis or encephalitis that damage the brain’s ability to control temperature, the body doesn’t allow the temperature to rise that high.

Fever phobia, says Barton D. Schmitt, a pediatrician at the University of Colorado School of Medicine in Denver and author of the 1980 survey, is the propensity of “many parents to panic with everyday harmless fevers that are in the normal range of 100 to 104.”

In general, a fever is the first sign that the body is attacking an infection. All vertebrates have developed a means of raising body temperatures, placing the evolutionary origins of fever back some 300 million years.

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Research also suggests that old-fashioned warnings about keeping out of a cold draft might not have been that far off base. Cold temperatures can lower the body’s core temperature from 1.6 to 3.2 degrees, enough to give some infectious organisms already in the body or being inhaled into the nose a chance to take root and grow.


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