‘Fever phobia’ may be worse than the fever
A thermometer is the only piece of medical technology in most homes, so it’s natural for parents to take a child’s temperature at the first sign of illness. But increasingly, pediatricians are advising caregivers to think about leaving the thermometer in the medicine cabinet.
In a report published last week in the journal Pediatrics, experts cautioned against “fever phobia” and instructed doctors to do a better job of educating parents on the relative insignificance of an elevated temperature. Too many parents and caregivers react rashly to a number north of 98.6 degrees Fahrenheit and make unnecessary trips to the doctor or administer unneeded fever-reducing medications, the report said.
“It’s been ingrained in people that if you have a fever, you treat it,” said Dr. Michael P. Poirier, an expert in pediatric emergency medicine at Eastern Virginia Medical School in Norfolk, Va., who has studied caregivers’ response to fever. “But you should treat the symptoms, not the fever.”
Evidence of fever phobia is everywhere. One study found that the temperature that parents and caregivers considered to be a fever ranged from 97 to 105 degrees. Another study found that 25% of adults would give a child a fever-reducing medication for a temperature below 100.
While a fever is one sign of illness, it’s not the only sign — and often, it’s not even the most significant sign, experts say.
“More emphasis should be placed on the illness and comforting the child,” said Dr. Alan Nager, director of emergency and transport medicine at Children’s Hospital Los Angeles. “Fever is just one particular symptom.”
Not that parents can be blamed. It’s hard to resist reacting to a hot little forehead and sad, rheumy-looking eyes.
But parents just don’t appreciate that fever is the body’s way of fighting an infection, said Dr. Janice E. Sullivan, the lead author of the Pediatrics report and a professor of pediatric critical care and clinical pharmacology at the University of Louisville.
The fever is a sign that the immune system is doing its job to fight invading viruses, bacteria and other bugs. Studies in animals show that those whose fevers were not lowered with medications recovered from illness faster than animals whose fevers were treated.
“Fever decreases the ability of viruses and bacteria to reproduce,” Sullivan said. “It causes white blood cells to increase and fight infection. It may shorten the duration of the illness.”
Parents and caregivers may think it’s important to get a child’s temperature back to normal as soon as possible. In one study, 85% of parents said they would wake a feverish child in order to give fever-reducing medications. But the report urges doctors and parents to consider comfort as the main reason to provide fever-reducing medications.
If a child has a fever of 100 but is playing and eating, it’s probably not necessary to administer medication. However, if a child with a temperature of 100 is lethargic, cranky and achy, it makes sense to give ibuprofen or acetaminophen to soothe the child, Sullivan said. Parents should call the doctor if they are concerned about additional symptoms, such as vomiting, coughing or a lack of urination.
Some parents take the child to the pediatrician or family doctor at the first sign of a fever. That too is probably not necessary if the child isn’t acting very sick.
“If you bring a child to a busy office practice or the emergency room, they are at risk for getting something even worse or getting unnecessary tests,” Poirier said.
There is an important exception: All fevers in infants younger than about 3 months should be checked out because a newborn doesn’t have a strong enough immune system to fight off infections and can become seriously ill.
Babies and toddlers are more likely to run higher fevers. But, with the exception of fevers of around 105, the height of the temperature most likely has little to do with the severity of the illness.
“There are plenty of benign illnesses that can cause high fevers,” Nager said.
Contrary to popular belief, there is little danger that a high fever will cause brain damage or any other permanent problems. It can lead to seizures, but febrile seizures don’t cause lasting harm, Nager said.
The other reason to avoid fever phobia is that it increases the risk of a medication overdose.
Acetaminophen and ibuprofen — the standard, over-the-counter fever-reducing medications for children — are safe when administered in the right dosages. But recent studies show it’s hard to get the dosing right.
“We know that about 50% of parents underdose or overdose these medications,” Sullivan said. Many of the problems are due to the use of inappropriate measuring devices, such as a kitchen spoon, instead of a pharmacy-issued dosing cup, spoon or syringe.
“We want to make sure that if parents are going to use medications to reduce fever, they are using them appropriately,” she said.