What every parent must know about fevers.

Disclaimer: I am not a medical doctor. Nothing in this post constitutes medical advice. When your child is sick or has an fever, you should always consult with your doctor. I have my doctor on speed dial and consult with him regularly during all sicknesses. The following post is not to be used to treat or diagnose your child, it is simply to further your understanding of the topic so that when your doctor tells you not to worry, you will understand why not to worry.

Fevers Save Lives

For years now, you’ve heard crunchy moms saying that fevers are good for sick children. You’ll hear, “Don’t give a fever reducer, a fever is a good thing! It fights the infection!”

Our bodies fight infection in a number of ways. One way is through fevers.  For example, according to the Society for Healthcare Epidemiology of America,  MRSA can not live in a climate that is 104 degrees.

In a paper called Clinical Report—Fever and Antipyretic Use in Children which was published by The American Academy of Pediatrics doctors explain that fevers themselves really are not dangerous:

 “Fever, however, is not the primary illness but is a physiologic mechanism that has beneficial effects in fighting infection. There is no evidence that fever itself worsens the course of an illness or that it causes long-term neurologic complications.”

What about a VERY high fever?

I hear from moms all the time who say, “Well, I don’t give Tylenol for a low grade fever, but a fever that gets to 104, I most certainly do. Those are dangerous!”  Well, I certainly suggest you call a doctor when your child has a high fever, but if he’s up with his science, he probably won’t suggest you do anything (provided the child is able to be awake, take in liquids and urinate) besides keeping a watchful eye on your child and let them know if anything changes.

Meningitis, while extremely rare, will always be taken into consideration by a pediatrician, and he will ask you questions to rule this out immediately. Prompt, persistent and continued communication with your child’s doctor in the event of high fevers will ensure you know what to do and when to do it. Here’s the thing, in a situation of Meningitis, Tylenol is not going to help your child’s outcome.

Just like those crunchy moms have been saying, the study went on to explain:

“Studies of health care workers, including physicians, have revealed that most believe that the risk of heat-related adverse outcomes is increased with temperatures above 40°C (104°F), although this belief is not justified. A child with a temperature of 40°C (104°F) attributable to a simple febrile illness is quite different from a child with a temperature of 40°C (104°F) attributable to heat stroke. Thus, extrapolating similar outcomes from these different illnesses is problematic.”

The only time the AAP’s paper suggests it could be wise to give a fever reducer is if the child’s fever has made them so uncomfortable that they refuse to drink liquids and then run the risk of dehydration.

But, Fevers Can Cause Seizures

Yes, that is true, but these seizures that are sometimes caused by fevers are called febrile seizures. While I would probably need anxiety medicine and be scared out of my mind also if that happened to my child, simple febrile seizures  themselves do not cause brain damage. There is no medical evidence that simple febrile seizures from a fever can cause death, brain damage, epilepsy, mental retardation, a decrease in IQ, or even learning difficulties. This doesn’t mean you can just blow them off, even febrile seizures warrant a trip to the ER for sure, but only to make sure that the seizure is not being cause by something life threatening, not because the seizure is itself life threatening. A fever induced seizure is just the brain responding to a change in temperature (either rising or dropping) that is happening rapidly.

Body temperatures above 108°F (42.2°C) can cause brain damage, but our brains have a shut off mechanism below that for this. Remember, fevers are a deliberate defense mechanism in our bodies. They are not tools of the infection, they are weapons against it. Fevers can only go this high with high environmental temperatures like being locked in a car in the summer or when in extreme heat. A fever is not heat stroke. A fever is your baby’s body’s first line of defense.

Let’s put it very simply in terms of the flu…

The simplified version of the normal progression of the flu goes like this: A virus enters the mucous membranes of the lining of our lungs. The virus hijacks cells, entering them and replicating themselves. The cells burst open and the viruses use the coating of the old damaged cells as a cloaking device. This is why viruses are sneaky. To the body’s immune system the new viruses simply appear to be pieces of the body’s own lung tissue.

Viral Replication 101

Viruses don’t reproduce, they replicate using our cellular DNA to do it. Once a replication is complete, that molecular chain gets released to repeat this process over and over. Here’s the thing though, at the end of these chains are little electrically charged switches that cause this “Be fruitful and multiply!” moment to occur. When the copy is complete for that virus, the electrical charge on the “switch” changes and the virus releases and repels the copy of itself. This process can take less than a second.  Within 72 hours, the viruses can go from one or two virus bodies to millions or billions. Here’s the thing though… that “switch” is temperature sensitive. And guess what? The body sees that its own cells are damaged and doesn’t want them to be able to make new ruined cells, so it creates a fever. That’s the very simplified version of things in a way that I think most people can understand. There’s a bunch more that goes into how/why the body gets rid of cells, but that’s the easiest way I can explain it.

The virus simply can not replicate even a single copy of itself within your child’s lungs if your child has a fever of about 101 to 102 degrees. It can’t because that switch is incapable of functioning in that warm of an environment. A temperature of about 102-103 degrees stops the viral replication process instantly. It doesn’t “kill” the virus, because a virus isn’t really alive in that way. It does however buy the body time to heal. At this point the body can work really hard to eat up the “damaged, hijacked lung cells.”

Pneumonia

As a last resort, since its first approach was circumvented by fever reducers, the body tries to quickly flush the infection from the lungs with  fluid to “cough out” the virus. This is called viral pneumonia.

So, you see, by giving a fever reducer and bringing a fever down to a “calm” 99 degrees in your child, all you are doing is allowing the virus to replicate and overcome your child’s body.  That is why my daughter’s doctor told me that, when she had a frighteningly high fever from the flu, he wasn’t worried about the flu. He was only worried about it progressing into pneumonia. This is not to say a child can not get pneumonia without fever reducers, it’s just far less likely.

What else not to do

• A cool bath is also not appropriate. Not only is it a horrible experience, it cools your child’s body temperature at a time when it needs to be hot. Plus,  it can cool your child’s body too quickly and remember, febrile seizures happen when body temperature changes too quickly.
• Rubbing Alcohol should not be used. I seriously can not even fathom ever thinking this would be OK, but people do it. You should not ever do this. You shouldn’t do it because it will crack and dry the skin leaving it open to other infection, it will allow for super strong bacterial infections like hand sanitizer does, and also, it will get into the blood stream and that is simply not OK for a child.
• You should also not take away their blankets. When a child has a fever, if you take away their blankets, they will feel even more cold. This is a horribly achy feeling. Instead of giving Tylenol or Motrin to make them comfortable, try snuggling up with them to keep them feeling warm and calm instead. Remember, touch releases endorphins which will make your child more comfortable. Touch will also help reduce their stress and cortisol level. A lower cortisol level means a better immune response.