Monday, November 10, 2014

Fever: Myths & Facts

The Trials & Tribulations of Fever:
Myths & Facts

1.     Does a fever above 102.5 mean you need to go to the ER?

One of the most common questions parents ask is “at which temperature is a fever dangerous”?

Before going into more detail, a fever is defined as a temperature above 100.4°F or 38°C. Read more information on taking your child’s temperature

There is no set number that dictates whether or not a fever is dangerous. I have seen children with fevers of 105°F who are playing and running down the hallway, and conversely, have seen children with a temperature of just above 100°F feel miserable and become very ill.  Additionally, the seriousness of a fever greatly depends on the age of the child. Any infant with a fever who is less than 3 months of age should be urgently evaluated by a physician because of their increased risk for serious infections. Infants less than 3 months old with a fever can become very ill, very quickly. Infants less than 3 months old should have their temperature measured rectally if there is concern for fever or illness.

Rather than a set number, pediatricians look more for other symptoms and physical examination findings that may accompany a fever to determine severity. For instance, any child who is lethargic, unable to drink fluids, or is in any way concerning to a parent, should be evaluated by a physician. A child who is happy, playful, and able to eat and drink, can typically be observed at home even if they have a fever.

It is also important to know that your child’s temperature will NOT continue to rise if you do not give them medications like Tylenol® or Motrin®. The instances where temperature will rise above 106 or 107 degrees are in cases of heat stroke (i.e. being left in a car) or in children who have underlying severe medical problems affecting their brains ability to regulate temperature.

2.     Myth: You should always give medication to reduce a child’s fever because the temperature will continue to rise.

As mentioned above, unless there are rare circumstances, a child’s temperature will not continue to rise uncontrollably. Our body’s mechanisms to control our internal temperature will take over and keep the fever from going too high.

Fevers are actually a good thing!
Fever means that your child’s body has recognized that there is a foreign process occurring in their body (like an infection) and has started fighting the infection.

Because fevers can make children uncomfortable and even act a little “wacky”, medications to reduce fever can be given to help control the symptoms. Fever reducing medications should not be given just because of a number.

Fever reducing medications like Tylenol® or Motrin® are given based on the weight of the child. The weight (measured in kilograms) is what determines the dosage amount.
                Motrin® (ibuprofen) should not be given to children less than 6 months old.
Do not guess the correct dose of medication, ask your child’s pediatrician what the correct dose should be for your child.

3.     All teaspoons and tablespoons are created equal. (True or False)

Take a look around your kitchen. You are likely to have a couple, if not several different teaspoons or tablespoons. Just because something is labeled as such, does not mean that it will give the correct amount. I have seen several utensils labeled as teaspoons which can be off by as much as 50%, and causing too little or too much medication to be given if used to dose a medication. Side effects of too much medication can be severe, and even deadly, so the importance of correct dosing cannot be overstressed.

When giving medication to children, it is best to use a syringe or standard measuring device that shows how many milliliters (mL) are being provided to the child. Ask your pharmacist for syringes or medicine cups to provide the correct dose to your child.

4.     Fact: High fevers can cause a child to have a seizure.

Febrile seizures, which is a seizure occurring while the child has a fever and not related to an underlying seizure disorder, like epilepsy, is rare in children. While most febrile seizures occur at temperatures above 102°F, the reason for a seizure to occur is more likely related a rapid rise in temperature and family genetics rather than the actual number. If you have family history of febrile seizures, talk with your pediatrician about signs to look for and what to do in the event of a fever or febrile seizure.

5.     When should parents call the pediatrician?

In my practice, I tell parents that any time they are concerned about their child, I want to know about it so that we can discuss symptoms and make a plan that is best for their child. In general, if your child is having fevers for 4 or more days, your pediatrician should know about it. Any child who is less than 3 months old with a fever should be urgently evaluated by a physician. Additionally, if a child with fever is unable to drink fluids, is acting lethargic, has severe pains, or is acting in any way concerning to the parent(s), they should be evaluated by a physician.

For more information about fever and the recommended treatment, please consult with your pediatrician.

Read more about concierge pediatric care: providing 24/7 access to the pediatrician, house calls, and telemedicine, at Boca VIPediatrics

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