Fever causes fear- particularly in parents of young children. But is fever itself a dangerous thing? The answer is, almost never. And yet it often causes a lot of worry and stress.
In children most infections are viral and thus will get better by themselves. When an infection is present, the body’s thermostat (located in the brain) naturally raises body temperature to a higher set-point. The chills and shivering that may follow serve to increase muscle activity- this is the body’s way of heating itself up, to try and reach the new temperature set-point. According to the Royal Children’s Hospital, a body temperature above 38C indicates that fever is present in a child.
Misunderstanding of fever can lead to “fever phobia”, which may in turn lead to overly aggressive treatment, including unnecessary antibiotics. So what are people afraid of? Research has shown that around 90% of parents think fever itself can cause harmful side effects- including seizures, brain damage, coma, blindness and death! Thankfully, with the exception of febrile seizures, fever doesn’t cause any of these things. Febrile seizures (also known as febrile convulsions), whilst highly unpleasant, are generally not dangerous, and in any case, there is little evidence that anti-fever medications can do much to prevent them.
So, does this mean that fever shouldn’t be taken seriously? Of course not! There are certain situations, signs and symptoms, that do need careful management- these are explored in a helpful information fact sheet by the Royal Children’s Hospital- see link below. Medication to reduce fever can certainly help a child feel more comfortable. But in many cases, it’s simply not necessary to medicate, particularly if the child is otherwise well and active. The point is, the fever itself is not of concern.
Unfortunately, “fever phobia” can be harmful in its’ own right. Studies show that more than half of parents dose their children too frequently with medications such as Paracetamol or Ibuprofen, when they have a high temperature. This unintended overdosing puts children at risk of liver and kidney injury. Large numbers of caregivers say they use sponging with cold water to reduce fever, a practice which is pretty ineffective and can be unpleasant for the child, and may even cause harm by reducing the body’s ability to naturally lose heat, as it causes constriction of blood vessels in the skin. Some parents have also been known to sponge children down with alcohol solutions- this can cause toxicity by passing through the child’s skin, and thus should never be used.
It’s important to note that fever is not the same thing as hyperthermia. Hyperthermia happens when there is too much heat from a source outside the body, such as when a young child is forgotten in a car on a hot day. Unlike fever, hyperthermia is dangerous, and can lead to serious harm, even death. It’s quite possible that some of the fear around fevers comes from a false connection in people’s minds between these two different issues.
With regard to treatment, fever-reducing medications should only be given as needed, and can be stopped once bothersome symptoms have resolved, or when the child feels more comfortable. Giving combinations of Paracetamol and Ibuprofen, or alternating them, is not recommended routinely, as it is known to increase the chance of giving the wrong dose of one or other of the medications. And there is certainly no need to wake a sleeping child to give a dose of medication to bring down a fever (though in studies, around 80% of caregivers said they would do this!). Finally, as always, adequate fluid intake is essential.
For more information on fevers in children go to http://www.rch.org.au/kidsinfo/fact_sheets/Fever_in_children/
By Dr Aifric Boylan