Fever is one of the most common reasons why families bring their children for urgent medical evaluation. It is important to remember that fever is a symptom of an infection, and that complications caused by an infection are not caused by the fever itself.
Fever causes unpleasant symptoms for both children and adults, including sleepiness, achiness, poor appetite, and headache. This is the actual reason why it is recommended to treat a fever. Reducing the fever, sometimes even by as little as one degree, can improve the patient’s symptoms, making them more comfortable and better able to keep hydrated and well nourished.
Fever with Seizures
The fear that fever may cause a convulsion, or seizure, is based on fact. Children from about six months to about five years of age may have something called “benign febrile seizures.” These are generally brief convulsions involving the entire body that last for less than 10 minutes and are followed by a brief period of sleepiness or crankiness. Within minutes, the child is back to their usual state. It is believed that this happens because the body temperature goes up very quickly and the immature brain is confused about what to do with the temperature change. This causes a “short circuit” in the brain, which presents as a seizure. Fortunately, these types of seizures do not cause epilepsy or brain damage and often happen only once.
Some children have repeated febrile seizures, but these are also benign and do not cause long-term complications. Research studies suggest that treating children with fever medications probably does not prevent febrile seizures. Interventions such as ice baths or wiping a child down with alcohol are not recommended to try to stop the rise of temperature and may cause other complications. Febrile seizures are limited to children between the ages of six months and five years. Seizures occurring at the same time as fever in children outside of that age range must be regarded as something potentially dangerous and not as benign febrile seizures. In these cases, the cause of the seizure is not the fever, but the illness itself or another chronic condition.
Fear of fever crosses cultures and arises from times before modern medicine was able to diagnose diseases and prove that complications are caused by the infections themselves and not by any of the symptoms, such as fever. Here are two of the most common myths, or “old wives’ tales” about fever.
Uncontrollable Fevers are Dangerous
A common fear is that a fever that is not completely controllable means that the infection is more dangerous. This is a fever myth. There are times when you cannot completely control a fever—either you cannot get it to go down to a normal temperature or the fever resumes before the next dose of medication is due. This lack of control is quite common and is not a reason to suspect that the infection is more serious. Some types of infections generate fever that is harder to control than others, such as influenza.
Fever of influenza is commonly difficult to control. The fear of the inability to control a child’s fever is based in the assumption that fever is dangerous, and therefore, the temperature needs to be brought down. The real reason to treat the fever is to make the sick person more comfortable. If your child has a fever of 102.5°F but is drinking well and running around the house, there’s no urgency to bring the temperature down. In this scenario, the fever is likely bothering the caregiver more than it bothers the child. Fortunately, most children tolerate fever well and bringing their temperature down by even a degree can make them feel better.
High Fevers Cause Brain Damage
One of the most common fears about fever is that a high fever can cause brain damage. In reality, the body temperature must be above 107 °F before there’s any damage to the brain. This fear may be related to some uncommon infections of the nervous system that can cause brain damage and often present with moderate to high fevers. Remember that it is the infection that causes the brain damage and not the degree of fever.
It’s not uncommon to see children with fevers of 104-106° who tolerate it very well and are running around. Children with normal brain function do not get fevers much above 106°F because their brain is able act like a thermostat to keep the temperature from going above that. Therefore, it is highly unlikely that a child with an infection will have a fever high enough to cause any damage to the brain.
What to Remember about Fever
We all need to remember that fever is a symptom and not a disease. Just like a cough or runny nose or even diarrhea, sometimes we can make the symptom completely better with medications and sometimes we can’t. Whatever we can do to decrease the symptoms will help the sick person feel better, even if we can’t make the symptoms go away completely. The same thing is absolutely true about fever. When your child has a fever, do your best to make them comfortable and consult your primary care practitioner about other things you should do and when you should take your child for professional medical evaluation.
Lou E Romig, MD, FAAP, FACEP