Hot Children

mother taking a child's temperatureby Steven D. Blatt, MD

Starve a cold, feed a fever? Or is it, feed a cold, starve a fever? Everyone knows a normal temperature is 98.6º Fahrenheit. What’s a fever? 99º? 101º? Why does my doctor care if my child has a fever? Do fevers keep going up and up? Can it hurt if it gets too high? How do I treat a fever?

Before we even start this discussion, we need to consider the concept of body temperature. Most people know that there are two scales, Celsius and Fahrenheit. 99º Fahrenheit is equivalent to 37.5º Celsius. There are different places to take the temperature: rectal, oral, or in the ear. There are some important differences. A rectal temperature is higher than oral and is considered the most accurate. Ear temperatures are more difficult to interpret. Of course, this all is based on a thermometer that is accurate.

The “normal” body temperature is 98.6º Fahrenheit, but that might not be your child’s normal temperature, which may be 98º or 99º. A better way to say it is 98.6º Fahrenheit is an average normal temperature. Body temperature varies during the day so that it is elevated in the evening. There is also variation with the menstrual cycle. Doctors don’t start considering an elevated temperature to be a fever until it’s greater than 100.4º F (38º C) for infants or 101.3º F (38.5º C) for older children. Fevers may actually help the body fight the infection that is causing the fever.

A fever is a physical sign that there is an infection. Common childhood infections with fever include ear infections, throat infections, pneumonia, and viral illnesses. Some infections have fever as the only physical sign or symptom. Signs and symptoms may help the pediatrician diagnosis an illness. For example, ear pain without fever may be from a viral illness such as a cold or Upper Respiratory Infection while ear pain with a fever may be due to a bacterial middle ear infection or Otitis Media. The physical examination would add additional information to this diagnosing process.

Should a fever be treated with acetaminophen (Tylenol) or ibuprofen (Motrin or Advil)? Certainly if the fever makes your child uncomfortable, antipyretics (fever reducers) should help them feel better. Other than that, the fever isn’t harmful. If your child with a fever feels cold, add blankets and additional layers of clothes. If your child feels hot, remove the blankets and clothes. You can place the child in a bath of warm water; even warm water will make your child feel better whereas cool water will make your child uncomfortable. If you do choose to treat the fever with medication, remember that acetaminophen needs to be administered every 4 hours and ibuprofen every 6-8 hours. Be sure to check the medication label for the proper dose. It is not uncommon for parents to give this medication at too low a dose or not frequently enough.

Is a fever harmful? Parents often ask me if the fever will get so high that it will cause harm. There are some toddlers who have a brief, non-harmful seizure with a fever. This is called a febrile seizure. These are scary to the parents but truly are non-harmful. In general, fever does not cause significant harm. The body is made so that the highest temperature with a fever is almost always less than 105º F (40.5º C). Although a temperature is a sign that there may be a serious infection, the fever is not itself harmful. There is a condition called heat stroke or hyperthermia which is a high body temperature caused by environmental factors, such as running a marathon in 95º heat. This is not due to infection. These conditions are potentially harmful and need prompt medical attention.

So what’s the bottom line?
• What is considered a fever varies on the situation, but in general a temperature is considered a fever when it is greater than 100.4º F (38º C) for infants or 101.3º F (38.5º C) for older children
• Fever can be treated with acetaminophen or ibuprofen for comfort
• Fevers are rarely harmful
• Fever is a sign of infection
• Most fevers and the associated infections are due to viruses, but some are caused by bacterial infections
• When in doubt, contact your doctor. Although most fevers resolve without any intervention, some do require medical intervention

By the way, I have no idea if one should feed the cold or the fever.×700&Procedure=W1403&streamtype=fhi&suppressButtons=yes

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