“Fever is a normal response,” says Dr. Shannon MacPhee, chief of emergency medicine at the IWK Health Centre in Halifax NS. “From a physiological point, when our immune systems crank up the heat, it’s usually a sign that the body is fighting an infection caused either by bacteria or viruses.
So why the panic when body temperatures rise—especially in children? “There are a lot of fears about fever,” says Dr. MacPhee, “and many myths about the danger it poses.”
Chalk it up to “fever phobia,” a term coined in 1984 by Colorado pediatrician Dr. Barton Schmitt to describe the popular misconceptions around fever. In what later was described as a myth-busting article, Dr. Schmitt urged doctors to do a better job of allaying unrealistic fears about elevated temperatures, stressing the importance of educating parents about fever, explaining that temperatures vary throughout the day, often rising slightly at night, and that fevers are rarely harmful below 41.7°C (107 F). Schmitt encouraged parents to be guided more by the condition of the child than by the degree of the fever and endorsed establishing parental guidelines for when a fever merits involving a physician.
There have been many medical advances since 1984, and ample assurances that elevated temperatures do not necessarily require medical attention, yet fever remains one of the most common reasons for seeking pediatric care, in part because parents don’t want to take any chances, and in part because this generation of children is exposed to an increased number of bugs at daycare facilities.
“We call it daycareitis,” says Dr. MacPhee. “Today, the average pre-school child will have 10 viral infections a year. Some infections will be milder than others. Winter is the time when they occur most frequently.”
Dr. MacPhee tackles the myth that children must be treated whenever one of these almost monthly infections results in a fever. “People have come to believe that they should treat a fever,” she says. “We live in a society with ready access to over-the-counter medications (OTCs) and we feel compelled to use them ourselves and to give them to our children. However, the truth is that in most cases there is no medical reason to treat a fever with OTCs. What we are really doing is treating symptoms such as aches and pains.”
Instead of heading for the medicine cabinet when a child has a fever, Dr. MacPhee encourages parents to monitor their children for changes in activity level and worrisome symptoms. “Most fevers don’t last very long,” she explains, “and the degree of the fever is not as important as how the child looks. I have three children under the age of 10. When they have a fever, I don’t treat them as long as they’re up and playing. A child’s behaviour and appearance tell more about illness than the reading on a thermometer.”
In assessing the condition of a child with a fever, Dr. MacPhee suggests monitoring for symptoms like changes in behaviour, extreme irritability, redness and swelling, problems with urination, severe headache, stiff neck, unusual skin rash, sensitivity to bright light, confusion, refusal to eat and drink, persistent diarrhea and/or vomiting.
“The duration of the fever is another way to help assess its severity,” she explains. “If a fever lasts for more than 48 hours, it’s best to get medical attention.”
A large part of Dr. MacPhee’s role as an emergency medicine specialist is educating parents, particularly in regard to fever. “Immunizations have made fevers less dangerous than they once were,” she says, “and there’s a decrease in childhood diseases such as chicken pox, bacterial meningitis and ear infections, but parents want to be sure they don’t miss something that could have helped their children.”
So when is a fever high enough to warrant medical attention? “The answer is different for different people and age groups,” says Dr. MacPhee. “For newborns, and anyone with a compromised immune system (including people receiving chemotherapy) a temperature higher than 38°C (100.4 F) is a sign that attention is needed. For the rest of us the number to watch for is 38.5°C (101.3F).