Fevers in kids a symptom not a disease

It had been a long night for the mother of the sick 8-month-old. The little boy had started with a fever of 102 the previous evening and again was fussy and hot upon waking the next morning. Mom paged me before office hours to discuss his illness. “His fever keeps coming back,” she explained, obviously worried.

We reviewed the baby's symptoms over the phone. I told the mother that if she felt more comfortable having him seen, she could call to set up an appointment when the office opened. I completely understood the mother's concern, but I also didn't want to pass up a teaching moment. So, I reassured her that the return of her boy's fever was not unusual since fevers tend to go up and down for the first few days of even the most routine viral illnesses.

Fevers are very worrisome for parents, and with multiple over the-counter fever-reducers readily available, we've created a bit of an obsession with fever management, a condition the American Academy of Pediatrics refers to as “fever phobia.” While fevers can be indicators of serious infection, caregivers should keep in mind that fever is not, in and of itself, a disease, but simply one symptom of a variety of common childhood illnesses.

In their March 2011 Clinical Report, “Fever and Antipyretic Use in Children,” experts at the AAP note that fevers actually have “beneficial effects in fighting infection,” and have not been shown to result in any long-term neurological problems in children.

Fever management should, therefore, not involve medicating and re-medicating a sick child until the temperature comes down to a “normal” 98.6 or chasing low-grade fevers in a child who is content and playful.

It's reasonable, however, to medicate feverish children in an attempt to make them more comfortable. Lowering fevers in an ill-appearing child can also help reassure worried parents, as well as physicians, since most patients with minor infections become less fussy, perk up and act more like themselves after they've cooled off a bit.

If fever is treated for comfort reasons, the academy recommends dosing fever-reducers based on a child's weight rather than age. This practice can effectively reduce fever and may also reduce some of the common errors in parental administration of antipyretics, which are reported to occur in as many as 50 percent of pediatric cases.

Both acetaminophen (Tylenol) and ibuprofen (Motrin or Advil) are approved for antipyretic use in children, though ibuprofen is not indicated for babies less than 6 months of age. When you dispense medications, always use the product's own dropper or measuring cup to avoid over- or under-dosing these fever-reducers. In addition, alcohol baths should never be used to reduce fevers since alcohol can be systemically absorbed through a child's skin.

Rectal temperatures of 100.4 F (38 C) or greater are considered to be true fevers. While a fever is not a disease, it can be a sign that a child is sick with a potentially contagious illness. A good rule of thumb when deciding when to send a recovering child back to day care or school is “fever-free for 24 hours” without the help of those handy fever-reducers.

• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.