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Tuesday, February 3, 2009
Tuesday Tips- Kids and Fever
Fever is so misunderstood in general.
I answer many calls about fevers every day, mostly from worried parents. When I worked in the pediatric emergency room, many patients visited with fever everyday.
Fever scares parents. It's easy to understand why, since some very serious illnesses present with fever as one of the symptoms; such as influenza, pneumonia, and meningitis. The truth is that most childhood fevers are due to mild viral illnesses which require nothing more than home treatment, and will last for less than 3-4 days. Fever is the body's natural way of resisting infections. Fever all by itself is not dangerous in any way and is part of the body's defense system. It is normal for a fever to fluctuate over the course of the day.
You might wonder why doctors and nurses advise giving medication to reduce fever, since most fevers are helpful. Well, if you've ever had a fever yourself you know how it makes you feel: shivery and uncomfortable, achy and tired. Taking fever medications like Tylenol (acetaminophen) or Advil (Ibuprophen) can bring the fever down temporarily to give comfort and allow the patient to rest.
It's important to realize that these medications don't affect the underlying cause of the fever and have only a short term affect. They also need to be given carefully according to your child's age and weight. If you're unsure, always check with a pharmacist to clarify the safe dosage to give.
Myth #1: Fever causes brain damage and seizures
The truth is, a normal childhood fever won't cause brain damage. The brain controls how high a person's temperature can go. Occasionally, a young child can have what is called a febrile seizure, meaning a seizure caused by fever. It is believed that these seizures are caused by the body's temperature rising rapidly. A seizure like this may look very frightening, but is not dangerous or damaging. It usually lasts less than a few minutes and the child recovers quickly. It is always a good idea to seek medical attention for a seizure, especially if it lasts longer than a few minutes or it is the first one your child has had, just in case the fever is not the only cause.
Myth #2 : High fever = more serious illness than a low-grade fever
This is not always true. Children and babies often have more frequent and higher fevers than adults. Rather than focusing on how high the fever gets, it is more important to notice whether or not the fever responds to home treatment (does the fever come down at least 1 degree celsius an hour after giving fever medicine and other cooling measures? does the child 'perk up' after the fever comes down?) and to notice what other symptoms the child might have:
Things to check for:
Breathing: Is your child breathing rapidly and shallow? Is she wheezing or having other noisy sounds with breathing? Is her colour pale? Is she having a hard time nursing from the breast or bottle because she has to break suction to breathe? Does he have a persistent cough?
Hydration: Is your child still drinking fluids well? Having wet diapers or urinating at least once every 6-8 hours? Is the urine pale or dark? Is your child having vomiting or diarrhea?
Level of Alertness: Is your child alert when awake? Confused or very irritable? (It's fairly normal for a child to be a bit clingy and tired when the fever is high, but he should perk up somewhat when the fever comes down) Does your child respond to you normally?
Any other symptoms: Complaints of pain, excessive crying that is hard to comfort, pink/cloudy or foul-smelling urine. A new rash or bruising. Neck stiffness or pain and headache. In babies- is there a bulging or sunken area over the soft spot on the scalp?
Prior Medical history: Any prior medical conditions, such as being born prematurely or having a congential heart condition, diabetes or asthma can make your child at higher risk in cases of milder illnesses.
Myth #3 : It Is Urgent to Bring a Child's Fever Down to Normal
As mentioned, since fever is not dangerous, it's not urgent to bring it down. If your child is sleeping comfortably there is no need to wake him to give medication for fever. Simply remove any extra layers of blankets and keep the house at a comfortable temperature. A hot environment and too much clothing will make it difficult for your child's body to let off the extra heat to cool itself. If he becomes too hot and uncomfortable, he will wake up to let you know.
Cold or even cool baths are not necessary and are actually very uncomfortable when a child has fever. They will usually cry and resist, get goose bumps all over and start shivering. Shivering is actually the body's way of trying to warm the skin, so this will work against trying to bring the fever down. If your child wants a bath, make sure the water is warm enough that it doesn't cause shivering.
Dress your child lightly in enough clothing to cover and prevent shivering. Give fever medicine if the child is uncomfortable and re-check the temperature after an hour.
Sometimes older children with a fever will find it soothing to have a cool cloth on their forehead, but just for comfort, not to try to cool their body down.
IMPORTANT note about babies under 3 months of age:
ANY fever (37.6 C or higher, measured under the armpit) in a baby under 3 months of age should be evaluated by a doctor immediately, even in the absence of other symptoms. Very young babies don't have a well-developed immune system and are at higher risk for serious illness.
Here is a really helpful website to refer to if you'd like to use an online tool to go through a symptom checklist to decide if your child needs medical attention for any symptom. Just type the symptom into the 'enter health topic' field and click on the GO button.
If I type in "fever" the first 2 results are:
'fever, ages 3 and under' and 'fever, ages 4 and older'
Choose the appropriate topic, then click on "check your symptoms" in the right hand list. This will guide you through a list of yes/no questions which will help you decide if your child needs more than just home treatment. It's very easy to navigate.
There are over 3000 topics to choose from with lots of detail and resources listed, and all the information is updated regularly to keep it current. It's a fantastic resource for any parent to have in their bookmarks.
* As always, the information I share here is general and comes from reliable sources, as well as my pediatric nursing experience. It doesn't replace a doctor's advice and is not meant to diagnose. If you are concerned about your child's symptoms, you should always contact your doctor for specific advice *