What is fever phobia?
The term “fever phobia” was first coined in 1980 by pediatrician Dr. Barton Schmitt. He realized based on a study of many parents that they were overly concerned with their child’s temperature. Most were under the impression that they should give a fever reducer with a low grade fever and more than half thought that a moderate grade fever could cause neurological damage to the child. There has been push to educate parents and medical providers about the extremely rare harm of fevers. However, nearly 40 years later I continue to see extreme concern from care givers about fevers in children. Most medical providers are well meaning, but we as a medical community are in part to blame for the continued obsessions with fever by stating it as a warning symptom in almost all discharge paperwork, ordering unnecessary labs and imaging in the setting of fever and placing children on antibiotics without otherwise good medical reason.
What is a fever?
First, it is important that everyone have the same understanding of what is considered a fever in the medical community. I have a lot of parents that bring their children to the emergency room for what they consider a low grade fever and when asked what the temperature was I often hear answers like “they felt warm” or “99.5, but that is high for my child!”. While both of these statements are valid (studies have shown that parents are good at detecting fever by feel and everyone’s baseline temperature is not 98.5) they are unhelpful in my assessment of the child. I am more concerned about how the child looks, the age of the child and what other symptoms they have. The technical definition of a fever is a temperature greater than 100.4. A low grade fever is considered up to 102 and a moderate fever up to 104. Most parents are shocked to hear this. Like the 1980s study showed, parents are still convinced that temperatures of 102 or more can cause permanent neurological damage.
What are the benefits and complications of a fever?
Fever has an overwhelming benefit compared to the extremely rare harm caused by fever. Fever is your body’s natural response to help fight infection and it is a trait found in many animal species. To be clear, fever is different than hyperthermia which is a state of unregulated heating of the body such as being out in the heat for a prolonged period of time, being locked in a hot car or having a medication reaction. Fever rarely goes above 105, but can rarely get to 107. Even at these high numbers fever does not cause brain damage or irreversible consequences.
I am frequently asked by parents about febrile seizures. This is a fairly common occurrence and is usually associated with some genetic component. They most commonly occur between the ages of 6 months and 6 years and most children outgrow them with no increased incidence of epilepsy long term when compared to the general population. Parents are often disheartened to hear there is not much they can do to prevent a febrile seizure if their child is prone to having one. I will tell parents to not worry about being aggressive with Tylenol and Motrin because of their inevitability. The good news is, the vast majority of febrile seizures are short lived and harmless and usually do not require any further medical work up. The incidence of status epilepticus (a prolonged seizure of greater than 15 minutes) is very rare but does require immediate medical attention.
Because fever speeds up the metabolic process in the body, children can become more easily dehydrated with a fever, so pushing oral fluids is important in treatment.
When to give fever reducers?
Unfortunately, parents can sometimes be too aggressive with Tylenol and Motrin and lead to increased and unnecessary risk of liver and kidney damage from overdosing these medications or giving them too frequently. Anyone who has had a baby or toddler with a fever knows that they can be quite miserable with a fever. It also leads to poor sleep and appetite which can compound the miserable state or both child and parent. Therefore, I recommend to parents to treat fever during the day when needed. Never wake a sleeping child to give fever reducers! And it is unnecessary to give a fever reducer if the child is otherwise asymptomatic from a low grade fever.
I tell parents to either stick to one fever reducer or to give both at the same time. Mistakes can happen when parents try to alternate them. Motrin is metabolized via the kidneys and Tylenol by the liver, so they are safe to give together, but I recommend waiting at least 6 hours between doses or to give a max of 3 doses in a 24 hour period. The best times to do this are in the morning if their child wakes with a fever and is symptomatic, mid day and just before going to bed in the evening. The doses for these medications are weight based and can be found on the side of the bottle. For children less than 2 it will say to consult a doctor. This is for good reason because very young infants do need prompt evaluation and should not be given Tylenol. There is also a wide weight variation in young toddlers and babies.
The dosing we use in the ER if needed is 15mg/kg of Tylenol and 10mg/kg of Motrin. In order to convert your child’s weight from pounds to kilograms, you take their weight and divide by 2.2. So a 22 pound one year old is 10 kilograms and would receive a max dose of 150mg of Tylenol and 100mg of Motrin. You need to consult the concentration of these medications but most children’s Tylenol is 160mg/5mL and Motrin is 100mg/5mL. So this child could have 4.5mL of children’s Tylenol and 5mL of children’s Motrin. It is very important that you have a correct weight of your child and read the medications correctly before blindly following these numbers. This is only an example to help guide you at home.
When should parents be concerned?
I believe knowledge is power and the more you understand about fevers, the more you can feel confident in treating your child at home without having to seek medical care. However, there are some very important instances in which it is imperative to seek medical help or consultation. Most of these reasons have to do with a more at risk population whose immune systems are compromised and not able to fight off minor infections easily.
-Babies less than 90 days old
-Unvaccinated or under vaccinated
-Sometimes babies who were born premature
-Children who have chronic illness such as sickle cell disease, cancer, diabetes, etc…
-Fever has been ongoing for more than 5 days and not improving
-Parents concern about the child’s general look and behavior
-Fever associated with other symptoms that are concerning such as difficulty breathing, repetitive vomiting or diarrhea with concern for dehydration, localized joint pain, certain abdominal pain, severe headache or neck stiffness, severe lethargy or listlessness
To sum it up, you can use common sense to know if you need to seek medical help but just remember that fever is simply a clue that there is an infection going on and in most otherwise healthy kids it is viral and self limited.
If you ever have questions or something doesn’t feel right, always feel free to seek medical evaluation from your pediatrician or local emergency room. If you want to talk to a doctor directly and have your child looked at, please consider requesting a video consult with me via my telehealth service. You can click the link below to get started.