ASK THE DOCTOR: Hot topic - When to fret over fever
By DR. JIM MITTERANDO
The Patriot Ledger

Q. When do I need to worry about fever in my children?

A. I receive numerous phone calls from concerned parents regarding their feverish children.
Fever, a temperature of 100.5 degrees Fahrenheit or higher, is the body's immune response to an infection.

Many variables determine a child's "normal temperature." For example, temperatures of up to 101 degrees can be caused merely by exercise, excessive clothing, a hot bath or hot weather.

Recent studies refute the common belief that teething causes fever in babies; most fevers result from viral infections and the body will fight back on its own.

"Fever phobia" contributes to misunderstanding; new research suggests that fever actually may assist the immune system in fighting infection.

Parents often feel helpless when their child feels badly, exacerbating "fever phobia." But it is important to remember that fever is not a harmful illness, but a symptom.

Do not believe the myth that a high fever can cause brain damage. The only reason to lower a youngster's temperature is to make the child more comfortable or to avoid a febrile seizure (in a child prone to seizure.).

I do not recommend bundling children in extra blankets or clothes to "sweat out the fever." Doing that simply raises the child's temperature and can make them feel sicker.
When dealing with a fever, "treat the child, not the thermometer."

Fever is only one of many signs of illness. The best indicator of a child's illness is his or her activity level and behavior. A child whose temperature is 104 degrees but appears active and otherwise normal probably is healthier than a child who is listless, refuses drink, breathes fast and has a temperature of 101 degrees.

The time to worry about a fever is when an infant is younger than 3 months. Doctors are more concerned about temperature of 100.5 or greater in newborns, because their immune systems are immature.

I recommend that infants younger than 3 months old with fever be seen by their physician. Your doctor may do blood tests at this age. But remember: Overbundling or overdressing can cause fever in infants, too.

Because of the extra vigilance necessary in monitoring fever in infants, I recommend using a rectal thermometer for greater accuracy. I find axillary (armpit) temperatures inaccurate and useless. After age 2, you can use the easier, though less accurate, ear thermometer or oral thermometer.

As the child grows, the immune system strengthens and fevers become less worrisome.

I recommend parents of patients 3 months to 3 years call me if the child's fever exceeds 102 and the youngster does not have cold or gastrointestinal symptoms.

If there are accompanying symptoms, such as runny nose, cough or diarrhea, I am less concerned that the fever may be the result of a serious infection. If there is no explanation for the fever, I prefer to examine the child to exclude a possible urinary tract infection.

After 3 years old, diagnosing the cause of the fever becomes easier because children can describe what is bothering them. Fevers and viral infections are commonplace in day care and school.

Two kinds of over-the-counter medications lower fever in children: acetaminophen (Children's Tylenol) and ibuprofen (Children's Motrin). Acetaminophen is gentler on the stomach than ibuprofen, but ibuprofen works longer and may treat pain better.

In newborns, I advise against using these medications because they may mask a fever, which could be a sign of serious infection in children so young.

Other fever tips:

-Call your doctor if a fever persists for more than one week.
-Avoid cool baths to bring down a fever; they are ineffective and uncomfortable. Sponging a child with a wet cloth, however, may be comforting.
-Never use rubbing alcohol, which can be absorbed into the skin.
-Remove warm clothing and extra blankets, which may elevate temperature.
-Encourage your child to drink fluids.
-Never give aspirin to children; it could lead to liver and brain damage (Reye's syndrome).
-Remember: Even minor viral infections can cause high fevers.
-Call your doctor if your child is breathing rapidly, because that could be a sign of pneumonia or asthma
-Do not disrupt a sleeping child to take his or her temperature.

Dr. Jim Mitterando is a family doctor at Health Care South/Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.

Copyright 2001 The Patriot Ledger
Transmitted May 1, 2001