Parents Should Not Fear Fever in Children, says AAP
As a parent, when your child is sick with a fever, the first instinct is to give medication that will normalize the body temperature. Pediatricians now warn that parents should not jump to the conclusion that a fever is always a bad thing and understand that it is a mechanism that actually helps the body fight infection.
Fever is A Normal Response to Infection
Clinically, a child has a fever when a rectal temperature is over 100.4 degrees F. Temperatures measured at other sites are usually lower and can vary by as much as one degree.
“Fever is the body’s normal response to an illness,” says study author Dr. Janice Sullivan, professor of pediatric critical care medicine at the University of Louisville (KY). It is more important to monitor children for symptoms of serious illness and make sure they don’t become dehydrated instead of being overly concerned with how high or low a fever may be, she says.
Sullivan and colleague Dr. Henry C. Farrar of the Arkansas Children’s Hospital have published new clinical guidelines for parents of children with fever in the new issue of Pediatrics, a journal from the American Academy of Pediatrics. In a study, the pediatricians found that as many as half of parents are giving their children the wrong dosage of fever reducing medications.
According to the guidance, physicians should help parents understand that fever in itself is not a primary illness, but a physiologic mechanism that has beneficial effects, such as retarding the growth and reproduction of bacteria and viruses. It also benefits the immune system by enhancing neutrophil production and T-lymphocyte proliferation. Overmedicating a fever could actually lengthen a child’s illness, the doctors warn.
The doctors also wish to dispel the myth that mild fevers can increase the risk of adverse outcomes such as brain damage. A fever is not life-threatening in an otherwise healthy child unless it is extremely and persistently high, such as greater than 107 F.
Parents’ primary goal when their child has a fever is to improve overall comfort level, rather than focus on temperature alone. Medications known as antipyretics (acetaminophen or ibuprofen) should be given at the appropriate dose for the child’s age and weight, avoiding overmedicating. While side effects are rare in these drugs, they do occur. Ibuprofen carries a risk of nephrotoxicity in children with dehydration or complex medical illnesses and acetaminophen overdose may result in liver toxicity.
Another common misperception is that parents must wake children at night to give medication to keep a fever down. Not so, say pediatricians. If the child is sleeping well, they are likely comfortable and need the rest to fight infection.
Parents should use the following guidelines when treating their child’s fever:
• The recommended dose for acetaminophen is 10 to 15 mg/kg per dose every 4 to 6 hours, and ibuprofen is recommended in a 10 mg/kg dose. There is some evidence that alternating doses of ibuprofen and acetaminophen may be beneficial, but that the regimen may be too confusing for parents to keep track of and that “questions remain regarding the safety” of this practice.
• Do not use a kitchen spoon to measure medication. Always use the proper measuring device, such as a marked medicine cup or oral syringe.
• Beware of other cough and cold products that contain an antipyretic. Combining these with a pain reliever/fever reducer could result in overdose.
• Keep children properly hydrated.
• Continually monitor the child for signs of serious illness and contact the pediatrician especially if a fever is above 100.4 in infants less than 2-3 months or with a fever of more than 103 degrees in a child of any age.
Sullivan JE, Farrar HC "Clinical report -- fever and antipyretic use in children" Pediatrics 2011; 127(3): 580-587.