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Don't be fever phobic
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Of course, Ms. W is right to be concerned. But her worry is misplaced. Rather than fear the fever itself will cause harm, what she (and I) should be worried about is the cause of the fever.
Ms. W is one of the world's gazillion fever-phobes. Don't you be one too. In case you are, let me talk you out of it.
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Normal temperature regulation without illness.
Deep inside the brain (in the "hypothalamus") is a temperature center, sort of like the thermostat in your house. Its job is to try to keep the blood at a constant temperature (typically 98.6, although this can vary by a degree or so in either direction).
- That's why it is good to take your baby's/child's temperature a few times when s/he is fine. It may be that his/her normal temperature is really 97.8, so that 99.8 could signify a fever.
- Usually we say someone has a fever if the temperature inside the body is 1.5 - 2 degrees higher than usual.
- Most pediatric providers will call it a fever when the rectal temperature is higher than 100.4 degrees Fahrenheit or 38.0 degrees Centigrade.
When the blood becomes colder than the 'set point', the temperature center orders the body to increase its metabolism (e.g., increase heart rate, digest some fat), which then raises body temperature. If the blood is a little hotter than the set point, the metabolism slows until the desired temperature is reached. (I'm simplifying a bit - blood flow to the skin, sweating, etc. may increase or decrease also.)
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Fever caused by illness.
There can be many causes for a fever (such as dehydration, over-bundling an infant, a very hot day). But, usually, fever = infection.
The immune system of the body senses a 'foreign invader' (such as a bacteria or a virus) and sends chemical messages to the temperature center to crank up the heat inside the body. This is a good and smart thing to do because:
- Some bacteria and viruses don't like the higher temperature and so are more easily destroyed by the immune system.
- The faster metabolism provides more blood and infection-fighting white blood cells and other chemicals to ward off the infection.
- The higher temperature may make the immune system elements more effective killers of the germs.
So repeat after me: fever is our friend, fever is our friend... It lets us know that an infection may be brewing, and, at the same time, it helps to fight off that infection. And that infection-induced fever doesn't go high enough (typically >106.5) to carry a risk of causing damage to the brain and body.
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Then why treat a fever?
The body's thermostat is rarely satisfied; it usually wants the temperature in the body to be a few degrees warmer than it is. That's why we feel cold or chilled when really we are already too warm. Hence, the main reason to treat a fever: to make your child feel more comfortable. Period.
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A few caveats
- This discussion does not apply to children who have seizures with fever ("febrile seizures"). They need their fever to be managed more aggressively to try to prevent recurrences.
- Any fever in the first months could indicate a possible significant infection requiring immediate attention.
- Don't get too caught up in the exact temperature. While it is true that higher fevers may signify a more worrisome infection, more important are your child's symptoms, such as respiratory distress, irritability, listlessness, lethargy, poor feeding, fewer interactions with then environment, rash, vomiting, diarrhea, etc. I'm much more worried about a listless child with a temperature of 101, than a smiling playful one with a temp of 103.
- If your baby/child looks sick in any of the ways mentioned above, call your pediatric provider, even if the temperature is not high enough to be called a fever.
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