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Don’t get so hot over your child’s fever

  • Orange County Register
  • Published Monday, March 10, 2014, at 12 a.m.

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When to see the doctor for a fever

Most childhood fevers (temperatures higher than 98.6) are beneficial, helping a child fight infection. But there are times when a visit to a doctor is advised.

Following are temperatures and symptoms that call for medical attention:

• Birth to 3 months: 100.4 degrees or higher regardless of how the infant appears. Because infants don’t show symptoms like older children do, any rectal temperature of 100.4 or higher should trigger a visit to the doctor.

• Age 3 months to 36 months: 102 degrees or higher. See a doctor if the child seems fussy or lethargic, is vomiting or can’t hold down foods or liquids, to rule out a bacterial infection that needs treatment. If none of these symptoms occur, parents can wait up to three days.

• Age 36 months and older: 104 degrees or higher. Also seek medical treatment more urgently if the child seems toxic, is not holding down liquids, is vomiting profusely, has severe abdominal pain or has a severe headache.

In general, see a doctor if the child has another medical condition such as cancer or heart problems, or has a new skin rash in conjunction with the fever.

The most common causes are colds, flu, stomach maladies, croup and bronchitis. Less common problems include kidney infections, meningitis and appendicitis. Fevers stimulate the immune system and help fight the invaders.

Sources: Behnoosh Afghani, clinical professor of pediatrics at University of California, Irvine; UpToDate.com; and American Academy of Pediatrics

Oh, no. My child has a fever. Quick, call the doctor. Go to the ER.

Get out the medicines to bring the temperature down.

That’s what most parents have been taught to do when their child feels hot and feverish. But is that the best way to react?

In most cases, no, doctors now say. In fact, with some exceptions, fevers are usually good for sick children, encouraging them to rest and sleep.

Tell that, though, to Esmeralda Garcia, 27, of Anaheim, Calif., who worries like most moms whenever her 4-year-old son, Eli, has a fever.

“I’m the person at 2 in the morning calling the after-hours nurse with one foot out the door to the ER,” she said.

“I drive my husband crazy with the old wives’ tales and home remedies,” Garcia said. “I called my mom and told her he had a fever and she said, ‘Slice some tomatoes and put them on the bottom of his feet because it has a cooling effect.’ So I did and then put socks on him.”

Did it work? She’s not sure, but his fever did come down. “Was it the tomato slices or the fever breaking?” she said.

A fever is a body temperature above normal. In children, this is considered 100.4 degrees on a rectal thermometer or 100 on an oral thermometer, according to physician’s resource UpToDate.

The American Academy of Pediatrics recommends that parents use fever-reducing medicines only to make a fussy child more comfortable, not merely to lower the body temperature. And parents should not wake up a sleeping child to give fever medication, the academy advises, as sleep is more important to the healing process.

“Fever … is not the primary illness but is a physiologic mechanism that has beneficial effects in fighting infection,” according to a 2011 AAP study, which also reported that half of parents surveyed gave the wrong dosage of fever medicines. “There is no evidence that fever itself worsens the course of an illness or that it causes long-term neurologic complications.”

In fact, the study found that fever tends to retard the growth of bacteria and viruses, pump up the body’s natural immune system and help patients recover more quickly from viral infections.

So what about dire warnings from generations of mothers about brains being cooked by too-high temperatures?

“I always heard you get brain damage and seizures from high fevers,” Garcia said, echoing generations of moms before her.

But, depending on age and general health, an older child can be feverish for as long as three days before it becomes worrisome. If a child needs to be seen by a doctor, it’s to diagnose an underlying cause, not to lower the fever itself.

Dr. Behnoosh Afghani, clinical professor of pediatrics at UC Irvine, said most fevers are caused by viruses, which can’t be treated by antibiotics, so parents who pack the emergency room demanding them will be disappointed.

Of course, there are times when a trip to the hospital is recommended:

Infants under age 3 months with fevers of 100.4 degrees or higher should see a doctor, because a lack of symptoms may mask serious conditions, said Afghani, who also treats children at CHOC.

“Fever in very young infants is serious,” Afghani said. “You should contact the doctor immediately to see if something serious is going on.”

For older babies, 3 months to 36 months, parents should seek medical help if a fever reaches 102 degrees, if the child seems fussy or lethargic, is vomiting or can’t hold down foods or liquids, she said.

Children older than three years old can tolerate fevers up to 104 before they need to see a doctor, unless they seem very ill, aren’t holding down liquids, are vomiting frequently, or have severe abdominal pain that may indicate a condition such as appendicitis, or a severe headache, which can be a symptom of meningitis.

A fever lasting more than three days should be attended to by a medical professional.

Parents of children with underlying health issues such as cancer or heart problems should always consult their physicians.

Occasionally, fevers will trigger “febrile” seizures in children under 5. However, these tend to be hereditary and aren’t necessarily related to how hot the child gets.

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