Fever occurs when the brain orders the body to raise its temperature in response to infection, injury, or other conditions.
Just as your furnace works harder when you raise the thermostat setting in your home, the body shivers, the heart races, and the blood vessels constrict in an attempt to raise the body temperature. Fortunately for humanity, a healthy brain does not set the body’s thermostat to dangerously high levels (or we would have been extinct long ago!).
Fever is different from hyperthermia. Hyperthermia is a dangerously elevated body temperature that is not under the body’s control. This can happen in the person running 4 miles on a 100 degree day, or the infant wrapped in 4 blankets on a warm day.
When we deal with an infection, our concern is not the fever itself but the cause of fever. The fever is not the enemy just as the check engine light on your car’s dashboard is not the root of the car’s problem. You can cut the power to your car’s dashboard to make the light go off, but there is still a problem in your car’s engine. The following are conditions associated with fever that should prompt you to call us immediately.
1. Fever associated with change in mental status, stiff neck, severe headache, difficulty breathing, new rash, new limp, or signs of dehydration.
2. Any infant less than 2 months of age with fever 100.4 or higher. (could be a serious bacterial illness)
3. Fever in a child who cannot adequately fight infection. Examples are children with diseases like cystic fibrosis, sickle cell disease, HIV, diabetes, and lupus. Also included are children on medications like chemotherapeutics and oral steroids (not inhaled).
4. Fever in a child who recently had surgery.
5. Fever with significant abdominal pain (could be appendicitis)
It is important to remember that treating fever does not treat the illness. We “treat” fever mainly for patient comfort. The best way to bring fever down is with an antipyretic medicine such as Acetaminophen (Tylenol®) or Ibuprofen (Motrin®), which lower the body’s thermostat setting. Do not use Aspirin, as this can cause a dangerous brain and liver condition called Reye Syndrome. Cool or even room temperature baths are not a good idea because they only temporarily bring the temperature down without lowering the thermostat setting. Imagine leaving your doors open on a cold, blistery day. Your furnace will just work harder trying to get that temperature back up! Your child may feel like she is submerged in ice water.
Febrile seizures are seizures that occur only in the presence of fever. They occur in some susceptible children aged 6 months to 6 years but are generally harmless (but very scary to you if you witness it). Her whole body will shake, jerk, or stiffen and you may see her eyes roll back. Sometimes I have seen kids get chills that look like a seizure but really are not. After the seizure he will appear very tired and “out of it” for several minutes.
Febrile seizures result from a rapid rise in temperature, and often times the seizure has begun by the time you recognize that your child has fever. If it does happen, roll him to his side on the floor to decrease the chance that he bites his tongue and to keep his airway open. If it is his first seizure with fever, you are best off calling 911 because at this point we don’t necessarily know that it is a febrile seizure. Then put your hand on his shoulder to make you feel better and wait for it to end and for the ambulance to arrive. They usually end within 5 minutes but occasionally may last much longer. Once we know your child gets febrile seizures and he has a brief one (less than 4 minutes), you don’t necessarily need to call 911, just call us. If it lasts longer than 4 minutes, do call 911.
If your child is developmentally normal, chances are he will outgrow febrile seizures and not go on to have epilepsy. If he does have any kind of developmental abnormality, the chance of becoming epileptic is much higher.