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The Informed Parent

Evaluate the Whole Patient—Not Just the Fever, Part 2

by John H. Samson, M.D., F.A.A.P.
Published on Jan. 09, 2006
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Last month we contrasted the natural impulse of the reptile when confronted with fever and the immediate reaction of parents when their child has a fever. Let us continue with a clearer understanding of the message fever gives and how we should respond to it.

It is more important to assess the patient's general condition than to rely on fever measurement alone. I have seen patients desperately ill with low fevers, and those suffering from a minor viral infection with a very high fever.

I can hear parents disagreeing. Their child had a fever convulsion. "Therefore, don't tell me fevers aren't dangerous.!" It is felt that febrile seizures are associated with a rapid rise in temperature. The overall height is not as critical as the rate of rise. Without question, if you know that your child will have a seizure if the body temperature goes above 104 degrees, you will try to keep it below that threshold. Most of the time the convulsion occurs before the parent realizes the child has a fever. Fortunately, febrile seizures are short lived and pose no deadly threat to the affected child. They are more traumatic to the observing parent.

Assuming this is true, why give medications to lower fever? Tylenol, Motrin, etc. can be given when the discomfort of the fever significantly effects the patient. Headache, muscle ache, sore throat and ear pain are good reasons to give medication, whether they lower fever or not. In the face of a serious infection, one notes the temperature is not usually reduced to the normal basal temperature of 98.6 degrees. The body does what is best, despite us.

I used to believe that a temperature over 105 degrees led to brain damage. It was not until attending medical school that I found this statement was not true. Having talked to thousands of parents I found this myth still continues. One can understand where the panic comes from. Keep the fever below 105 degrees or the brain will be damaged! This has been the all too prevalent admonition given to inexperienced caregivers.

Is there any place for ice water soaks or cool water baths to control fever? Unless you are dealing with the rare condition of malignant hyperpyrexia, NEVER! A child with fever under 106 degrees never needs submission in cold or lukewarm water. These measures usually provoke shivering which in turn keeps the temperature high. It becomes a losing battle that only fatigues and torments the child.

In measuring body temperature, remember the following:

  1. rectal temperature best assesses core temperature.
  2. forehead strips are not accurate enough and only evaluate skin temperature.
  3. axillary temperature is a poor substitute for a rectal reading.
  4. some journal articles have found electronic eardrum thermometers to be of questionable accuracy in patients under age five years.
  5. if done properly, sublingual oral temperature can be accurate and within one degree Fahrenheit of rectal core temperature.

If you feel compelled to lower the body temperature, as in the case of the patient with a known history of fever convulsions, you should:

  1. use warm temperature bath water.
  2. wet the child as you would for a regular bath.
  3. remove him and have the baby sit on your lap, unclothed so that the water evaporates off the body--this is what causes efficient cooling.
  4. if "goose flesh" occurs, or shivering is seen, dry the child off and cover with a dry towel to stop evaporation.
  5. after the shivering ceases, resume the same cooling procedure again.

As the title of this article indicts, fever is not to be feared. It serves a useful function and can indicate when medical attention is needed. It never supplants careful evaluation of the sick child, unless it reaches or exceeds 106 degrees. REMEMBER, a child with a fever of 102 degrees can be sicker than a child with a fever of 105 degrees. A temperature of 106 degrees or higher always mandates immediate medical evaluation. A concerned parent or babysitter should always seek medical attention or get professional advice if a child appears very ill or has unexplained signs or symptoms, no matter what the thermometer reads. The safest approach to this problem is the most conservative. If you think your child's condition demands professional medical care, don't talk yourself out of it. A phone call, a visit to your child's physician, or a trip to an emergency room is a small inconvenience and may prevent serious complications.




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