Fever Phobia? Knowing the facts and when to go to the hospital.

Our bodies are programmed to have a fever from time to time. Its healthy to a point, it
kills bacteria in our bodies, and its an intelligent evolutionary thing. We’re also
programmed to fear the fever as well. In fact, a survey done in 1992 and 2000 showed
that nearly half of paediatricians would give Tylenol or Advil, the majority of them
alternating between them. They also believed this approach to be the medical guideline
when, in fact, there were no guidelines telling them to do this (1). Either way, for parents
and physicians alike, fever can be scary in the moment. Just remember this, fever isn’t
inherently bad, the underlying cause of the fever is what needs to be addressed.

The severity of the fever does not mean it is a severe infection. In fact, children
have had quite high fevers, or fevers lasting days with no bugs being identified
(teething!). You can have a very serious illness with a low grade fever as well. Most
fevers are mounted to really minor viral or bacterial infections.

What is fever and why do we have it?

Fever is a change in the body’s temperature ‘set point’. This happens deep inside the
brain, in the oldest part called the hypothalamus. Common reasons for this to happen in
children are infections such as urinary tract infections and autoimmunity (ie. juvenile
arthritis, Lupus). We want a fever to mount an inflammatory immune response, kill bugs
with the heat, and suppress our appetite so we don’t feed the bugs.

Rectal temperatures (using a rectal thermometer) are the most accurate, axillary and ear temperatures are less accurate.


Do you trust yourself?

“Mothers are able to provide accurate information about the presence or absence of
fever in their children by touch and without the use of a thermometer. Thus …
physicians should heed the … statements of mothers presenting with only the
subjective complaints of fever …” (2)

Thats great! You have the intuition and know how to tell if your child is sick, how sick,
and trust when you feel you need to go to your doctor. Mothers (or any caregiver) could
rule in a fever 89% of the time by touch alone.

When to go to the doctor or hospital:

There is no shame in checking in with a professional. Here are the scenarios when you
should ABSOLUTELY go to the doctor (3):

Under 1 month old with a temperature of over 38C/100.4F
Under 3 months old with a fever over 38.5C/101.5F and nobody else in the family has a
cold. This age is most likely to have an infection with a higher fever. Think urinary tract
Any older child and all babies under 6 months old with a HIGH fever— over 40C/103.5F
Fever lasting more than 3-5 days
Dehydration (no tears, no skin elasticity, denying fluids, no peeing), stiff neck,
headache, persistent vomiting, rash, severe belly pain.
Impaired heart or lung function (skin colour changes, short of breath, rapid breathing,
drowsiness, unconciousness)
Child cannot tolerate the discomfort of fever, is not able to follow a treatment protocol.
Child at risk for developing epilepsy
Family history of seizures
Atypical seizures (>15 min.)
Multiple seizures within 24 hrs.
1 st seizure under 12 months old
History of nervous system abnormalities

Febrile seizure risk

This is the final straw for most parents when thinking about your child. What if they have
neurological or brain impairment? What if its all my fault? While seizures definitely can
happen and are scary, the risk of long lasting nervous system impairment is extremely
low. If a child has one febrile seizure lasting more than 10 minutes, that child will have a
10% greater risk of developing epilepsy (4). Children who have simple febrile seizures
typically aren’t hospitalized and there is no treatment necessary. The following are some
stats and info on febrile seizures:

Most occur in 3 months – 5 year olds. Usually from a non-brain related infection (ie.
throat infection, ear infection)

4% American children have a febrile seizure before the age of 7. This is considered
relatively common. Rarely they occur more than once during the same bout of illness

Usually occur at the beginning of an illness or when temperature spikes

• No increased risk of neurological defects, decreased IQ or epilepsy UNLESS they
have other risk factors (family history, abnormal development, previous
neurological deficit, seizure lasts >15 min)

This can be an overwhelming amount of information. Especially when your little one is
sick, screaming, and it all is happening at 3 AM. Take 3 deep breaths and know this:
The body can usually control the fever, there is low risk of neurological damage, fevers
are useful, and if you want the reassurance and comfort by all means seek medical
help. It is always reasonable in these cases!

Written by Dr. Mollie Brennan from Natural Care Clinic

1) Wong T, et al. Combined and alternating paracetamol and ibuprofen therapy for febrile children.
Cochrane Database Syst Rev.  2013 Oct 30;10:CD009572. doi: 10.1002/14651858.CD009572.pub2.
2) Graneto JW, Soglin DF. Maternal screening of childhood fever by palpation. Pediatr Emerg Care. 1996
3) Jennifer L. Hamilton, MD, Sony P. John, MD. Clinical Red Flags for Serious Infection in Children Older than One
Month. Am Fam Physician. 2013 Feb 15;87(4):254-260.
4) NIH. Febrile Seizures Fact Sheet. 2018-07-06. Accessed Nov 10 2018. Available from:
https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-She... .