http://www.nytimes.com/2001/07/10/health/10BROD.html

July 10, 2001

PERSONAL HEALTH

Easing Parents' Anxiety Over a Child's Fever

By JANE E. BRODY

espite many attempts to ease parents' fears about fever, many are still overly concerned about it, often to the potential detriment of their children.

In a recent report, researchers at Johns Hopkins Bayview Medical Center in Baltimore noted that "fever phobia persists" among parents of young children, and that health care workers might not be doing enough to calm parents. In fact, doctors and nurses often seem to add to parents' concern, resulting in unnecessary calls and visits to the doctor.

As the researchers, Dr. Michael Crocetti, Dr. Janet Serwint and Nooshi Moghbeli said in their report in the journal Pediatrics in June, "Fever is one of the most common reasons that parents seek medical attention for their children."

Facts About Fever

Fever is not an illness; it is a symptom of the body's efforts to counter a disturbance. Fever is a natural response that evolved to help the body cope with an insult, which can be an attack from outside the body, usually an infection, or occasionally an internal threat like an autoimmune disorder.

Excessive body temperature can also be the result of an inability to cool down, for example, when a person becomes badly dehydrated from vomiting or diarrhea or very strenuous exercise or when a child is left in a closed, hot automobile.

Fever helps the body combat viruses and bacteria by retarding their growth and by stimulating an immunological response. So, reaching for a drug to bring a child's fever down may make the child more comfortable but may also delay recovery. For example, chickenpox lesions take longer to dry up if fever-reducing drugs are given. Pediatric experts say that in most cases, fevers below 102 degrees need not be treated at all.

The height of a fever is not an indication of how sick a child is or how serious the cause may be. A minor sore throat caused by a virus that goes away on its own may send a child's temperature soaring, but a more serious strep throat requiring treatment with antibiotics, may result in only a low-grade fever. So, parents should note what other symptoms may be associated with a fever of any degree.

Despite the indicators on thermometers, normal body temperature is not fixed at 98.6 degrees, but covers a range from 97 to 100.4 degrees. Thus, pediatricians do not consider a temperature under 100.5 to be a fever at all. Normal body temperature also varies by time of day, age, general health status and degree of physical activity.

The body has a limit to how hot it will get, and unless it is overheated by an external source, body temperatures rarely exceed 106. In a small percentage of children, fever can cause a seizure. But as frightening as such seizures may be, they don't cause serious residual problems and most children outgrow them by about age 6. Still, a pediatrician should be consulted the first time a child has a seizure to be sure that it is not the result of a more serious health problem like meningitis or pneumonia.

Signs of Fever Phobia

The term "fever phobia" was coined in 1980 by Dr. Barton D. Schmitt, a pediatrician at the University of Colorado Medical Center in Denver, who found in a study that parents were often unduly concerned about fever and overreacted to it. In the new study of 340 people who take care of young children conducted by the Baltimore team, 56 percent said they were very worried about the potential harm of fever in children, 44 percent considered a temperature of 102 was high and 7 percent thought incorrectly that body temperature could rise to a lethal level of more than 110 in response to an infection if the fever was not treated.

And, 91 percent of those interviewed (most were mothers) believed that fever could cause serious harm; 21 percent listed brain damage and 14 percent listed death.

More than half said they would check a child's temperature more than once an hour when the child had a fever, 25 percent would give fever-reducing medication for temperatures under 100 degrees and 85 percent said they would wake the child to give such medication. The researchers called such behavior "excessive and intrusive to children during the time that they are recovering from their illness."

They stated that frequent taking of a child's temperature was neither necessary nor desirable, and that waking a child to give fever-reducing medicine was rarely warranted.

The study also revealed that many mistakenly believed in the desirability of alternating fever-reducing drugs, giving acetaminophen one time and ibuprofen the next. Finally, the study found that parents frequently gave these medications too often, which can result in toxic effects on the liver and kidneys.

Assessing and Treating Fever

In an article on fever in Contemporary Pediatrics in May, Dr. Molly E. Rideout and Dr. Lewis R. First, pediatricians at the University of Vermont College of Medicine, offered many suggestions about managing fever in children. Feeling a child's forehead is unreliable for determining the presence of a fever. Accurately measuring body temperature is most important in infants younger than 3 months, immunocompromised children and children who have previously had febrile seizures.

Rectal temperature is considered the most accurate method. New digital thermometers, which give a reading in one minute, are reliable and much easier to use. They come in rectal, oral and axillary (armpit) versions. Oral thermometers can be reliable when a child is old enough to cooperate in keeping the thermometer under the tongue for the required time.

Pacifier thermometers take more than three minutes to record body temperature, longer than most infants and toddlers would keep the devices in their mouths. Ear thermometers, the Vermont doctors stated, "are fast and comfortable and free of risk," but, they added, "there is controversy about their reliability," with measurements that vary significantly between right and left ears and even in the same ear.

Children needing fever treatment should not be given aspirin. Parents have been told for years not to give aspirin to children under 16, because in rare cases it causes Reye's syndrome, which can be fatal.

All children, even infants, can be given acetaminophen, and those over 6 months can be given ibuprofen. But for infants under 3 months, call a doctor before giving any anti- fever medication. For those under 2, ask the doctor about the dosage, which is based on weight. Acetaminophen is given every four to six hours, as needed, but no more than five times in 24 hours. Ibuprofen is given every six to eight hours, as needed.

Sponge-bathing a feverish child with tepid water can speed the effect of a fever-reducing drug, but may be very disturbing to the child and in itself does nothing to reset the body's thermostat.

ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE.  THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.