Fever is Good. Really.

sick kid-01In about 400 BC, Hippocrates said “Give me the power to create a fever, and I shall cure any disease.” Hippocrates knew that fever was a symptom of disease, not the disease itself. It is the body’s response to illness-its defense against infection.

It’s 2400 years later, and I still spend my days telling people that fever is good, we want fever, fever means that our child’s immune system is working… Fever rules!

A normal human oral temperature is between 97.6 and 99.6 degrees Fahrenheit (37.5 – 38.3 Centigrade). Rectal temps are about a degree higher, axillary and ear temps about a degree lower. Temperatures vary by about a degree through the day, increase when you exercise, and vary from person to person.

The most common cause of fever is infection, but there are other causes: illicit drug use (amphetamines and cocaine), medicine side effects, brain trauma, heat stroke, cancer, vaccine reactions, hyperthyroidism, and inflammatory diseases like lupus, rheumatoid arthritis, and irritable bowel disease. Most of the non-infectious causes give a persistent fever, while fever from infection generally gets better after 3-5 days.

Note that teething was not on that list. Teething can increase a baby’s body temp a little, but not to the point of fever.

Pediatricians define fever as a rectal temp above 100.4 F. Random, but it works as a general rule of thumb.

We get fever when a part of the brain called the hypothalamus is triggered by “pyrogens,” which cause release of prostaglandin E2. Prostaglandin E2 resets the hypothalamus to a higher temperature, like the thermostat in a house. This causes peripheral blood vessels to constrict (thus your munchkins cold hands), generation of more heat, and shivering (small muscle constriction to generate even more heat).

Fever works to fight infection in a variety of ways. High temperatures:

  • Limit the spread of a virus (like the common cold),  by blocking that virus’s ability to explode the cells in which it has been multiplying to spread further throughout your body.
  • Hinder a bacteria (like strep throat)’s ability to divide and make more bacteria.
  • White blood cells, the cells that fight infection, move around better with a fever.
  • White blood cells also chomp on bacteria better with that high temp (phagocytosis).
  • Toxins produced by bacteria don’t work as effectively with a fever.
  • T-cells, which also fight infection, proliferate better.

Fever is good.

There are doctors who will tell people that they should never treat a fever. I, however, am in the “treat for comfort” camp. Fever generally makes kids feel tired (not always a bad thing), fussy, and can make them feel cold. It is uncomfortable and can burn off a lot of fluid at a time when we want our children to stay hydrated. A rapid change in temperature in a young child (6 months to about 5 years) can cause a febrile seizure. If your child is miserable, not drinking as much as you would like, or in pain from a sore throat or headache, acetaminophen or ibuprofen will help him or her to feel better.

Brain damage occurs with temperatures above 108 F (42 C), with things like anesthesia reactions and heat stroke. Only in Hollywood do you get brain damage from a common illness with a 104 F  temperature.

Normal childhood viral infections like colds and gastroenteritis generally trigger fevers in the 99 F to 104 F range. Fevers tend to go up a little in the morning, improve during the day, and spike higher at night. That 103 temperature that improves during the day but then spikes at 10 PM is actually pretty reassuring, because that is the classic viral fever curve. Kids generally get better on their own with rest, fluids, and time.

Bacterial infections, like strep throat, pneumonia, or sepsis, are more serious and sometimes need treatment with antibiotics. They classically give fever all day long, rather than in that morning and evening viral pattern. They are accompanied by symptoms specific to the source of the infection, like lethargy, breathing problems, sore throat, earache, or pain with urination.

So, when to worry? Your doc will want to see any baby under 3 months with a fever, because their immune systems are inexperienced at that age. We like to see kids with 104 F temperatures or fevers that persist longer than 3 nights, just to make sure there isn’t anything bad going on. Call us if your munchkin has trouble breathing, lethargy, inconsolable irritability, an earache, or pain with urination. We like to see kids with fever if they have compromised immune systems or serious medical problems. We like to see kids with fever caused by heat stroke rather than infection.

Never throw them into a cool bath or rub them down with alcohol, because fever seizures are caused by a rapid change in temperature, not by the actual height of the temperature. It is safe to give a child a tepid bath about an hour after they have a dose of acetaminophen or ibuprofen, because the medicine will keep the temperature from bouncing back up.

Never give aspirin to kids because it has been linked to Reye’s syndrome.

And if you’re worried, call your pediatrician. It’s what we’re here for.

Domesticated Momster

Just a Cold? Or is it the Flu?

sick kid-01Any given year, between 5% and 20% of the US population will catch the flu.

Influenza, or the flu, is a virus spread in tiny drops of fluid that an infected person has sneezed or coughed out. Your children can inhale these, or rub droplets contacted from surfaces–or other people–onto their eyes, nose, or mouth. After a 1-4 day incubation period, your child becomes sick.

The initial symptoms of flu include a sudden, high spiking fever, chills, headache, tiredness, and body aches. From there it progresses through sore throat and congestion. Symptoms generally last about ten days, with the worst occurring during the first three days.

Children can be sick for longer than adults, and have more complications.

Complications of the flu commonly include things like pneumonia, ear infections, and sinusitis. Less common complications include fever seizures, encephalopathy, inflammation of the heart, and death.

Serious complications are more common in children with underlying health conditions, but even healthy children can become severely ill. During the 2014-2015 season, more than 145 children died, and more than 200,000 kids were hospitalized with flu complications. Generally about 43% of hospitalized kids have no predisposing health problems.

Children at the highest risk are those with underlying conditions like asthma, a compromised immune system (cancer, HIV/AIDS…), or with chronic diseases (diabetes, seizures…) Also at risk are babies under six months of age, who are not yet old enough to get the vaccine and whose immune systems are not yet adult sized.

We try to make sure high risk kids get their vaccines if they can, but we rely on other people to also get their vaccines to “cocoon” these kids so that they are not exposed. If parents, chid care providers, and the other kids in daycare get their flu shots, then chances are that the cute little baby with heart disease will not catch the flu.

Vaccines rule. Preventing disease is always better and safer than trying to treat it once a child is sick.

Flu vaccines come in two types–shot and inhaled mist. The shot is a dead virus, the inhaled mist is a live attenuated (very weak) virus. Neither can give you the flu or make your child autistic. Since we give the vaccine in the midst of cold and flu season, some people are bound to become ill in the weeks after they get it. It is easy to blame the vaccine. The shot can make your arm red and sore; the mist, since it is live, can give you a mild stuffy nose and a low grade fever. So much better than what the actual flu can do!

Last, what should you do if your child does catch the flu? If he or she has any underlying health conditions or is under two years old, call your doc. We have antiviral meds that, while they taste horrible and are not completely effective, do help.

Then, just like when they have a cold, make them rest, push any sort of fluid they will drink, and treat the symptoms. Ibuprofen will generally work better for the body aches and headaches than acetaminophen. Salt water drops or sprays work for stuffy noses, and for kids over four, cold and cough medicines will help them feel better.

Keep them home, because they are contagious. Adults are contagious for about 5-7 days; kids can be contagious for more than 10 days. Both can be contagious about a day before they have any signs of illness.

Call your doc if your child has any breathing problems, lethargy, fever that persists for more than three days, or isn’t starting to get better after the first few days. Or just if you want to. That’s what we’re here for.