Fever is by far the most common symptom for visit to a Pediatrician. For most parents, fever is one of the most concerning and alarming symptoms their child can have. Many parents have false beliefs (myths) regarding fever. They think it will hurt their child. They worry and lose sleep when their child has a febrile ailment. In this article, I shall bust the most common myths about fever.
Myth #1- My child feels warm, so it is a fever
Fact- Children can become warm for many reasons. One of the common causes is excessive clothing, especially in a young infant. Other causes are playing hard, crying, getting out of a warm bed, or hot weather. In these cases, they cool down to normal in about 20 minutes. However, most children who act sick and feel warm do have a fever.
Myth #2- The only normal temperature is 98.6 °F and any temperature above 98.6 °F is a fever
Fact- Fever is defined as oral temperature more than 100 °F or 38 °C1 (yes more than this temperature only !). Armpit temperature is normally 1 °F or 0.5 ° C lower than the oral temperature. In essence, normal body temperature varies with the site of recording. Also, body temperature is normally 1 °F or 0.5 ° C higher in the evening compared to the morning. Oral temperature between 98°F to 100°F is normal.
Myth #3- Fevers are bad and are dangerous to my child (hence it must be treated aggressively)
Fact- Fever is not caused directly by a virus or bacteria, but it’s actually by your child’s immune system fighting the germs. It is a protective mechanism and a sign that the body’s immune system is turned on. Higher temperature reduces the multiplication of germs. Most fevers are good for sick children and help the body fight infection.
In fact, before antibiotics were discovered, many patients with neuro-syphilis were treated by inducing fever injecting malaria pathogen2. Malaria was then treated with quinine. Of course, some patients succumbed to malaria (not fever), but neuro-syphilis was a terminal ailment with certain death. Luckily Alexander Fleming discovered penicillin in 1928!
Although it might cause discomfort, we may be causing more harm than good by treating fever.3 Treatment of fever is not of much benefit in reducing the disease course and has been documented to increase viral transmission in common cold and flu. Most guidelines recommend treating fever only if it causes discomfort to the child.4
But what if your child has febrile fits?
About 1 percent of children between 1 to 5 years of age can have fits with a fever – this is called a febrile seizure or febrile fits. Febrile seizures are scary to watch, but they usually stop within five minutes. They do not cause brain damage or have long-term side effects. Children who have had febrile seizures have similar mental development and learning abilities compared to other children. Furthermore, treating fever has been ineffective in preventing febrile seizures.5 In other words, if your child has febrile seizures, and if the seizure has to occur during the current fever episode, it will occur regardless of whether you treat the fever or not.
Fact- When an antibiotic specific to the causative bacteria is used, it will help the fever to come down soon provided it is caused by bacterial infection. However, most fevers in any age group are caused by the virus. If you do feel your child needs antibiotics it is better to visit a Pediatrician. Purchasing antibiotics directly from the pharmacy is more likely to cause harm. (Read “The 12 common myths in the common cold”) Most Indian medical shops are not manned by certified pharmacists,6 despite rule by the Supreme Court of India. Also, pharmacists are not allowed to prescribe drugs by themselves.7
Myth#5-The exact temperature is very important. If it is high, the cause is serious
Fact- How your child looks is what’s important, not the exact temperature. If the fever is high, the cause may or may not be serious. Contrary to the popular belief, the high-grade temperature can be caused by bacterial as well as viral infections.8 If your child looks well and is playful, the cause unlikely to be serious. It is better to have a playful child with a high-grade fever than a lethargic child without fever or a low-grade fever. In other words, look at your child and not at the thermometer.
However, if your child is less than 3 months of age, they must be seen by a doctor. This is because these babies have immature immunity and hence any ailment can suddenly become serious. Read “Fever in children-the best strategies at 3 different sites-home, hospital or emergency” to know when it is safe to treat fever at home and when you should visit a doctor or take the child to the emergency. Most Pediatricians admit babies less than 3 months with fever and start antibiotic injections. Fever > 101 °F armpit or 102 °F oral (Yes more than this temperature only) is defined as high degree fever.9 The corresponding temperatures are 37.5 °C axillary and 38 °C oral in a Celsius thermometer.
Myth #6- If the temperature doesn’t come down, the cause is serious
Fact: Whether fever comes down or not, is not related to the seriousness of the infection. The height of the fever and how long it lasts do not tell us whether it is caused by a virus or bacteria. Again, what matters most is how your child looks.
Myth #7- High fever causes brain damage
Fact- Fevers from infections do not cause brain damage, even when they get up to the 104 – 106°F range (around 42 °C). A temperature of more than 105 is seen only in malaria. The only time an elevated temperature can cause brain damage is when it reaches above 108 degrees, and this is very rare and is not due to fever but due to heat strokes and anesthetic drug reactions.
Myth #8- Getting drenched causes fever
Fact- As discussed previously, fever occurs due to an immunological response to infection. Getting drenched can no way cause this symptom. In fact bathing with lukewarm water during fever reduces body temperature and makes your child feel better. Although, most parents would not resort to this (neither I am suggesting you do), if the child does get drenched inadvertently, it is not a cause for alarm. In fact, in a large review,10 two studies demonstrated bathing during fever to be beneficial, whereas the other 5 showed it to be equivocal.
To conclude, fever is a symptom of an underlying infection, mostly viral and not an ailment by itself. It is harmless and often beneficial to fight the infection. We do more harm than good by treating it, especially when the child is not bothered by it.
Kindly comment if any of these facts you do not agree with, giving reasons. for the same. You can also ask any queries you have.
The following are the links to touch and infrared thermometers to monitor fever at home
- CDC Definitions of Signs, Symptoms, and Conditions of Ill Travelers
- Treatment of syphilis with malaria or heat
- Fever and sickness behavior: Friend or foe?
- Fever in under 5s: assessment and initial management
- Antipyretic agents for preventing recurrences of febrile seizures: randomized controlled trial
- Most med shops run by unqualified ‘pharmacists’
- Fact Check: No, Indian government has not approved pharmacists to run clinics in the country
- Fever in Children: Pearls and Pitfalls
- Fever, fever patterns and diseases called ‘fever’ – A review
- Physical methods for treating fever in children