For many parents, fever is one of the most concerning symptoms a child can have. As a board-certified pediatrician, I want to put some of the scary fever myths behind us and set the record straight!
MYTH. My child feels warm and likely has a fever.
FACT. Children can feel warm for a number of reasons. For example, put your hand to their forehead when they’ve been playing or exerting themselves, when they get out of a warm bed, or when they’ve been outside in warm weather. I assure you they will feel “warm,” but that’s the body’s way of radiating heat and normalizing body temperature. Once inside or calm, the skin temperature returns to normal within a half hour.
I too have sometimes put my hand to my daughter’s forehead, but I try to catch myself before I fall into this old wives’ tale. If you’re concerned enough about a temperature, then go ahead a pull out a thermometer instead of relying on your hand which really isn’t reliable.
MYTH. All fevers are bad for children.
FACT: Many parents have a fever phobia and think a fever alone is detrimental. Fever is one of the body’s ways of fighting the infection. It’s a sign of inflammation occurring, and it is a normal response. Depending on the circumstance under which the elevated temperature occur, I often recommend treat the child, not the number. If your child is happy and playing/acting normally, no worries! If your child is uncomfortable while with fever, then go ahead and treat to help them feel better.
MYTH: A low-grade fever can range from 98.7°F and 100°F (37.1°C to 37.8°C).
FACT: These are still considered normal variations of the body’s temperature, and a true fever is 100.4°F in children. We believe the average median “core” temperature is 98.6 °F but that being said, normal temperature does vary during the day (see above). Core temperature is more reliable than outward skin temperature. That’s why for newborns we recommend rectal temperatures for accuracy, and for older children, orally measured temperatures are the most accurate. The accuracy of temporal thermometers that are swept across the forehead really depends on the make, model, and brand. Often, I find the more you pay, the better the quality. Personally, I find axillary sometimes tend to run a little lower and ear (or auxiliary) thermometers tend to run a bit higher. Rather than do the math and subtract or add yourself, I recommend sticking to the more reliable brands. If in doubt or have concerns, call or visit your pediatrician!
MYTH. If the fever is high, the cause is serious.
FACT: Not necessarily. If the fever is high, the cause may or may not be serious. If your child looks very well, the cause is perhaps less likely to be serious. One exception is in infants less than 28 days of age. They should always be seen by a health care provider right away if they have a fever because their immune systems are not fully developed. If it’s the weekend or office is closed and your baby spikes a fever, it’s best to call the on call physician and take them to the ER in this case. Newborns with fever are something pediatricians take very seriously.
MYTH. If you can't "break the fever", the cause is serious.
FACT. Fevers that don't come down to normal can be caused by viruses or bacteria. The response to fever medicines tells us little about the cause of the infection. That determination is made by a pediatrician after careful analysis of the history and exam of a child.
MYTH: Fevers can be dangerous, even causing brain damage or seizures.
FACT: Fevers are associated with some dangerous disease processes, but fever itself is actually a protective mechanism from the immune system. It’s a sign that the immune system is on to whatever pathogen the body is fighting. There is no particular number or degree of fever that we know can cause brain damage. As for seizures, the vast majority (96 percent) of children do not have seizures with a fever.
Febrile seizures are a particularly different topic that probably deserves its own blog poss. What we know about febrile seizures is it’s not the exact number but really the rate of temperature rise that precipitates the fever. Children who have had febrile seizures are not at greater risk for developmental delays or learning disabilities.
MYTH: All fevers need to be treated with fever medicine (such as acetaminophen or ibuprofen).
FACT: As a pediatrician and a mother, I advocate treating a fever if the child is uncomfortable. If they’re running around and playing as normal, then why treat? On the other side of the spectrum, I’ve treated my daughter with Tylenol when she is ill with a viral process but fever-free to provide comfort and pain relief. These medications are very safe for children in appropriate dosages, but the most important thing is how your child appears. If you do choose to treat the fever: We know that the immune system can still work at normal body temperatures. There is also no evidence that you're going to be sick longer if we treat the fever, and we want kids to be comfortable. Other ways you can help keep your child comfortable is to encourage fluid intake. Fevers can definitely cause dehydration. You can also remove a few layers of clothing if it helps them feel comfortable, depending on how over-dressed they may be. Don’t let them be so cool that they shiver and no cool water baths, please!
MYTH. Without treatment, a fever will keep increasing.
FACT: Actually, the body has a temperature set point deep within our brain. We have mechanisms to drive our temperature up and down. With the exception of specific cases such as heat stroke, serious brain infections, or comatose states, the brain does recognize when the body is too hot. Most fevers from infection don't go above 103° or 104° F. Very rarely, we may also see 105° or 106° F. WITH treatment, we can see a fever decrease by 2-3° F. It is normal for fevers to last 2-3 days with infections. If they persist, it’s worth telling your pediatrician to rule out other serious disease process. Fevers that lasts 5 days or more- even with other symptoms, even if you saw someone on the first or second day of the illness, is worth having your child checked out. Yes, it may still be a virus, but just to be sure we are not missing a red herring or another disease process is developing.
MYTH: A fever that goes away for a few days and then comes back means you should continue to give anti-fever medication.
FACT: Not true! Treat the child, not the number! If your child was doing better, and then suddenly, symptoms worsen or fevers return, it could be another virus or it could be a secondary infection. It’s not your job as the parent to know that. That’s what your friendly, board-certified pediatrician is for!
I hope this helps to put some of those scary fever phobias to rest!
Of course, this is for information purposes only and should not be construed as personal medical advice or diagnosis. It is the responsibility of the parent/guardian to seek appropriate medical attention when they are concerned about their child, including asking their healthcare provider about any clarification that may apply to their own child’s needs.
This post is meant to educate and should not replace the medical judgement of a licensed healthcare provider who is evaluating the patient.