Fever is a symptom of much concern for every parent. It can create insurmountable fear among caretakers. Obsession to bring down the temperature can draw the attention away from what truly matters in the care of a child with fever. Parents may have different definition of fever from health care providers. Our body temperature fluctuates throughout the day (a swing of as much as 1.7°C) and doctors generally do not consider a child to have fever unless the body temperature reaches 38°C.
There are various methods and types of thermometers to measure body temperature at different parts of the body, giving rise to more confusion to parents. Temperature can be measured by placing the thermometer in the rectum (most accurate), armpit (least accurate) or under the tongue. Fever strips and pacifier thermometers are inaccurate. Thermometer placed in the ear canal is unreliable for temperature measurement of infants less than 6 months old. The forehead thermometer is reliable for all ages.
Fever is commonly caused by infections but there are other causes of fever which are not related to infection, for example cancer, autoimmune disease and even teething. In the event of infection, the body temperature is raised due to higher set point in the brain. This is a mechanism to disable the enzyme function of bugs which are responsible for infections, retard bacteria growth and enhances our body immune system to fight the infection. However, when fever is too high, it gives rise to metabolic stress, increases consumption of energy, and may lead to dehydration.
When a parent sees that his or her child has high-grade fever, one of the commonest comment is that it will lead to brain damage. This is utterly untrue and unfounded. Brain damage due to fever is considered a myth. What is more important is to look for the underlying cause of the fever.
“Fever is directly related to death”. Another false claim by many lay people. It is the underlying disease process that leads to death. And the height of temperature alone is not always related to disease severity. Fever also does not predict that seizure will happen in a child, even if the child has history of febrile convulsion (a condition where the child develops seizure in the presence of fever).
There are people who routinely recommend giving paracetomol (a type of fever medicine) for children who had vaccination in order to prevent fever. Such practice may blunt antibody response to the vaccination received earlier. Even if there is fever after vaccination and the child appears well and not disturbed by it, the fever can be left alone because most of the time it is self-limiting.
Having mentioned all these, fever should still be treated if it causes the child to be uncomfortable or dehydrated. The aim is to keep the child as comfortable as possible and not treat the fever at the expanse of the child’s comfort. There is really no point to force fever medicine down the throat of the child or insert medicine into the anus if the child is feeding well, active, running about and is unaffected by the presence of fever. These can be traumatic for the child. And imagine if we do that, it will create an uphill task for us to ensure the child to take other more essential medication like antibiotics.
There are times that parents give oral paracetomol to a child regularly (4 to 6 hourly) but the fever never really subsides. In fear of myths such as fever causing brain damage, death or seizures, they give further doses of paracetomol into patient’s rectum, not realizing that this may cause overdosage and liver toxicity. Sometimes alternating different type of fever medicines may help but it increases chances of inaccurate dosing or overdosing. Different types of medicines should not be combined because of potential toxic effects when given together.
One common practice is to perform tepid sponging on a child with high fever with the sole aim to bring down the high fever. In essence, this can only be detrimental to the patient. This is because the brain which is functioning like a thermostat had already been trying very hard to regulate the body temperature at a higher set point but over enthusiastic and ignorant caretakers and even some health care providers (sorry to say) decides to overcome this natural phenomenon by fully exposing and sponging the child with water (sometimes with ice cold water). This in turn will lead to severe shivering, increased metabolic rate and energy consumption of muscles. Imagine if we walk into winter naked and without clothes. This is the exact experience that our children will get when they have fever and have to undergo this awful experience of tepid sponging. This method is outdated and certainly not recommended in the management of a child with fever. All the child needs is some loose clothing and fever medicine combined with care and love from all of us, of course with some awareness as well.
In summary, the temptation to treat fever as if it were the noxious culprit of all childhood febrile illness can be great, even to health care providers, but we cannot lose sight of what science has taught us, that is fever is only a sign, a part of many other symptoms of a real problem. If we succumb to such temptation, then we are treating our children less for the benefit and more to allay our own anxieties as parents. A sleeping child should not be awaken solely to be given fever medicine.
(written by Dr Ng Khuen Foong)