Dr. Bob: Fever in my child scares me. When she gets sick and runs a fever, I worry about seizures and serious infection. She is now 6 years old and has fewer high fevers, but she had many when she was very young. Is there a possibility of brain damage? I know that I will worry about any grandchildren the same way.
Answer: Your question gets the core of many pediatric visits and concerns of parents. Let’s review a basic principle of a fever – it is a normal reaction of the body to fighting an infection, usually a viral infection. In that sense, it is a healthy sign that the body recognizes an infection, mounts a response to the infection (white blood cells and certain chemicals are released that cause the body to raise the temperature), the immune response works, and then the fever comes back down. We all know this cycle of chills (when the fever is coming) and then sweats (when the fever goes away). This cycle can occur many times in the course of a “routine” viral infection. The height of the temperature is not as concerning to me as the status of the child. I have seen many children with high fevers (104 degrees F) that look mildly ill and some with low grade fevers that concern me greatly. So, the assessment of the child is more important than the temperature per se and that is why a visit to your pediatrician at times of concern is very important.
Now I stated that fever is a normal reaction to fighting a viral infection. We certainly can and do treat the fever since we know that the child will feel better (and the parents will feel better!). I will not cover the dosing of medications for fever here, but I do want to address several fever-related issues.
- Newborns and infants – Fever in newborns or infants is of concern and should be taken seriously. The fever might be a sign of a serious infection since the early immune system is not as good in warding off viruses and bacteria. And bacteria are much greater harm to newborns and infants. Again, the status of the infant should still be assessed when they are ill. The lack of fever is not necessarily reassuring if the infant appears ill. Blood tests and cultures are usually indicated.
- Children with chronic disease – Children with heart disease, respiratory disease, renal disease, neurologic disease, cancer and other chronic problems are at increased risk for serious infection because their immune systems are challenged from the underlying conditions. Fever in these children is more of a concern and calls out for assessment and possible treatment. The fever can rise rapidly and be a sign of a serious infection that needs antibiotics right away.
- Febrile seizures – A small percentage of children will have a seizure with a high fever.Fortunately, when this occurs, it is self-limited, does not signal that brain damage will occur, and typical development ensues. Every so often, you read about seizures with fever (this is actually different than febrile seizures) leading to a neurologic problem. This is usually associated with an underlying problem that needs more attention.
Fever in children without underlying problems is more concerning to the parents than the doctor. Treatment is often not necessary. We know that it is part of the body’s normal defenses to fight the infection. Nobody likes fever and treatment is fine, but panic is not needed unless other signs of serious illness are present.
Dr. Saul is Professor of Pediatrics (Emeritus) at Prisma Health and his website is www.mychildrenschildren.com. Contact Dr. Bob at askdrbobsaul@gmail.com with more questions.