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Fever

An elevated body temperature.

While the standard for normal body temperature is 98.6°F (37°C), normal body temperatures actually fluctuate within a range of one to two degrees, making it impossible to formulate a precise definition of fever based on a specific temperature. Children's temperatures are generally higher than those of adults and fluctuate more widely. They may vary depending on the time of day, the child's emotional state or level of physical activity, the amount of clothing worn, or the surrounding room temperature. In general, temperatures under 100°F (37.7°C) are considered "subfebrile" (i.e., not indicating fever). Rectal temperatures of up to 100.4°F (38°C) may be considered normal.

A part of the brain called the hypothalamus acts as the body's thermostat, keeping its temperature at or close to 98.6°F (37°C). When there is an infection (or certain other types of disease), the body's white blood cells produce specific proteins (endogenous pyrogens) that reach the brain through the bloodstream and stimulate the hypothalamus, which signals the body to increase its metabolic rate and consume oxygen faster, resulting in a higher body temperature. Fever is one of the ways the body defends itself against infections. It is commonly caused by viral and bacterial infections, including colds, earaches, and flu. When fever is present, the production of infection-fighting white blood cells is increased, and their effectiveness is enhanced. More serious potential causes of fever include pneumonia, urinary tract infections, appendicitis, and meningitis. Fever can also be caused by non-infectious conditions that produce inflammation—such as juvenile rheumatoid arthritis, Crohn's disease, and lupus—as well as overexertion, dehydration, allergic reactions, insect bites and stings, and toxic reactions.

A child's temperature can be taken in several ways. Rectal temperatures are about half a degree higher than oral ones. A rectal reading is considered more accurate than an oral one, which may be affected by previously eaten hot or cold foods or by a child's breathing. Underarm temperatures are considered reliable for young infants, and new electronic thermometers can measure temperature through the ear. Although fever is generally a cause for concern among parents, high fevers are not necessarily a sign of serious illness. Unlike adult temperatures, the level of a child's temperature does not necessarily indicate the severity of an illness. A mild cold may produce a fever as high as 105°F (40.5°C), while the fever accompanying pneumonia may only be 100°F (37.7°C). The temperatures of newborn infants are particularly unreliable because the baby's temperature control mechanism is not yet adequately developed.

Although fevers are generally not dangerous, they are treated because they cause discomfort and can prevent children from getting the sleep and nourishment they need in order to get well. Aspirin was the medication most commonly used to lower fevers until 1980, when researchers found that the use of aspirin to treat children's fevers caused by influenza and chicken pox was associated with Reye's syndrome, a dangerous condition that causes liver impairment and brain damage and can result in coma and eventual death. Since then, acetaminophens (sold under such brand names as Tylenol) have become the most widely recommended drugs for treating fever in children. Acetaminophens, which are available in liquid form, tablets and capsules for oral use, and as suppositories, are effective in treating fever but do not share aspirin's inflammation-reducing properties. Ibuprophen (Advil, Nuprin, etc.) is an effective fever reducer that is also an anti-inflammatory. However, it has not been on the market as long as acetaminophens and has been known to produce allergic and gastrointestinal side effects. A fever can also be reduced one or two degrees by sponging a child with room-temperature water (about 70°F [21°C]) while he or she sits in a tub filled with water up to waist level.

One frightening aspect of fever in infants and young children is that it can lead to a type of seizure called a febrile convulsion. These convulsions occur in 3-5% of all children and appear to be linked to an existing predisposition rather than to the severity of the fever or how quickly it has risen. Febrile seizures recur in approximately half the children who have them; about a third experience a second recurrence. Alarming as they are, there is no evidence that febrile convulsions cause any permanent damage or lead to epilepsy. They usually last only a few minutes (sometimes only seconds). While the seizure is happening, the child's head should be protected from injury and the airways kept open. Keeping the head turned to the side will prevent choking in case of vomiting. If the seizure lasts more than five minutes, an ambulance should be called. Whether or not emergency treatment is needed, a physician should be notified. It is important to determine that the seizure was due only to fever, rather than meningitis.

Most experts agree that a doctor should be notified immediately when fever appears in an infant under the age of eight weeks. Children at this age are susceptible to serious, even life-threatening, infections that can come on suddenly and need immediate attention. For children up to the age of three years, a doctor should be notified of any fever over 103°F (39.4°C). In older children, a fever of 105°F (40.5°C) or over requires prompt medical attention, as does any fever that lasts longer than four or five days. Medical attention should also be sought for any fever accompanied by unusual irritability or sleepiness, listlessness, pain, a stiff neck, difficulty breathing, reduced urination, or any other symptoms that arouse suspicion.

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