Impeding a fever not necessarily such a hot idea

BODY HEAT

December 08, 1992|By Linell Smith | Linell Smith,Staff Writer

Suddenly the toddler seems a little out of sorts; her eyes are glittering and she has the ruddy flush and feel of fever. No matter how familiar a sight, it can cause anxiety in the most reasonable parents.

Yet physicians worry that many parents have become fever phobic, obsessed with controlling fevers because of their misconceptions about the nature of elevated temperatures. Several local doctors say fever should be viewed as a sign of an underlying illness, not as a disease itself. They also point to studies suggesting that fever is the body's natural way of fighting infection.

A 1989 report in the American Journal of Pediatrics, for instance, showed that children with chicken pox who were given acetaminophen (Tylenol) to reduce their fevers often took a half-day longer to recover than those who didn't, says Timothy F. Doran, a Baltimore pediatrician and one of the authors of the study.

Dr. Doran blames the medical profession for furthering the notion that fever itself is dangerous: "As soon as you go to the emergency room, they stick the thermometer in your mouth. Not until the last 10 years have we gotten a better understanding of the physiology of fever. We need to help parents understand that it's not the fever that's dangerous, it's whatever is causing it.

"Parents should be more worried about the appearance and attitude of their sick children than about the height of their fevers. I'm less concerned about a child with a temperature of 105 who's playing around and active than one who has a temperature of 101 and is lethargic."

In infants, fevers should cause concern, physicians say. Parents should always consult a pediatrician if the feverish child is less than 2 months old because fevers in that age group often point to serious bacterial infections, which can be treated with medication. For children, temperatures under 100 are not considered fevers.

Common illnesses such as ear infections can provoke high fevers that often catch parents by surprise, doctors say.

"A temperature of 105 is not unusual in such normal childhood illnesses as strep throat, chicken pox, normal childhood viruses and roseola -- and those aren't necessarily serious illnesses," says Dr. Jean Ogborn, instructor of pediatric emergency medicine at Johns Hopkins Hospital. "Herpetic stomatitis, or mouth blisters, can also give you high fevers."

Sometimes children can run mild fevers without any illness at all. Dr. Barnaby Starr, a pediatrician at Union Memorial Hospital, points out that children's body temperatures often rise if they are dehydrated or teething.

Many parents try to reduce a child's fever simply because they fear it might lead to convulsions or brain damage.

"Some children -- maybe 4 percent -- will at some time or another have a convulsion with a fever," says Dr. Doran. "It's related to the height of the fever and usually occurs within 24 hours of the onset of the fever. Those kinds of seizures are completely benign. If someone is at the point where their child has had a fever for a couple of days, they usually don't have to worry about seizures."

Rather than continuing to climb, a fever will reach a certain point then level off, he says. Brain damage is unlikely to occur unless a temperature reaches 108 degrees.

When should parents try to reduce a fever?

"I think Tylenol is a good drug for the relief of symptoms, such as a headache or the pain of an ear infection," says Dr. Doran. He says, however that he often advises parents who call about fevers of 101 or 102 not to treat them if their children are playful and active.

Dr. Starr emphasizes that fever helps the body fight infection.

"It makes your metabolism and immune system work harder. If you try to give Tylenol every three hours, you could make an illness last longer."

BY DEGREES

Parental concerns about fever have led to an exotic array of digital thermometers and skin fever strips for children. There's even a $120 infrared thermometer designed to measure fever accurately in less than a second when the instrument is pointed correctly at a child's eardrum.

` Among the choices:

* Glass mercury thermometers

Advantage: Accurate, reuseable.

Disadvantage: Hard to read, breakable.

Cost: $4.

* Digital thermometers

Advantage: Accurate, easy to read, reuseable.

Disadvantage: Replace battery.

Cost: $12.

* Fever strips for forehead

Advantage: Easy to read, non-invasive.

Disadvantage: Less accurate, cannot reuse.

Cost: $2.50.

* Tympanic thermometer

Advantage: Accurate temperature in less than 1 second, non-invasive.

Disadvantage: Results can vary unless used precisely. Replace battery.

Cost: $120.

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