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Hot Dog

By Dr. Scott Hamilton
December 27, 2019

My feisty little dog Milou hates squirrels. They're harmless, but you wouldn't know it the way he barks and barks when they're running around the yard.  When we let him out a high speed chase ensues, him nipping just behind the trespasser's tail, before the enemy slithers through the fence and is gone.  Milou continues to bark, his shrill yapping annoying everyone, particularly my back-fence neighbor, who blows an air-horn when he's had too much. Like Milou and squirrels, parents and grandparents are irrational regarding fevers. Their fear stems from what fevers used to mean in children, generations ago.  Before 1990, fevers could mean life-threatening illnesses like meningitis and blood infections.  Before 1950, it could mean polio or measles.  Ancient memories probably haunt dogs too, their DNA wired to attack intruders into territory and food supply meant for the pack. Like squirrels, fevers themselves are harmless, and actually good!  They're part of the body's immune response to invading infections.  The brain senses evidence of infection and sets the body's thermostat to make fever.  Just like cooking food kills germs in it, fever makes it harder for germs to grow in the body, giving the immune system a chance to overtake the infection and destroy it.  Myth buster: fevers don't hurt the brain, and seizures that accompany fever in infants and toddlers are rare and benign.  Finally, vaccines have eliminated the vast majority of serious infections that fevers once heralded.  These days, fevers usually mean mild illnesses like cold viruses and ear infections. More important than the fever is how your child is ACTING with the fever.  Kids in terrible pain, who work hard to breathe or drink poorly, or are lethargic; those are the ones we worry about. But if your child is drinking well, breathing comfortably, and of course tired from the fever but wakes up to act reasonably alert, then no emergency! For feverish kids who feel rotten, give them anti-fever medicine, like acetaminophen (Tylenol), or ibuprofen (Motrin, Advil).  Sometimes fevers make kids breathe fast, have fast heart beats, and act tired.  If these improve after medicine, that tells us things are okay. There's a term for irrational fear of fevers, like my dog's irrational hatred of squirrels- "fever phobia."  This term describes that fear, and the lengths parents go to combat it.  Some examples of parents talking fevers: "It shot all the way up to 100!"  "His fever was 102, so he had to come to the ER."  "I took her temperature every hour."  "He was shivering, I was afraid he might catch a seizure." These attestations reveal misconceptions about fever.  Fever is defined as temperature greater than 100.4 Farenheit, but temperature height rarely correlates with severity of illness.  In other words, higher fevers don't mean your kid's more sick. Some children in the hospital with pneumonia have temps of 101, some at home with ear infections are 103. Fevers don't cause brain damage, and won't rise to life-threatening levels if untreated.  But given these fears, parents go to extremes. They take their kids' temps hourly, wake them up at night to give them medicine, bathe them with rubbing alcohol, and visit the Emergency Department, as if their babies will burst into flames like overheated race car engines. Fevers are actually good.  As we said above, it's part of the body's defense mechanisms against infection.  There's a faction in pediatrics that wonders if we should even give anti-fever medicine, that maybe without them kids would recover faster.  No one has studied that yet, and certainly giving ibuprofen or acetaminophen (Tylenol)  helps your child feel better. Feverish kids feel bad- they have headaches, they don't drink well, they breathe fast and their hearts go fast, and they sleep so hard they can be difficult to arouse.  Anti-fever medicine makes these better.  Kids drink better, act more appropriately, and generally scare parents less.  But give enough- as much as the box says!  While fearing fevers, many also fear overdosing their children, and don't use adequate doses to alleviate symptoms or fever.  Then when the fever persists, they panic more. And no alcohol baths- these CAN poison children through skin absorption. With medicine, remember you're treating to help your child feel better, not necessarily eliminating fever.  If you can't get the fever down, don't panic.  As long as your kid's breathing comfortably, drinking adequately, and arousable, that's okay.

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