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Feverish Dilemmas
(Pyrexia - Fever)

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article published on page 33 in the February 26, 2014 issue of
The Mississauga News under the feature: Health & Beauty, Medicine Matters.
Portrait of Dr. Peter W. Kujtan, supplied 2005
Dr. Peter W. Kujtan

Fever in children causes much grief and worry in parents. It does not always signify the progression of rampant disease.

Acute fever refers to body temperature greater than 38.5 °C. and is a defensive response by the body to help augment our immune system. Our own immune cells release substances called "pyrogenic cytokines" which tell the brain thermostat when to raise body temperature. These cytokines get triggered when the immune cell recognizes certain proteins or signals produced by bacteria or viruses.

It is important to remember when you give a fever medicine to a child; you are inhibiting the signals going to the thermostat, and not the current temperature, so it takes time to see a result.

Fever tends to be higher after sundown, and unless the temperature is over 42 °C, there is little reason to be measuring every hour, and will only serve to aggravate your own anxiety and worry. Multiple readings any less than 4 hours apart don't help the diagnosis.

Having our immune system raise the body temperature helps stop invasion and replication of invaders in our body. The immune system can more easily defeat the enemy if their numbers are kept low.

The problem most parents have with fever is that the process of dealing with invasion is taxing to the body, produces aches and pains and an unhappy looking child.

Medications should only be used for comfort, and I often caution parents about misguided efforts to eliminate fever totally. The statistics suggest that 99.2 percent of children with a new fever below 40 °C are doing fine, are likely viral in origin, and will recover in a few days' time. Even when the fever gets over 40 °C, only five percent of toddlers have significant illness requiring treatment.

There are some exceptions to the rule when fever is the only symptom. Newborns in the first 8 weeks of life who develop fever need a medical evaluation. Children who have a prolonged fever lasting several weeks, and those that develop a second feverish episode several days after the first one passes, require medical evaluation.

In toddlers who are followed on a regular basis, it has been shown that Doctors are able to pick out the ones requiring treatment based on clinical intuition much of the time. This trait becomes eroded in centers where there is easy access to walk-in clinics.

Discuss with your doctor how to treat fever when those viral infections hit. Most toddlers can battle 6 to 12 viruses a year or more, and each successful battle produces a stronger immunity for the next.

Understanding the nature of fever is the key to feeling at ease. Most practices have qualified nurses on 24-hour call who can access physicians. They can be a source of reassuring advice at 3 a.m. when it seems that things are not going right.

Related resources:

SickKids offers tips for treating fever in children from the Hospital for Sick Children, Toronto. Recommendations by Drs. Goldman and Scolnik on treating a child's fever. "A study conducted by Drs. Ran Goldman and Dennis Scolnik, from the Emergency Department at SickKids, surveyed 248 parents who came to the hospital with children with fever. The study determined that 41 per cent of visits to the Emergency Department could have been prevented if parents had properly treated the fever at home."

Fever and Taking Your Child's Temperature from KidsHealth.

Check Your Symptoms: Fever or Chills, Age 11 and Younger from HealthLinkBC (British Columbia).

Everything You Ever Wanted to Know about Fever from the Children's Hospital of Eastern Ontario (CHEO).

Fever from Wikipedia. "Fever (also known as pyrexia) is a common medical sign characterized by an elevation of temperature above the normal range of 36.5 - 37.5 °C (98 - 100 °F) due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering."

Fever from MedicineNet, by Medical Author: John P. Cunha, DO, FACOEP and Medical Editor: Melissa Conrad Stöppler, MD. What is a fever? How should I take a temperature for fever? What is the treatment for a fever?

Fever in Adults from eMedicine Health by Medical Author: Charles Patrick Davis, MD, PhD, and Medical Editor: Melissa Conrad Stöppler, MD.

Fever and Taking Your Child's Temperature from Kids Health.

Treating Fever in Children from Web°MD.

Fever from MedlinePlus. "Fever is the temporary increase in the body's temperature in response to some disease or illness.
A child has a fever when the temperature is at or above one of these levels:

• 100.4 °F (38 °C) measured in the bottom (rectally)
• 99.5 °F (37.5 °C) measured in the mouth (orally)
• 99 °F (37.2 °C) measured under the arm (axillary)

An adult probably has a fever when the temperature is above 99 - 99.5 °F (37.2 - 37.5 °C), depending on the time of day."

Fever in Infants and Children from the College of Family Physicians of Canada.

Caring for a Child with a Fever from Healthy Child Manitoba. What is normal body temperature? What is a fever? How do you know if a young child has a fever? What is the best way to take a temperature? How do you take a temperature in the armpit? How do you take a temperature in the ear? What should you do if your child has a fever? Medication.

Fever Fears: A Guide for Treating Fever in Children by Leslie Gross Klaff, Parents Magazine. "You can't take chances when your child has a fever, but you shouldn't panic either. We'll explain what to look for so you can stay calm -- and help her feel better fast."

Fever: Ask Dr. Sears.

Ask Dr. Marla: Your Baby's Fever.

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