Studies show that nearly half of phone calls to pediatricians are about fever. As a pediatrician on call for 35 years I think that is probably an underestimate.
Why is that?
Many parents think that a temperature over 98.6 F is a fever. Most pediatricians consider a temperature of 101 F or higher as a fever, except in infants under 3 months where we pay attention to temperatures over 100 F. Any pediatric practice worth its salt has a handout or a website page describing fever as one of nature’s way to fight infection, as usually caused by common viruses for which antibiotics are no help, and as relieved easily by simple medicines.
Why do people fear fever so much?
1. People used to die from fever.
Yellow fever, Typhoid fever, and even scarlet fever, which pediatricians now consider just “a strept throat with a rash”, easily cured with penicillin.
2. “Is there a fever?” is usually the second or third question the pediatrician asks when a parent calls about a sick child.
This naturally reinforces the parent’s concern about fever in the child’s illness.
3. Fever can cause seizures.
Yes, BUT febrile seizures are not all that common, but when they occur they are ugly and scary. BUT, seizures usually happen as the temperature spikes up from normal. By the time a parent finds a child’s temperature to be 102, and the child has NOT had a seizure, the child is NOT going to have one with that fever. Therefore, logically, the time to worry about a febrile seizure is when the child’s temperature is normal. That is very hard for parents to understand, particularly if their child had a seizure with a previous fever.
4. Advertising media competition for market share among fever reducers (Advil, Motrin, Tylenol, and aspirin in the past) reinforces our perception that fever is bad.
5. Temperatures on the rise are expected by the parents to continue to rise.
This hardly ever happens, and many parents think that a fever over 103 F causes brain damage. Parents are not consoled by telling them that the brain can tolerate fevers of 106 or 107 F without permanent damage. Duration of fever is important, of course, but most fevers from viral infections peak in the afternoon/evening and go down in the morning for three days. This “roller coaster” is comforting to the pediatrician as an indication of a viral infection, but it seems to signal to the parents that the “fever is coming back” and “could get higher”.
6. Parents often measure fever duration in minutes, but pediatricians do so in hours or even days.
Every pediatrician remembers the phone call at 3 AM from the parent whose child just woke up with a temperature of 101 F and no symptoms except “being cranky”. It is virtually impossible to decide what is causing a fever in a child without symptoms in the first 24 hours. In fact, most viral fevers last for three days, go down during the day and go up at night, and cause no significant toxic symptoms. That is a key term for pediatricians, “toxic symptoms”. We often say to patients that if a child acts sick without a fever we are more concerned than about a child with a temperature of 102 F and is acting well. Yale University has led several studies looking at how clinicians pick the sick or “toxic” child out of all those with fever in the emergency room. They found that the more experienced clinicians did this better than the less experienced ones, and came up with a practical definition of toxicity independent of fever.
7. We desire zero risk level in our lives, and a fever, no matter how small or how short in duration, indicates that something may be wrong.
How can we explain that everyone must remove their shoes at the airport because one person had a bomb in a shoe, but we somehow can’t get gun owners registered and we accept the much greater risks of our kids being shot?