It is not uncommon to get multiple phone calls a day about fevers in a pediatric practice.  Sometimes those fevers aren’t actually fevers, but just mild variations in the normal day-to-day temperature.  Nevertheless, parents develop concerns and fears over this variation in temperature and what it could mean for their child.  But what led to this common fear?  

Earlier this week I saw an advertisement for Advil’s new dual action medication – Advil + acetaminophen.  One pill.  Both medications.  But why?   I have nothing against Advil, Motrin, Tylenol, or any of their generic substitutes.  Managing fevers and pain to help our kids and ourselves feel more comfortable is sometimes indicated.  However, this combination of fever-reducers in the market makes me wonder how much our fear of fevers has taken over our daily lives.

How does our body manage its temperature?

It is widely accepted that our body’s basic metabolic activity is the main contributor.  It is not uncommon for your temperature to fluctuate by 1 degree Fahrenheit throughout the day, typically hitting its “normal” around 4 AM and peaking between 4-6 PM.  Excessive exercise can increase your core temperature for up to 30 minutes, usually returning to normal shortly afterwards.  All of this is controlled by the thermostat of the brain – the hypothalamus – which releases prostaglandins to adjust our temperature as needed.  

But what happens when we get a fever?  

As infection from a bacteria or virus occurs, cytokines are released in the body.  This triggers your hypothalamus to raise the core body temperature.  As the core body temperature rises, cellular activity increases.  This increase in cellular activity improves the activity of your body’s immune system through various mechanisms.  The most immediate response is an increase in innate immune cell activity toward the specific infectious organism.  This allows your body to start fighting the infection right away while it prepares other components to develop a prolonged resolution to the illness as well as long term immunity.  The increase in core body temperature also inhibits replication of the virus or bacteria in the body, further limiting its ability to cause worsening symptoms.  

Are we hurting ourselves by taking antipyretic medications?

You may have heard the advice to give ibuprofen and/or acetaminophen for fevers, sometimes being told to alternate between the two.  This alternation was started to minimize the risk for side effects from overusing either medication; however, it does not have an increased effect on fever control overall.  Taking these medications is sometimes needed to help our children feel better, allowing them to sleep, eat, or drink fluids more readily during significant illness.  But could this also be hurting them?

Studies involving the flu have shown a 5% increase in flu complications in those patients who took a fever-reducing medication compared to those who did not.  Patients in the ICU also had a worse outcome when frequently given these medications.  This is most likely due to prolonging the infection in the body by preventing its natural immune response from occurring to its full strength.  Warm-blooded animal studies, such as rabbits, with infections and fevers also show an increase in complications if not allowed to develop a fever.  

If our bodies were meant to have fevers, why do we worry about them so much?

Fevers are one of nature’s ways to help us fight infections and improve survival rates.  Our cold-blooded reptilian friends (who can’t create a fever on their own) also require an increase in core body temperatures to fight infections.  They accomplish this by sitting in the sun.  Even plants develop fevers when infected by increasing mitochondrial activity – did you know the temperature of a plant’s leaf can increase 2 degrees when infected with certain types of fungi?  

So if creation included the use of fevers to help us prosper, why are we scared of them?  This most likely began before frequent vaccination.  Nowadays, when you call your pediatrician for a fever we usually tell you, “Monitor for now.  Fevers could last 3-4 days with a viral infection. Etc.”  However, before widespread vaccination it was unknown if your child’s fever was a common cold versus something more sinister.  Polio, measles, diphtheria – these infections could lead to severe consequences for your child, and many times the initial warning sign was a sudden onset of fever.  This led to a common correlation of fever leading to things like brain damage.  However, fevers don’t cause brain damage (at least not at the levels our body will let it rise).  What DID cause brain damage was the infectious source itself.  

Over generations, this fear of your child developing a fever was conditioned into a common concern.  Even though vaccines have led to a dramatic decrease in many of these infectious causes for fevers and significant complications, the fever phobia lives on.  Marketing in magazines and on commercials will commonly show a child with a fever of 100; the parent’s face shows concern, worry, and many times fear.  But don’t worry, because you can give them a medicine to fix it! Right?  However, the use of that medication may actually prolong the illness, sometimes leading to other complications.

As I type this, the current pandemic has disrupted the fear of fever even more.  Could your child’s illness be COVID?  Is it this new MIS-C complication I keep hearing about?  This increase in concern is similar to how parents felt during those pre-vaccination generations.  The unknown is a scary concept.  With that said, be sure to contact your pediatrician if your child has a fever.  Listen to their guidance.  But don’t feel like you HAVE to start medications to bring that fever down.  Let it do its job.  Monitor for new or worsening symptoms, and if these occur then your child probably needs to be evaluated.  

What is your normal routine when your child develops a fever?  Do you run to the medicine cabinet or let the fever persist?  Don’t beat yourself up if you feel like you are one of those parents who get completely freaked out when we see triple digits on the thermometer.   We have been trained to act that way.  

Embrace the imperfect parent that you are.  We all are.  

Imperfect Dad, MD