$Unique_ID{PAR00004}
$Pretitle{}
$Title{Medical Advice:  Fever}
$Subtitle{}
$Author{
Editors of Consumer Guide
Chasnoff, Ira J}
$Subject{Fever Fevers oral rectal armpit temperature temperatures thermometer
thermometers}
$Log{}

Your Child:  A Medical Guide


Fever


     Everybody knows what a fever is, but many people don't know what it
means.  One common error is to assume that the higher the fever, the sicker
the child.  It is also commonly believed that fever is a child's enemy--that
it should be fought and the temperature brought to normal as soon as possible.
     The fact is that children past early infancy tend to develop high fevers
with little provocation.  Relatively harmless illnesses like roseola often
cause temperatures as high as 106 degrees_F, whereas many serious diseases,
such as leukemia and polio, may cause only a slight rise in temperature or
none at all.  Furthermore, it is not true that high fever causes brain damage.
     Remember that the degree of fever does not necessarily indicate the
degree of severity of the illness.  A child with pneumonia or meningitis who
has had a fever of 104 degrees_F is still quite ill even when the temperature
has been artificially reduced to normal.  A child with a strep throat and a
fever of 101 degrees_F is no less sick than the same child with a strep throat
and a temperature of 104 degrees_F.  Other symptoms (such as exhaustion,
confusion, and difficulty in breathing) indicate the severity of the illness,
not the degree of fever.
     It makes more sense, in fact, to regard a fever as a child's friend
rather than as an enemy.  A fever is an early warning signal that a child is
ill.  Fever also speeds up the body's metabolic processes (possibly including
its resistance mechanisms) and, in some instances, may help the body's
defenses overcome an illness.
     Fever, together with other symptoms, also acts as a barometer to help you
judge when an illness is ending.  For example, the course of a fever may
indicate whether an antibiotic is working effectively.  Finally, the pattern
of daily fluctuations in fever is characteristic of certain illnesses and may
aid the physician in making a correct diagnosis.
     A high fever does have disadvantages, however.  It makes a child feel
uncomfortable and, as it develops, may cause chills.  If a fever continues for
days, it may weaken a child so that it takes longer for the child to
recuperate.  In susceptible younger children, a fever may lead to convulsions
(see "Convulsions with fever").  For all these reasons, it is sensible to
reduce a fever.  However, it is important not to confuse treating the fever
with treating the illness, not to panic as a fever rises, and not to harm the
child in your anxiety to fight the fever.

A MATTER OF DEGREE

     No one can accurately estimate the degree of a fever by touch.  If your
child feels warm or appears ill, you must use a thermometer to accurately
register the temperature, which your doctor needs to know in order to plan
treatment.
     At any given moment, different parts of the body are at different
temperatures.  Furthermore, normal temperatures vary as much as 3 degrees_F
over the course of a day even when a child is healthy.  A rectal temperature
of 99.8 degrees_F or less, an oral temperature of 98.6 degrees_F or below, and
an armpit temperature (which is the least accurate) of 98 degrees_F or less
are all considered normal.  Despite these variations, all thermometers are
marked to indicate 98.6 degrees_F as normal.
     For the most reliable readings at any age, the rectal thermometer is
recommended, although it takes a little longer for the temperature to
register.  (A rectal thermometer differs from an oral one only in having a
more rugged bulb.)  The most practical instrument for home use is a
stubby-bulb thermometer, which can be used to take a child's temperature in
any of the preferred ways.

USING THE THERMOMETER

     Before using the thermometer, shake it briskly a few times to make
certain that the top of the mercury column is below 96 degrees_F and that the
bulb is intact.
     To take a rectal temperature, first lubricate the bulb of the thermometer
with petroleum jelly, and then spread the child's buttocks with the thumb and
forefinger of one hand so that the anal opening is clearly visible.  Insert
the bulb of the thermometer gently into the center of the anus and hold it
there for two to three minutes.  (Only the bulb portion of the thermometer
needs to be inserted to get an accurate reading.)
     The child should feel no pain or discomfort from having his temperature
taken rectally, but he probably will not like being restrained.  However, it
is important to keep the child from moving so that the thermometer will not
break.  To take a baby's rectal temperature, place the child face down on a
solid surface and put the heel of your hand firmly on the lower back.  An
unwilling toddler can be firmly clasped between your thighs and bent forward
over one of your legs.
     Although less reliable, an oral temperature reading is sufficient and can
be taken in a child who is old enough to hold the bulb of the thermometer
under the tongue with the mouth closed for three minutes.  (If the thermometer
breaks and the child accidentally swallows the mercury in the thermometer,
don't worry.  Thermometers contain elemental mercury, which is a nonpoisonous
and harmless form of the metal.)

CARE OF YOUR THERMOMETER

     After each use, the thermometer should be shaken so that the mercury
level is below the "normal" level of 98.6 degrees_F and then washed with soap
and cold water.  Sterilize the thermometer by soaking it in rubbing alcohol
before storing it in its case.  Place it back in the medicine cabinet where it
will be handy the next time you need it.  Do not let children treat the
thermometer as a toy.

TREATMENT OF FEVER

     The most reliable medications for lowering fever are aspirin and
acetaminophen, a nonaspirin pain reliever.  You can give one children's
aspirin or the equivalent amount of acetaminophen for every 15 pounds of
weight.  This dose can be repeated every four hours.  Other basic guidelines
for administering aspirin or acetaminophen include the following:

1. Do not awaken the child to give aspirin or acetaminophen.
2. Do not mix aspirin and acetaminophen or alternate them.
3. Call the doctor if fever persists longer than 48 hours or if other signs of
   illness are present.

     Keep a feverish child only lightly clothed or covered to allow the body
heat to escape, which will help lower a fever.  Other methods of reducing a
fever include placing the child in a lukewarm bath and encasing the naked
child in a wet sheet.  A child with a consistently high temperature should be
under the care of a doctor.
     Although giving aspirin has long been the accepted home treatment for
lowering a fever, aspirin should not be used if the child has a viral
infection, particularly chicken pox or influenza.  A condition called Reye's
syndrome has been associated with the use of aspirin in the treatment of
chicken pox or influenza (see "Reye's syndrome").  Reye's syndrome is a
relatively rare type of encephalitis (inflammation of the brain) accompanied
by changes in the liver.  The condition usually starts after the child has
begun to recover from chicken pox or influenza.
     It has not been proved that aspirin causes or promotes Reye's syndrome,
but it is recommended that aspirin not be given to children with chicken pox
or influenza.  Instead, sponge baths and acetaminophen (which has not been
linked to Reye's syndrome) should be used to manage the fever and other
symptoms.

RELATED TOPICS:  Chicken pox; Convulsions with fever; Influenza; Reye's
syndrome