To Mothers and Fathers: Let's Embrace Fever!
Professor Kenzo Takahashi, M.D., Ph.D.
Accessible Rail Medical Services Tetsuikai, Navitas Clinic Kawasaki,
Department of Pediatrics, Kanagawa, Japan
This summer in 2023, along with the ever-present concern of the novel coronavirus, there's an outbreak of summer colds among children. With summer colds, an increasing number of parents find themselves grappling with their children's fevers. It's worrisome when young children develop a fever, isn't it? Concerns arise, like, "Could it damage their brain?" or "Will a persistent fever lead to pneumonia?" The worries seem endless.
Pediatricians are likely among the medical professionals who most frequently deal with patients with fevers. No matter how mild the symptoms of a child appear to be, if it's the parents' first child, and especially if it's the child's first fever, I make it a point to explain thoroughly. Even if the medical practitioners deem it to be a mild case, for parents, it may be their first experience, and they may perceive it as severe.
Over the years, I've been consulted about various concerns related to fever and have learned a lot in the process. In this context, partly as a way of giving back, I will provide knowledge and coping methods related to children's fevers.
Facing a child's fever can be a source of immense anxiety for parents. However, there's no need for excessive worry. While fever might seem alarming, it's primarily beneficial to the body, and rarely harmful.
Is Fever Harmful?
Typically, when infections from viruses or bacteria occur, a fever ensues. A common concern associated with fever is the risk of brain damage. However, it's extremely rare for standard fevers to cause brain damage. Concerns about brain injury do arise with temperatures exceeding 42℃(107.6℉), but the human body, when confronted with common infectious diseases - be it influenza or adenovirus - doesn't usually reach such temperatures. Scenarios with temperatures surpassing 42℃ are predominantly associated with severe dehydration or heatstroke.
Reviewing the following Western hospital sites and resources, (1) to (3), it's evident that excessive anxiety over fever is unwarranted. Particularly, the site from Texas Children's Hospital communicates their message through "Top 5 Fever Myths and Facts".
(1) Seattle Children's Hospital - Fever Myths Versus Facts
(2) MedlinePlus – Fever
(3) Texas Children's Hospital - Top 5 Fever Myths and Facts
When examining infectious diseases as the cause of fever, viruses are the primary pathogens affecting children. It's believed that these viruses proliferate most effectively at around 37℃(98.6℉). Bacterial reproduction largely operates the same way. This means that when the body exhibits a slight fever, it provides an environment conducive for these pathogens to multiply. Conversely, the body's immune response becomes activated in tandem with the fever.
Now, consider what happens if the body temperature climbs to 38℃ (100.4℉), 39℃ (102.2℉), or 40℃ (104℉). In the presence of pathogens, their reproductive capacity diminishes while the immune system intensifies its activity. This essentially translates to the body naturally treating the infectious disease. Therefore, the notion that disregarding a fever could lead to pneumonia is illogical. However, it is conceivable that if pneumonia has already set in, the body could be fervently elevating its temperature in an attempt to treat it.
To summarize the discussion thus far, fever is not detrimental to the brain, and a higher fever can, in fact, be indicative of a more effective therapeutic response. For instance, during the onset of a fever, one may experience chills, which is a reaction where the muscles shiver in an attempt to produce heat. Essentially, it's the body's attempt to elevate its temperature rapidly. To such an extent, the human body endeavors to defend itself from pathogens through febrile responses.
However, while the fever has its benefits, it's undeniable that the accompanying discomfort during a fever is something one would wish to alleviate, isn't it? Let's now delve into how to manage fever.
Mechanism of Fever: The discomfort when hands and feet are cold
During the initial stages of fever, one often experiences persistent cold sensations, which can be the most distressing period. This is accompanied by a pronounced feeling of lethargy. For toddlers who can't yet articulate their feelings, this might manifest as constant demands to be held or as inconsolable crying. In adults, this phase is characterized by feeling cold, intense fatigue, and even when tucked under a blanket, the tips of their toes feel icy cold, leading to restless sleep and uncontrollable shivering.
However, eventually, sleep comes, and upon waking, one might find themselves sweating and the once-clutched duvet kicked aside. Doesn't it then feel as if the body has somewhat eased? The body is gradually acclimating to the feverish state. For children, when their hands and feet are cold, it indicates the onset of the fever. During this phase, they might be irritable due to the cold sensations. However, soon enough, these previously irritable children may start to doze off intermittently, indicating they are adjusting to the fever. Since the body produces the fever as a necessary response to illness, it naturally tries to adapt to this state. The body operates in a remarkably rational manner.
Understanding this mechanism can assist in more effectively supporting a child during their fever. If you touch their hands and feet and they feel cold, sympathize with their discomfort from the chills. If you're uncertain whether the child feels cold or hot, try placing your palm (which is usually warm) against their toes. If the child pushes their foot into your hand, it indicates they're seeking the warmth due to their chills. In such cases, wrapping them affectionately in a blanket can be soothing. If they persistently demand to be held, it's best to indulge them and hold them for a while.
Once the warmth permeates every nook and cranny of the body, the individual will soon drift into sleep. After a while, you may find that the child, who was initially snug under the blanket, has kicked it away or has rolled out of the futon. This is a clear indication that they have warmed up adequately and no longer require additional heat. It would be best to dress them in lighter attire at this point.
While some might advocate for "traditional wisdom" by keeping a child wrapped in blankets indefinitely, it's crucial to be wary. Over-insulating them can cause excessive heat retention, potentially leading to dehydration.
Why Don't They Drink Fluids?
Many parenting books or articles on fevers frequently advise, "Be cautious of dehydration when your child has a fever." Consequently, many parents desperately attempt to ensure their child consumes sufficient fluids. However, especially when the child's hands and feet are still cold, they often resist.
The rationale behind this is straightforward when considering the aforementioned fever mechanism. When the body is fervently trying to elevate its temperature, consuming fluids could potentially cool it down internally. That said, even if a child doesn't consume water during the initial stages of a fever, it doesn't necessarily lead to dehydration, so there's no need for undue concern.
Why Do Children Resist Fever-reducing Sheets?
A common concern I hear from parents is, "My child dislikes the cooling sheet and always peels it off." The reason for this is quite simple: the application is often premature. The body instinctively avoids anything that might detract from the heat it's trying to generate. Notably, even the best-quality cooling sheets only maintain their efficacy for a few hours. Keeping them on once their effect has waned could trap heat and exacerbate discomfort.
The ideal time to cool down is after the hands and feet have fully warmed up. From that point, removing the excess heat will also alleviate discomfort. Rather than applying a sheet, it may be more effective to use a cooling pillow or cold packs. While cooling the head is optimal, some children might resist even if they are adequately warmed.
In such cases, a clever technique involves placing cold packs inside a child's backpack and having them wear it. This strategy was shared by mothers of some patients, and upon trying it on my own children, it proved exceptionally effective. Indeed, mothers often possess invaluable wisdom.
When Should Fever-Reducing Medications Be Used?
After reading thus far, one might naturally question, "When should fever-reducing medications be administered?" In reality, these medications aren't essentially mandatory. Yet, haven't we often heard, "Use them when the temperature is above 38.5℃(101.3℉)"? Surprisingly, there is no scientific basis for this specific threshold. A more accurate statement would be, "If the temperature rises above 38.5℃, it's permissible to use them," rather than mandating their use.
It's often said that temperatures above 38.5℃ pose a lower risk of causing hypothermia as a side effect. Thus, while it's acceptable to use these medications, mechanically resorting to them every time the temperature crosses this mark is inadvisable. If you suppress a fever that the body is earnestly trying to raise, the body's temperature may spike again once the medication wears off. Continual usage of fever reducers in such scenarios can drain the body's energy.
It's essential to note that there's a significant difference between reducing the core body temperature with medication and cooling the body externally. For effectively activating the immune system, cooling the body's surface to alleviate discomfort is more beneficial than altering the core temperature.
Has Enrolling in Daycare Led to Frequent Fevers?
It's not uncommon to hear concerned grandparents proclaim, "Children in the past didn't get fevers this often. There must be something amiss with our grandchild! Maybe they're manifesting psychosomatic symptoms because their parents are too busy!" This perception is partly accurate and partly mistaken.
Historically, services like infant and toddler daycare didn't exist, meaning children rarely congregated in groups. So, during the times when the grandparents were active parents, it was infrequent for infants and toddlers to experience regular fevers.
However, nowadays, infant daycare is a norm. This means numerous children, still with developing immunity, are brought together. What happens when a cold-causing pathogen infiltrates this setting? Infections and associated symptoms like fevers and runny noses are almost guaranteed. Even if a child seems to have recovered and returns to daycare, they might swiftly come down with another fever. By developing fevers, children are essentially activating their immune system to combat these intruders earnestly. As evidence, after about a year to a year and a half, the frequency of such fevers usually diminishes. This trend might be somewhat inevitable for families where both parents are working. It's not a psychosomatic response.
In conclusion, it's a natural occurrence for children with still-developing immunity to experience recurrent fevers. Given this, we should endeavor to skillfully manage these fevers and support our children's immunological growth.
Note: This article is an edited and expanded version of an article originally published in the MRIC email newsletter by the Medical Governance Association on July 9, 2019.
About the Author
Professor Kenzo Takahashi, M.D., Ph.D.
Graduate of the Faculty of Medicine at the University of Tokyo (1994). Expertise in International Community Health, International Maternal and Child Health, and Infectious Diseases.
During his medical school days, he was deeply inspired by the community health volunteer system in Thailand, leading him to aspire to international health and public health. Following the advice of his mentor, he became a pediatrician. After experiences in remote island medicine in Tokunoshima, Kagoshima Prefecture, and urban pediatric emergency care, he furthered his studies due to witnessing a major measles outbreak, leading to the acquisition of his doctorate. His journey included affiliations with Juntendo University, the International Division of the Ministry of Health, Labour, and Welfare, National Center for Global Health and Medicine, and Yokohama City University. Since April 2014, he has been a professor at the Graduate School of Public Health at Teikyo University. He practices as a pediatrician at Navitas Clinic Kawasaki and Tokiwakai Jyoban Hospital. His motto is to "Reflect upon observing the field, and ponder while watching the children."