DON'T LET FEVER PHOBIA FOOL YOU

                         Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: TUESDAY, January 12, 1993                   TAG: 9301120270
SECTION: EXTRA                    PAGE: 1   EDITION: METRO  
SOURCE: Jane Brody
DATELINE:                                 LENGTH: Long
DON'T LET FEVER PHOBIA FOOL YOU
A conscientious new mother asked whether she should purchase a $120 thermometer that instantly measures body temperature when placed against the eardrum.
But the mother was asking the wrong question. The right question is, should the baby's temperature be taken at all, and if so, when? A second question is, if an infant's or child's temperature is taken, how accurate a reading is necessary? And third, what, if anything, should be done to reduce a fever?
Infants and children rarely need to have their temperatures taken, and when they are taken, they rarely need to be precisely recorded. In most cases, feeling the child's forehead is enough of a clue. And unless a fever is very high, treatment to reduce it could be counterproductive, knocking out one of the body's prime defenses against invading bacteria and viruses. Studies of infected animals have shown that those whose body temperatures are allowed to rise are more likely to survive.
If anything, pediatricians are worried not about parental laxity or inaccuracy in recording their children's temperatures, but about an excessive focus on the "degrees Fahrenheit" and insufficient attention to other signs and symptoms of illness that are usually more revealing and important. A child who is very ill may have only a slightly elevated temperature, while another who has a common respiratory infection may run a fever of 104 or more.
"Fever phobia" has become a frequent topic of concern in the pediatric literature. Experts say that undue attention to a child's temperature and mishandling of fevers generate a great deal of unwarranted parental anxiety, avoidable medical complications and countless calls and costly visits to doctors, clinics and emergency rooms.
It is time, they insist, to put fever into perspective as just one sign of ill health, often not a very telling one, and to reassure parents that fevers related to illness are in themselves rarely dangerous. A child's temperature would have to soar to over 106.5 degrees before there is danger of brain damage or death. This almost never happens unless the body's natural ability to cool itself is impaired, say, by enclosing a child in a sun-baked car or bundling a sick baby in too many coverings.
More important than precisely recording body temperature is monitoring a sick child's behavior and other symptoms. A child with a temperature of 104 who is alert and active is far less worrisome than a child with one of 101 who is unusually drowsy and irritable and has a stiff neck or high-pitched cry, which can be symptoms of meningitis.
Low-grade fevers in children rarely require more than symptomatic therapy: increased liquid intake and lighter clothing. Beyond 102, a fever that is associated with obvious discomfort can be treated with acetaminophen or aspirin, drugs known as antipyretics because they lower the setting of the hypothalamic thermostat. Acetaminophen is preferred because aspirin sometimes causes Reye's syndrome, an often fatal disease, in children with influenza or other viral infections. The main purpose of treating a moderate fever is to increase comfort, not to reduce the fever per se.
If a child's temperature rises above 104, sponging with slightly cool water (not ice water, cold water or alcohol) can be helpful, but only if it is done an hour or more after antipyretic (temperature-lowering) medication has been given. Otherwise, sponging can be counterproductive; if the thermostat setting is still elevated, the body will respond to sponging by shivering to generate heat.
Similarly, if the condition causing the fever persists, the temperature will begin to rise again once the effects of the antipyretic wears off. However, pediatricians advise against waking a sleeping child to give another dose of the antipyretic.
Body temperature is controlled by an area at the base of the brain called the hypothalamus, which acts very much like a thermostat. The temperature setting normally hovers around 98.2 degrees, give or take a degree. But in infants and young children, the normal temperature range is 97.1 to 100 degrees, lower after sleep and higher after eating and other activities.
An infectious illness calls the body's immune defenses into action. Activated white blood cells release interleukin 1 (formerly called endogenous pyrogen), which tells the hypothalamus to push up the setting of the body's thermostat. Interleukin 1 also lowers the level of iron in the blood, which impairs the survival rate of bacteria and viruses, which need high blood levels of iron to reproduce.
Chills and shivering (very rapid muscle contractions that generate heat) commonly occur as the body tries to raise its temperature to match the new higher setting of the thermostat. When the hypothalamus functions normally, which it does nearly all the time, its maximum setting is about 106.5, below the point of serious danger to the brain and other body tissues.
Although most parents associate fever-related seizures with soaring temperatures, febrile seizures can occur even at temperatures below 104. In fact, they often occur within the first 24 hours of illness, before parents are even aware that the child has a fever. Febrile seizures, while frightening to observe, rarely cause injury and do not damage a normal brain unless they persist for more than an hour.
Body temperature can also rise without a shift by the hypothalamus if the body is unable to cool itself properly. This may occur as a result of severe dehydration, during an intense physical activity like running in a marathon (particularly if the weather is warm and not enough liquid is consumed) or if a child is left in a hot car. In such cases, there is no protection against a potentially lethal rise in body temperature, which could soar to 108 or beyond.
For infants and most young children, body temperature can be accurately and inexpensively measured with a rectal thermometer. Although it may take one to two minutes to get a precise reading, within 30 seconds the mercury will rise to within a degree of the right temperature, which is sufficient for most purposes.
Older children can use an oral thermometer, placing the bulb under the tongue and holding it there, without talking, for two minutes. Oral temperatures are half a degree lower than rectal temperatures. Experts frown on armpit measurements, which they say do not give reliable readings.
Babies under 6 months rarely run more than a slight fever, even if they have a serious infection. For older infants and children, fevers up to 102 are considered low-grade and fevers of 104 are considered moderate.
According to Dr. Barton D. Schmitt, a pediatrician at the University of Colorado Medical Center who has studied fever phobia, it is not necessary to call the doctor for a fever alone unless it is very high (105 or above), the baby is less than 3 months old, the fever has lasted more than three days without an obvious illness or the child has a serious underlying condition like heart, kidney or lung disease.
Keep in mind, too, that when fever is caused by overheating the body, antipyretics are of no use, since the thermostat setting remains normal. Heat illness can be life-threatening and should be considered a medical emergency, to be treated by rapidly cooling the child with cool fluids both inside and out.

Jane Brody writes about health issues for the New York Times.

by Bhavesh Jinadra by CNB