Fever can be scary. It brings in many parents and even adults no matter the time of day. However, there is a lot of misinformation regarding fevers which brings about this important discussion. Using available evidence, we are going to talk about fevers and some of the main myths versus the actual evidence. As always, with topics like these, it is worth remembering that this does not replace clinical judgment and is meant to be informational. Any time there is concern, it should be appropriately evaluated and managed.
There are a lot of caveats in this discussion so please listen to the podcast in addition to reading these show notes for a better understanding of the many pearls related to this subject. Also, as always, links to the related evidence are built into the actual blog post and you can click on the links for further evaluation. However, some responses may not have links in them, but are most likely cited earlier in the post.
Myth: A warm child is a febrile child.
Fact: Not exactly. Children can be warm for many reasons. Activity such as play, environmental temperatures, crying, and infection are all potential causes. There are some others such as brain injuries that can cause an elevated temperature, but these are usually pretty clearly identified or at least suspected. Although most children who are ill appearing and feel warm do have a fever, it is best to actually measure a temperature. Keep in mind, core body temperatures, especially rectal, are most accurate.
Myth: Oral temperatures between 98.7° and 100° F (37.1° to 37.8° C) are low-grade fevers.
Fact: These are actually still considered normal temperatures. The temperatures can very throughout the day. A true low-grade fever is 100° F to 102° F (37.8° - 39° C).
Myth: If there is a fever, it is bad for the patient.
Fact: Fevers are part of an immune response and as such are helping fight infection. Temperatures between 100° and 104° F (37.8° - 40° C) are beneficial in of itself. If the patient is in pain or appears uncomfortable, using agents such as ibuprofen and acetaminophen can be beneficial while also treating the fever itself.
Myth: If we treat the fever, the patient will be sicker and for a longer period of time.
Fact: Current evidence does not demonstrate that antipyretics such as acetaminophen or ibuprofen will slow the resolution of fever in patients.
Myth: Well, a temperature over 104° F (40° C) is bad, right? It can cause brain damage!
Fact: This is actually based on data that is not directly related to fevers and infections. It is not the temperature itself in infection that is harmful to the brain. Based on the best current evidence, only temperatures above 108° F (42° C) can cause brain damage. It is incredibly rare for temperatures that high and usually seen in unique situations such as with certain drugs, brain injuries, or in very hot environments (like when a child is left in a car). Temperatures elevated to over 104° F (40° C) have been also seen in athletes during events without harm.
Myth: A high fever will cause a seizure and that is bad.
Fact: Febrile seizures are actually uncommon. Some newer evidence demonstrates it may not actually be the temperature, but the illness and the body's response. If a febrile seizure does occur, it is usually benign although it can appear scary. These usually do not cause an permanent damage and rarely will cause future seizures or learning disabilities.
Myth: You should treat the fever to prevent seizures.
Fact: In studies that have been performed, medications used to treat fevers do not reduce the incidence of seizures from occurring.
Myth: The fever is going up and it has to be treated.
Fact: Our body has its own thermostat. Most of the time, fevers will not go above 104° F (40° C). They rarely go to 105° or 106° F (40.6° or 41.1° C) and while these are considered "high" fevers, they also are not causing harm.
Myth: We have been treating the fever, but it will not go back down to "normal" with the medicine.
Fact: Treatment will only bring most fevers down by 2° or 3° F (1° or 1.5° C). Sometimes lower doses may not be as effective and acetaminophen 15mg/kg and/or ibuprofen 10mg/kg is recommended.
Myth: We can only use ibuprofen or acetaminophen to treat the pain and fever.
Fact: Combined or alternating therapy with ibuprofen and acetaminophen may be more effective at reducing the temperature than one medication alone but the improvement in child discomfort is inconclusive with current evidence.
Myth: An exact temperature is important.
Fact: The patient's appearance and condition is more important than the actual number.
Myth: The fever is high so it must be bad.
Fact: A temperature does not indicate the severity. Serious bacterial infections can be seen even with normal or low body temperatures. It is more about the appearance of the patient.
Myth: If we cannot "break the fever" then it has to be bad.
Fact: We see this happen both with viruses and bacteria. The response to medication does not define the severity of illness.
Myth: We brought the fever down so now it should stay down.
Fact: It is very normal for fevers with most viral infections to last for 2-3 days. When the medicine wears off, the fever will come back and can be treated again. The fever will resolved once the infection resolves.
There are many great resources out there that can be trusted when it comes to the discussion of fever in patients. The SGEM has some great reviews on specific subjects especially with the use of anti-pyretics (fever reducers). Another great resources for tons of details would beEM Cases.
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