Mother: My baby had a fever
Me: How high was the fever?
Mother: I don’t know. So hot he would burn you if you touched him.
Everyone has had a fever. Maybe not quite that high, but they’re common. They make us feel crummy. And, they’re the source of a lot of angst among patients. Especially parents. The fever talk is one that I give frequently to moms and dads. Hopefully I can put you at ease that next time you or someone you love develops this hyperpyrexia (fever).
First, fevers themselves are not dangerous. They don’t fry your brain. Yes, a fever usually means there is an infection (rarely, fever is related to something different going on, like a reaction to a drug, or something that has triggered inflammation in the body). Fevers don’t tell us whether an infection is serious or not. Just, that there is an infection present. Even how high the fever is doesn’t go very far with predicting how bad an illness is. Doctors look at other things as we try to determine if there is something to be worried about. We’ll get to that below.
We treat fevers with acetaminophen (Tylenol) and ibuprofen (after 6 months of age). Ready for the big shocker with these two drugs? Whispered voice: you can give them both at the same time. Gasp! Yes, these two drugs are in different classes. Their side effects don’t add to one another. So, you can give them together. You don’t have to alternate them back and forth every 2 hours. You CAN alternate them. But, you don’t have to. Don’t give either one more frequently than every 4 – 6 hours.
Here’s another pearl. Whether or not a fever goes away when you give Tylenol and/or ibuprofen doesn’t tell us whether the infection is serious. You can have meningitis (a serious brain infection), give Tylenol, and the fever may go away. Some fevers from just a simple virus may not get better with just a dose of medicine. We have to look at other things to determine whether or not to be worried.
It takes a lot of experience to identify really sick patients. But, here is some stuff I look at to help determine if I need to start testing.
• Age – the younger the child, the closer I have to look at him. Children less than 2-3 months age usually require testing by the doctor. With newborns, they don’t show as many external signs of serious illness as older children and adults. Elderly patients, also, warrant a closer look when they have a fever.
• Appearance – a child who is truly lethargic is worrisome. But, that’s doctor lethargic, not parent lethargic. Lethargic to doctors doesn’t just mean lying around. If I started an i.v. on your child, would he get upset and fight? If he doesn’t have the energy, I’m definitely worried. Difficulty breathing, severe headache, stiff neck, and really pale color warrant an evaluation.
• Duration – when fevers are lasting 5-7 days, I start thinking about doing some testing. Fevers lasting a week or longer can be from something other than infection.
• Other factors – someone getting chemotherapy, which suppresses the immune system, should be evaluated at the first sign of fever. Also, recent surgeries to go along with that fever would make an evaluation more important. Some other common conditions that warrant a closer evaluation: children not immunized, diabetics, elderly, dialysis patients, i.v. drug users, and anyone with multiple serious medical conditions.
This list is not complete. Any time you are worried about someone with a fever, get checked out. If you have a child who seems to be getting worse instead of better over time, see the doctor. But, don’t hesitate to treat the fever before you go. We will believe you that your child had a fever. Honestly, it helps me more to see how the child looks when the fever goes away. Everybody looks bad when they have a fever. But, if the child’s fever is gone, and she still looks quite puny, I might need to do some tests.
Most fevers don’t need antibiotics, but we can cover that in the future. Meanwhile, the next time someone at home gets sick, treat it with Tylenol and ibuprofen, sit back, and watch the magic. A little extra TLC doesn’t hurt either.