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Before treating, learn fever's boons

Feverish children are one of the most common reasons parents make panicked calls to doctors or head to the emergency room. But Minnesota internist and pediatrician Greg Plotnikoff rarely recommends bringing the body temperature back to "normal" with over-the-counter drugs.

Instead, he touts the benefits of fevers, the body's natural response to infection, and explains the downsides of treatment. When a high body temperature is artificially lowered, it can prolong the illness and make it more difficult for the body to fight against bacteria or a virus, he said.

"A fever is dangerous when it is suppressed and not recognized," said Plotnikoff, an integrative physician at Allina Health Care's Penny George Institute for Health and Healing in Minneapolis. "The best case for using (acetaminophen and ibuprofen) is to enhance comfort, either for the person or for their caregiver," he said. "For example, a child with a painful ear infection can keep parents up all night."

Still, most people overreact to fevers, research suggests, because they are commonly regarded as an illness that must be treated, rather than a sign that the body's immune response has kicked into gear. Parents suffering from "fever phobia" overmedicate, use cold baths unnecessarily and check a child's temperatures too frequently, studies show.

They also wake up their sleeping children solely to give them medication — though 80 percent of physicians say this is a bad idea — and unnecessarily rush them to the clinic or emergency room. In some cases, the children who arrive with what parents think are fevers aren't even truly feverish.

"If you treat fever, some research suggests the illness lasts longer and the patients are contagious longer," said Kentucky pediatrician Janice Sullivan, co-author of the American Academy of Pediatrics' guidelines on fever and medicine use in children. She encourages parents to ask the question: Is it better to let my child have some minor discomfort and a fever rather than just automatically treating them with antipyretics?

Physicians, however, often do suggest using acetaminophen or ibuprofen because people expect them to "do something," Sullivan said. Only a minority of doctors cite "discomfort" as the main reason for using the drugs, "which emphasizes the need for physician education," she said.

Here are six more things you may not have known about a fever:

High fevers do not cause brain damage. "Brain damage may occur from an infection such as meningitis or encephalitis," said Sullivan, but not from fevers. Brain damage can result when the body temperature soars to 108 degrees Fahrenheit, but this is caused by hyperthermia, or heatstroke, which is very different than a fever from an illness. Brain damage or death can occur if, for example, a child is left in a closed car in hot weather. Fevers also aren't likely to make an illness worse.

Bringing down a fever doesn't prevent seizures. Febrile seizures, which frequently result in an ER visit, are fairly common in children younger than 6 (about 3 in 100 kids), Plotnikoff said. Back when he was working in the emergency department, "I think several parents would have been surprised and even upset if I did not offer them acetaminophen or ibuprofen for their child," he said. But there's no scientific evidence supporting the idea that preventing or suppressing a fever prevents a febrile seizure, Plotnikoff said. And while febrile seizures are frightening to watch, they usually stop within five minutes and cause no permanent harm.

Fever-reducing medications may aid the spread of the influenza virus. In a modeling study, researchers at McMaster University showed that those who take anti-fever medications may release more of the influenza virus into the environment than those who don't take the drugs, increasing the possibility of transmission and flu-related death. During fever, the immune system makes more chemicals that fight infectious viruses, previous research has shown. "It may be that the medications are interfering with body's ability to fight off a viral infection," said study co-author Paul Andrews, an assistant professor of psychology, neuroscience and behavior at McMaster.

Fever may coordinate the immune response. Fevers range between 99 to 106 degrees Fahrenheit. Outside of these temperatures, the activity of macrophages decreases. macrophages, or white blood cells, target and attack pathogens. "They seem to become maximally active in the febrile (elevated) temperatures, suggesting that fever is helping coordinate the immune response," said Andrews. Higher temperatures may also promote the production of a naturally occurring protein called interferon alpha, an effective weapon against the influenza virus that makes it harder for viruses to replicate, said Andrews.

Fevers can be harmful for children with certain medical conditions. A child who has cardiomyopathy or certain other chronic diseases will not tolerate the effects that fever has on the body, said Sullivan. "When a child has a fever, their heart rate increases and they lose more fluid through their skin. A child with a cardiomyopathy may not do well with a higher heart rate as their heart may not work as well." Parents should discuss managing discomfort and fever with their pediatrician at well-child visits so they are prepared when their child is ill, she said.

Ibuprofen vs. acetaminophen. "Both bring comfort and reduce fever," said Plotnikoff. "I hesitate to use ibuprofen in anyone who is dehydrated." Some evidence suggests combining the two is more effective than the use of a single agent alone; however, combined treatment may be more complicated and contribute to the unsafe use of these drugs. As many as one half of parents administer incorrect doses and approximately 15 percent don't give enough acetaminophen or ibuprofen, according to the AAP. But since fever can be a useful ally against infection, some say it's better not to take either type of drug.
