Fever in Children and Fever Phobia in Parents

What Is Fever?

Temperature of our bodies is amazingly steady despite significant variation in environmental temperature. The thermo regulatory center is in our brain at hypothalamus, which act like a thermostat with a set point at normal body temperature. This is done by balancing heat production (by metabolic activity in liver and muscle) with heat loss through a skin and lung.

Fever occurs when the thermostat set point is raised above the current body temperature. When the body is exposed to infection organisms such as viruses or bacteria a number of so called pyrogens are produced as part of inflammatory response. These pyrogens can then act on the thermostat to raise the temperature set point by the release of a substance called prostaglandin. Now once the set point is raised heat generating action in the body like cellular metabolism in mostly skeletal muscle come into play to raise the temperature to the new set point.

What Is Fever Phobia?

Fever is one of the most common reasons that parents seek medical attention for their children. Parental concern usually arises because of the belief that fever is a disease rather than a symptom of an illness. This misconception and unrealistic concerns about the fever which ranges from thinking about the brain damage, losing their children, and the disease causing the fever is a potentially dangerous one rather than relatively benign one are termed fever phobia.

This parental fever phobia which exists across socio economic classes is strongly reinforced sometimes by the action of pediatric medical professionals, who are widely considered to be the primary resource of the subject. It is even emphasized as a discharge instruction, from emergency department and inpatient facilities as a warning to parents to call or return if fever develops or persists. So there is incongruence between the education of the family and the practice of the pediatrician. This mixed message which remains in existence does cause parents to lose sleep and experience unnecessary stress due to unwarranted concern about the harmful side effect of the fever.

Advice to Parents Regarding Their Febrile Child and Unwarranted Concerns about Harmful Side Effects of Fever:

I know it is hard to resist reacting to a hot little forehead and sad eyes, but if you remember the following, you will know when is the time to worry about your child’s fever and when you can be more patient and do not stress yourself.

1. Make sure your child has really fever (axillary temperature greater than 37.5°C or rectal temperature more than 38°C). Taking temperature by hand can be misleading.

2. Fever is only a sign of a disease and does not indicate the type of the disease or its severity no matter what the level of temperature is, high or low.

3. Remember that, especially in a child less than two to three years, most of the time the cause of the fever is viral infection, which is usually benign, and causes no serious damage to your child.

4. Fever is the body’s way of stimulating immune system, increasing white blood count, and fighting against infection. It also decreases the ability of viruses and bacteria to reproduce. Fever apart from being a sign of disease in your child, it has many beneficial effects and does not go higher and higher and usually not go beyond 41°C.

5. When your child has a fever, look for other signs i.e. Is he playful and looks normal between episodes of fever, is he alert and not weak or lethargic, does he smile, and has a normal color, these are the good signs indicating that the cause of the fever is not that serious and covers most cases of febrile children. If so, you can wait and do not stress yourself and do not need to call your doctor in the middle of the night. There is one exception and that is in a child less than six months of age where the immune system is not mature and the presence of fever may be an indication of a serious bacterial infection, which in that case you should call your pediatrician.

6. If he looks sick or constantly cries and irritable, is not playful, there is change of alertness, has a respiratory distress or swallowing problem, or the fever is persisting for more than two to three days, these are the bad signs and you should consult your pediatrician.

7. Febrile convulsion sometimes happen in kids less than four years, which usually stops after a few minutes and causes no problem, but if your child already had seizure in past or there is history of convulsion in the family, or any sign of neurological or central nervous system insult or problem, he needs more attention and should consult your pediatrician.

Dr. Hossein Sardarizadeh M.D. 
Specialist Pediatrician (Board Certified) 
Armada Medical Centre