Every winter I am reminded of the great “Fever Phobia” that plagues parents everywhere. In the Northeastern U.S., where I practice, we’re up to our necks in snow, ice and viruses. Cough and cold viruses, stomach viruses, and flu viruses—you name it, we’re seeing it. And the number one reason by far parents call us is—you guessed it—fever. On an average weekend on-call during the winter, 95 percent of the phone calls I receive are directly related to fears about fevers.
Dr. Barton Schmitt, a well-known primary care pediatrician, first popularized the term “fever phobia” in an article published in 1980. He noted that a majority of parents believed that moderate fever can cause serious neurological side effects and therefore treated fever aggressively with medications. He encouraged pediatricians to do a better job educating families about the “normality” of fever. Over the past 30 years, have we been effective in doing so? Not so much. Despite rising concerns about the overuse of over-the-counter anti-fever medications like acetaminophen and ibuprofen, “fever phobia” is alive and well. An updated report in the journal Pediatrics found that, compared with the Schmitt study, “more caregivers listed seizure as a potential harm of fever, woke their children and checked temperatures more often during febrile illnesses, and gave antipyretics or initiated sponging more frequently for possible normal temperatures.” The authors’ conclusion? “Fever phobia persists. Pediatric health care providers have a unique opportunity to make an impact on parental understanding of fever and its role in illness.”
Dr. Janet Serwint, a professor of pediatrics at Johns Hopkins and co-author of the aforementioned study, was recently quoted in a New York Times article on fever phobia by pediatrician Perri Klass:
“I personally think there should be much more education about (fever) at well visits,” says Serwint, adding that parents need to understand “the helpfulness of fever—how fever actually is a well-orchestrated healthy response of our body.”
I try very hard during both well and sick visits to counsel parents about the realities of fever. Most children will have a fever at some point in their lives. In fact, they should! I try to reframe fever as a positive sign that a child’s immune system is doing what it should. Fever is a sign that our body is doing what nature intended it to do when faced with an infectious intruder. Some studies have suggested that rectal temperatures over 106 degrees may more likely suggest a bacterial focus versus a viral infection, that is true. And a fever over 100 degrees in any baby under two months should be taken very seriously. Some children—less than 5 percent—will have a seizure with a rapidly rising fever, but these febrile seizures, while scary to parents, are not associated with any lingering neurological damage. In fact, there is no specific height of fever associated with brain damage.
Can fevers make children miserable? Sure. I’m not advocating letting a child suffer, but I do encourage parents to treat the child, not the fever. For example, a child with a 101-degree temperature who’s calm and playful and staying well hydrated does not necessarily need medication to reduce his fever. In fact, hydration may be one of the single best ways to help a child feel more comfortable. And that’s one of my other main points. Reaching for acetaminophen or ibuprofen does not have to be your first choice when confronted with fever. Consider a sponge bath with luke-warm water and towels. (Do NOT dunk you baby in a cold bath or sponge them down with alcohol.) Think about rubbing cooling essential oils like mint or eucalyptus mixed with massage oil on your child’s feet. Explore homeopathic belladonna (usually the 30c strength for acute use) if it seems appropriate and comfortable to you. I like to provide families with options, and then we can work together to find what works best for them and their children. I understand we all feel a need to actively “do something” when our kids are sick. It’s how most of us were raised and it’s how the medical system works in our country. Got a symptom? Treat it! That is the “disease-care” system we have, rather than a true “health care” paradigm focused on prevention and wellness.