What is Fever?
Is fever the bodies ability to fight off an infection? Yes and no. When we get an infection our body begins attacking the virus or bacteria with white blood cells. This release of cells causes the hypothalamus to kick in which raises temperature and in return more of a release of white blood cells are released. The more severe the attack the body recognizes, then more of our so called troops are released to fight the infection. There are times an infection is actually walled off by pus and the body is fooled. Many infections do not necessarily have to have a fever. As this author has said many times nothing in medicine has a one hundred percent certainty. So what is a fever? In reviewing the Mayo clinic’s site, and other medical sites there is a universal number that is touted as an absolute number of what is a “medically significant” number. A normal oral temperature is 98.6F (37C), a normal rectal is 99.F (37.2C). This can range by one degree very easily. It is important to note most normal body temperatures rise in the evening. Many medical text and web sites state it is not significant until it reaches 100.4F. This is mildly ridiculous. Why? If we go by exact numbers we always run into trouble. If your child has a temperature of 100.2F, than it is NOT significant? You may laugh, however I have had many patients that are that rigid and by the book. A child can have a pneumonia with no temp, a temp of 99.9F orally, or 103F. There are too many variables to state a fever of”x” is always the way to go with treatment. I have had a five year old with severe pneumonia and a low grade fever which is below the 100.4 F number and a strep throat case with a 102.F temp. The entire presentation must be looked at. How long have they had the fever? How was the fever taken? How do they look clinically? Does the fever respond with fever reducing medication? As you can see there is much more to a fever than a rigid number and rigid assumptions.
Most texts and medical sites are in universal agreement that attention needs to be given immediately for a child under 3 months with a fever of 101.F. Once again, if the child is four months old and they have a 100.F fever is that less severe? Good judgement is an invaluable tool when it comes to assessing your loved one with a fever. You know their past history, you know how they are more prone to certain illness. We do know that fevers over 103F are concerning, especially in children less than one year old and the elderly. These fevers should be reduced, but not rapidly. If we operate with the premise that fever is one of the driving forces to increase white blood cells, which fight off infection then it is common sense that we do not want to stop that production. In essence the war is on to fight the virus or bacteria, by lowering the temp we decrease our bodies ability to fight off the infection. Fevers are good, let me repeat that, “Fevers are good for our body!” All too often we have a knee jerk reaction to rush someone to the clinic, or push the acetaminophen and ibuprofen to reduce a 100.F fever.
How to take a temperature?
A temperature can be taken by using a thermometer. The thermometer has advanced greatly over the years, however not necessarily for the good. The validity of the forehead strips are not accurate compared to the oral. Ear thermometers are convenient and quick and are probably the worst. Too many variables effect the reading. The light has to hit the eardrum at a direct angle to get an accurate reading. Any cerumen (wax) will effect the reading. At one clinic where I worked we were finally successful to remove all digital ear thermometers. In reviewing the literature the most accurate readings would be in this order; a rectal temp, oral temp with digital read out, and axillary last. At the clinic where I work presently all temps are taken orally, (thank goodness.)
Place the thermometer in the mouth, under the tongue and listen for the beep. It usually only takes about one minute. This is not difficult, however there are some basics that are important for accuracy. No hot or cold beverages or smoking fifteen minutes before temp is taken. Keep your mouth closed, any gaps or checking before the time is up will effect the accuracy. A brief (gee whiz) factoid; a crude estimate of temperature. For every degree your temperature goes up your heart rate goes up approximately ten beats a minute. With a temp of 102.F your pulse rate should be around 110 to 115 beats per minute. The exception to this rule is malaria and mycoplasma pneumonia, where it is not uncommon for the pulse to not go up for each degree of temp.
How do you treat a Fever?
Fever reducers are primarily Acetaminophen and Ibuprofen, with brand names of Tylenol, Advil and Motrin. Aspirin should NOT be used due to the increased risk of Reyes. Syndrome. In looking at the research Ibuprofen is safe and to date there is not one confirmed case of Reyes because of Ibuprofen. Ibuprofen can cause more stomach irritation than Tylenol, and Tylenol has the benefit of having a rectal suppository form in case of intense vomiting. Tylenol has shown to reduce fevers quicker however Advil and Motrin appear to last longer. It is safe to use both at the same time, although in children there is a risk of kidney problems. I have recommended on wilderness expeditions to take two Tylenol and three Ibuprofen at the same time every eight hours for moderate pain. It works very well and I have not any problems or side effects. ibuprofen can exacerbate an asthma attack if one has a predisposition to asthma.
In severe cases I have given Tylenol with Advil and wet cool soaks. As the air hits the wet skin there is a cooling effect to slow the temp down. Never do ice baths, as this is too dramatic. One will cause the person to shiver, which increases burning calories and the temp will go back up.
Bayberry, an old remedy used primarily by Native Americans with good evidence of reducing pain and fever. The downfall here is we have no reliable data to dosage or amount. I personally have tried it as a tea, and it did reduce my fever, not dramatically but I clearly could tell a difference. This is a sample size of (one) and far, far from scientific. Side effects of too much Bayberry are diarrhea and nausea, which is common with many herbs. I have had many patients who take a walk down the herb/natural path which is not a bad route;however not knowing correct dosage leads to side effects. Eventually I am hopeful there will be more work done in this area.