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Fever Phobia

By Dr. Lawrence Rosen

The number one reason parents call their pediatrician is what many of us call “Fever Phobia.”  It was Dr. Barton Schmitt who first popularized the term in an article published in 1980.  Many parents still believe that fever can cause serious neurological damage, so they treat fever aggressively with medications.  Not much has changed over the past 30-plus years since Dr. Schmitt’s observation.  Despite rising concerns about the overuse of OTC anti-fever medications like acetaminophen and ibuprofen, “fever phobia” is alive and well.  An updated report in Pediatrics found that, compared with the Schmitt study, “more caregivers listed seizure asa potential harm of fever, woke their children and checked temperaturesmore often during febrile illnesses, and gave antipyretics orinitiated 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.”


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.  Is fever ever a reason to worry?  Some studies have suggested that rectal temperatures over 106 degrees may more likely suggest a bacterial focus versus a viral infection.  A fever over 100 degrees in any baby under two months should be taken very seriously. Some children – less than 5% - will have a seizure with a rapidly rising fever, but these febrile seizures, while scary to parents, are not associated with any lingering neurologic 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, as I note in my book, Treatment Alternatives for Children, 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 alternatives like homeopathy if it seems appropriate and comfortable to you.  I do 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.  But we don’t need to demonize symptoms like fever; instead, we should reframe them as the natural processes our bodies utilize for repair.  And that’s nothing to fear.



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