FEVER FACTS
There is a short list of problems that prompt people to seek care in an emergency department. Right away
one thinks of pain, bleeding, or trouble breathing. But also on that list is fever.
The first thing you need to know is that a temperature of 98.6 degrees isn’t so much “normal” as it is
“average”. “Normal” usually varies from 98.2 to 98.8. In addition to that, your temperature varies
throughout the day with lows in the early morning and highs in the late afternoon. Therefore a temperature
may not be considered “abnormal” unless it is less than 97 or more than 100 degrees.
Despite this wide variation in “normal” temperatures, studies have shown that even people who tend to run
a lower temperature than average will raise their temperature into the official “fever” range when
appropriate. The general rule is that “fever” starts at 100.4 degrees when the temperature is taken rectally.
Rectal temperatures are as close to “core” temperature readings as we can generally manage.
Fever is not a disease in and of itself. It is a symptom of an illness. Fever is one of the ways that our
bodies fight infections. The human body can survive a high temperature much better than a virus or
bacteria.
So that raises the question as to whether or not a fever needs be treated. Generally temperatures less than
102 degrees do not require treatment. (That having been said, a temperature of 101 degrees generally starts
to make the patient feel achy and run-down and can be treated if needed for comfort.) Temperatures above
102 degrees are generally treated with acetaminophen (Tylenol) or ibuprofen (Motrin/Advil). Aspirin is
avoided in children because of its association with an illness known as Reye’s Syndrome. It is not
necessary to bring the temperature all the way back to normal. Remember that fever can be beneficial for
your body. It should be anticipated that the fever will return when medication wears off and repeated doses
likely will be necessary.
There are non-medication ways of reducing fever as well. The patient should be dressed in lightweight
clothing to allow heat to dissipate through the skin. Light blankets should be used during sleep. Activity
should be reduced to prevent the generation of body heat. Liberal fluids should be allowed. (Fever causes
fluids to be lost from the body in ways that are generally not visible, for instance, by sweating or by
breathing.) A sponge bath using lukewarm water can also quickly reduce fever, especially when other
methods are not successful.
Never add rubbing alcohol to bath water; never use it directly on the skin. Children can absorb the alcohol
through the skin and it can poison them. None of the above methods of fever reduction should be followed
to the point of causing shivering. Shivering is a method of raising body temperature and should be
avoided.
So if fever isn’t necessarily an enemy, how do I know when I should call a doctor?
1) Look for associated symptoms. Call your physician if the patient has a headache and stiff
neck, trouble breathing, a loss of appetite and abdominal pain, trouble swallowing, a rash, or
pain with urination. In small children, look for excessive fussiness or the opposite, being too
sleepy.
2) Generally temperatures of 103 and higher warrant contact with your doctor.
3) For infants less than 3 months old, the doctor should be contacted about any fever because
children that young have an immature immune system.
4) Patients with chronic illnesses like diabetes, lung disease, heart disease or kidney problems,
should have a lower threshold for contacting their doctor than healthy people.
5) While there are viruses that can cause fever for five days or more, in general, you should
contact your doctor if a fever persists for more than three days.
A few other things that you should know about fevers include…
1) The degree of fever does not indicate the type of illness or predict the proper course of
treatment,
2)
3)
4)
5)
Many viral illnesses in children cause temperatures of 103 or 104 degrees,
Viral infections are the most common cause of fever,
Antibiotics do not treat viruses and do not reduce fever,
Febrile seizures occur in susceptible patients with a rapid change (rise) in temperature, not
necessarily the height of the fever.
6) Young children often have five or more febrile illnesses a year.
The last thing that you should know about fevers and their treatment is that if you choose to use
medications to treat the fever, it is absolutely necessary for you to read the package directions. There are
numerous fever and cold medications sold over the counter. Many of these products have similar sounding
names and can easily be confused with one another. These medications are toxic when used in excess. If
given a choice between age-based and weight-based dosing in children, use the weight-based formula.
Hopefully this information will make your next encounter with fever less frightening. And remember that
you don’t have to fight the battle alone. Your pediatrician, primary care physician and the staff at the
emergency department are there to help you if you have questions or concerns.
Nancy Edwards, MD, is the President of the Emergency Department physicians practice and
Medical Director of Emergency Services at Tobey Hospital. She will take on the role of President
of the Medical Staff for Tobey Hospital in 2006.