It’s the middle of the night, and your little one wakes up crying. After you stumble across the house and, if your house is anything like mine, trip over a few shoes, toys, the family dog, etc. on the way to their room, you reach your child, feel their forehead, and immediately realize they feel like a little firecracker. Of course…fever (per Murphy’s law) loves to rear its ugly head in the middle of the night, usually resulting in kiddos losing sleep and generally feeling miserable and parents with even more sleep deprivation combined with a good deal of worrying about what could be going on. Over the next few posts, I will be discussing all things fever and hopefully can answer some of your most “burning” fever questions before the next 3am temperature spike in your household.
“Fever in and of itself is not harmful.”
To begin the discussion, let’s try to understand fever from a scientific standpoint (I know…I’m putting on my nerdy doctor glasses and white coat now, but this is where the fun and learning really begins). Fever is not an illness. Rather it is almost always a symptom of an underlying condition, which, in children, is usually a viral or bacterial infection. Fever in and of itself is not harmful. Actually, fever indicates that your body is mounting a response to some kind of “invader” to the body. And in many cases, this very natural response to counter infections of various sorts is quite effective. You see, viruses and bacteria are very particular about the climate in which they can replicate. They find 98.6 (or average human body temperature) to be the perfect climate to multiply. When the body senses one of these invaders, one of the quickest means to get rid of them is to “turn up the heat” if you will, so that their environment becomes inhospitable and they no longer have the ideal conditions to replicate.
And if you want to get really technical and nerdy (like I do) - the actual process by which the body does this is quite interesting! When our immune system senses one of these invaders, substances called cytokines are produced. These cytokines travel to the the hypothalamus, which sits at the base of the brain and, amongst many other important functions, serves as the body’s thermostat. When the hypothalamus sees these particular cytokines, a cascade pathway is triggered that increases the body’s temperature and serves to make those viruses and bacteria uncomfortable. So as you can see, in children with a normal immune system and hypothalamus, increased temperature is an indication that the body is doing what it can to get rid of infections.
“But keep in mind: Real, bonafide fever is typically defined as a temperature of 100.4 or higher.”
Now that we have the biochemical stuff out of the way, let’s discuss what actually defines a fever, and how to determine if your child really has one:
Temps that matter… I think most people have 98.6 ingrained in their mind as to what a temperature should be, but in actuality, everyone’s temperature fluctuates throughout the day. If we had a temperature probe attached to us 24 hours a day, it would be common to see readings ranging from 97 to 99 at some point during the day. Body temperature typically will be highest in the evening time and lowest in the early morning, but again, this is variable. But keep in mind: Real, bonafide fever is typically defined as a temperature of 100.4 or higher.
Where to take a temperature? Now, some locations for taking temperatures are more accurate than others. For instance, rectal temperature is the best way to measure the temperature in infants and young children. For older children who can hold a thermometer under their tongue, an oral temperature will give a good approximation of actual internal body temperature. Other means of measuring temperature such as axillary (under the arm), temporal (scanners across the forehead), or tympanic (in the ear), can have some variability which is why I view these methods for taking the temperature as “screenings” especially for young infants. I often have parents tell me that they took their child’s temperature axillary so they added a degree to the reading. Well, while axillary temperatures are in most cases lower than the core, internal temperature, there are no medical based studies out there that say these readings are exactly one degree off. And as you will see in upcoming posts, one degree can make a big difference!
So the next time your child has a temperature above 100.4 (and they are over 2 months of age), rather than immediately hitting the panic button, take a moment to “thank” their body for trying to fight off those foreign invaders. In upcoming posts on fever I will address further issues including when is fever an emergency, when and how to treat a fever, as well as give you a bit of advice before purchasing your next thermometer. So stay tuned!