Fever is a Friend (if you’re a T cell)

Fever (temp>100.4F) is an appropriate response to foreign invasion by the body.  Some kids rage.  Other kids simmer.  I spend a lot of my time in clinic working to reassure not only patients but co-workers as well that fever is not in itself dangerous.  It can be an important indicator of disruption and useful for both diagnosis and healing.  I have intuitively had mixed feelings which resulted in reservations about using Tylenol (acetaminophen) since I started practicing medicine.  This intuition was shaped by personal trauma in almost losing my little brother to the toxicity of this drug.  Glutathione is an important intracellular antioxidant.  Tylenol eats this stuff up.    This is the last thing we need when we are ill.  That being said small, well-timed doses are different than using max dose Tylenol around the clock throughout an entire illness.  The body can regenerate glutathione if a kid had a healthy diet before they became ill.  I have parents that start treating kid’s “fever” the second they hit 99F.  Which results in more doses than any liver should have to accommodate.

Ibuprofen has its risks to immune function and the kidneys as well.  But when a child’s fever is terribly uncomfortable or even more dangerous the child is not drinking fluids due to lethargy from super high temps, fever control can be an excellent adjuvant to their care.  I like that ibuprofen is an anti inflammatory because much of the discomfort we feel when we are ill with fever is due to the inflammatory changes in the body.  Yes, inflammation is another normal reaction of the body to invasion but too much is downright uncomfortable.  Again it is about judicious dosing and careful use.  If you are going to make the body clear a substance make it worth it.

Many parents ask me at what temperature is a fever dangerous?  If you have a normal functioning brain your body will not go higher than ~107.  Febrile seizures are not normal.  They occur in persons who are susceptible and often have family histories.  And even as scary as they are simple febrile seizures are not dangerous.  Complex febrile seizures are a different animal often occurring in folks on the spectrum of epilepsy.  And with epilepsy illness lowers seizure thresholds.  People with epilepsy often know to adjust their seizure medicines when they are ill because of this phenomena.  But again this doesn’t apply to a regular kid.  So no.  Your kid will not seize with a high fever unless they have a type of seizure disorder!

Fever duration is much more interesting than how high it gets.  For some beautiful reason most viruses cause about 72hrs of fever.  Almost like magic.  There’s a few outliers but for the most part if your kid runs fever for <72hrs they are fighting a virus and will clear it.  This applies to kids over 6mos.  Lil babies are different and warrant a look over by a provider as their immune systems are still trying to figure themselves out and their blood brain barrier is more permeable than an older kid.

Ideal body temp for our CD8+ T cell (our innate good guys) kill mode is about 101.5F.  So rather than trying to get your child to normothermic this is a good number to aim for with your dosing.  If your child is happy, warm and drinking fluids then just leave them alone.  Let their body do the thing it is trying to do which is super efficiently killing bad guys!  A cool cloth to the forehead feels good.  A cold bath does not.

Fever >72hrs or fever associated with lethargy, inconsolability, urinary symptoms, or obvious skin lesions should always be checked out by a provider.  Or if your intuition is telling you something more is going on here…always trust that.  Sitting at home alone in fear sucks.  Been there.  Even if the trip results in reassurance listening to your own intuition is paramount.  Intuition and fear get tangled up sometimes.  More to come on that another day.

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