Fever

Definition
A fever isn't an illness itself, but it's usually a sign that something out of the ordinary
is going on in your body. Fevers aren't necessarily bad. In fact, fevers seem to play a
key role in helping your body fight off a number of infections.

If you're an adult, a fever may be uncomfortable, but it usually isn't dangerous unless
it measures 103 F or higher. For very young children and infants, however, even
slightly elevated temperatures may indicate a serious infection.

Because a fever can occur with many different conditions, other signs and symptoms
can often help identify the cause.

Most fevers go away in a relatively short time — usually within a few days. Not all
fevers need treatment with medications. And it's possible for fever medications to
have side effects, especially for the very young.

Symptoms
A fever occurs when your temperature rises above its normal range. What's normal
for you may be a little higher or lower than the average temperature of 98.6 F. But a
rectal temperature higher than 100.4 F is always considered a fever. A rectal
temperature reading is generally 1 degree Fahrenheit higher than an oral reading.

Depending on what's causing your fever, additional fever symptoms may include:

 Sweating
 Shivering
 Headache
 Muscle aches
 Lack of appetite
 Dehydration
 General weakness

Very high fevers, between 103 and 106 F, may cause:

 Hallucinations
 Confusion
 Irritability
 Convulsions

Fever-induced seizures
About 4 percent of children younger than age 5 experience fever-induced seizures
(febrile seizures). The signs of febrile seizures, which occur when a child's
temperature rises or falls rapidly, include a brief loss of consciousness and
convulsions.

Although these seizures can be extremely alarming, most children don't experience
any lasting effects. Febrile seizures are often triggered by a fever from a common
childhood illness such as roseola, a viral infection that causes a high fever, swollen
glands and a rash.

Causes
Even when you're well, your body temperature varies throughout the day — it's lower
in the morning and higher in the late afternoon and evening. In fact, your normal
temperature can range from about 97 to 99 F. Although most people consider 98.6 F a
healthy body temperature, yours may vary by a degree or more.

Your body temperature is set by your hypothalamus, an area at the base of your brain
that acts as a thermostat for your whole system. When something's wrong, your
normal temperature is simply set a few points higher. The new set-point, for example,
may be 102 F instead of 97 or 98 F.

What happens with a fever

When a fever starts and your body tries to elevate its temperature, you feel chilly and
may shiver to generate heat. At this point, you probably wrap yourself in your thickest
blanket and turn up the heating pad. But eventually, as your body reaches its new set-
point, you likely feel hot. And when your temperature finally begins to return to
normal, you may sweat profusely, which is your body's way of dissipating the excess
heat.

A fever usually means your body is responding to a viral or bacterial infection.

Sometimes heat exhaustion, extreme sunburn or certain inflammatory conditions such
as temporal arteritis — inflammation of an artery in your head — may trigger fever as
well. In rare instances, a malignant tumor or some forms of kidney cancer may cause
a fever.

Fever can be a side effect of some medications such as antibiotics and drugs used to
treat high blood pressure or seizures. Some infants and children develop fevers after
receiving routine immunizations, such as the diphtheria, tetanus and acellular
pertussis (DTaP) or pneumococcal vaccines.

Sometimes it's not possible to identify the cause of a fever. If you have a temperature
higher than 100.9 F for more than three weeks and your doctor isn't able to find the
cause after extensive evaluation, the diagnosis may be fever of unknown origin. In
most cases, though, the reason for your fever can be found and treated.

When to seek medical advice

Fevers by themselves may not be a cause for alarm — or a reason to call a doctor. Yet
there are some circumstances when you should seek medical advice for your baby,
your child or yourself.
For infants
An unexplained fever is greater cause for concern in infants and in children than in
adults. Call your baby's doctor if your baby:

 Is younger than 3 months of age and has a rectal temperature of 100.4 F or

higher. Even if your baby doesn't have other signs or symptoms, call your
doctor just to be safe.
 Is older than 3 months of age and has a temperature of 102 F or higher.
 Has a fever and unexplained irritability, such as marked crying when you
change your baby's diapers or when he or she is moved.
 Has a fever and seems lethargic and unresponsive. In infants and children
younger than age 2, these may be signs of meningitis — an infection and
inflammation of the membranes and fluid surrounding the brain and spinal
cord. If you're worried that your baby might have meningitis, see your doctor
right away. Don't wait until morning to see your usual physician — meningitis
is an emergency.
 Is a newborn and has a lower than normal temperature — less than 97 F.
Very young babies may not regulate their body temperature well when they
are ill and may become cold rather than hot.

For children
Children often tolerate fevers quite well, although high temperatures may cause
parents a great deal of concern. Still, it's best to be guided more by how your child
acts than by any particular temperature measurement. There's probably no cause for
alarm if your child has a fever but is responsive — making eye contact with you and
responding to your facial expressions and to your voice, is drinking plenty of fluids
and wants to play.

Call your pediatrician if your child:

 Is listless or irritable, vomits repeatedly, has a severe headache or

stomachache, or has any other symptoms causing significant discomfort.
 Has a fever after being left in a very hot car. Seek medical care immediately.
 If fever persists longer than one day in a child younger than age 2 or longer
than three days in a child age 2 or older.

Ask your doctor for guidance if you have special circumstances, such as a child with
immune system problems or with a pre-existing illness. Your doctor also may
recommend different precautions if your child has just started taking a new
prescription medicine.

Don't treat fevers below 102 F with any medications unless advised by your doctor.

Sometimes, older children can have a lower-than-normal temperature. This can

happen to older children with severe neurological impairments, children with a life-
threatening bacterial infection in the blood (sepsis), and children with a suppressed
immune system.

For adults
Call your doctor about a fever if:
  Your temperature is more than 103 F
 You've had a fever for more than three days

In addition, call your doctor immediately if any of these signs and symptoms
accompany a fever:

 Severe headache
 Severe swelling of your throat
 Unusual skin rash, especially if the rash gets rapidly worse
 Unusual eye sensitivity to bright light
 Stiff neck and pain when you bend your head forward
 Mental confusion
 Persistent vomiting
 Difficulty breathing or chest pain
 Extreme listlessness or irritability
 Abdominal pain or pain when urinating
 Any other unexplained signs or symptoms

Taking a temperature
To check your or your child's temperature level, you can choose from several types of
thermometers, including electronic thermometers and ear (tympanic)
thermometers. Thermometers with digital readouts and those that take the
temperature quickly from the ear canal are especially useful for young children and
older adults. Because glass mercury thermometers harm both humans and the
environment, they have been phased out and are no longer recommended.

Although it's not the most accurate way to take a temperature, you can also use an oral
thermometer for an armpit (axillary) reading. Place the thermometer in the armpit
with arms crossed over the chest. Wait four to five minutes. The axillary temperature
is about 1 degree Fahrenheit lower than an oral temperature. If you call your doctor,
report the actual number on the thermometer and where on the body the temperature
was taken rather than adding or subtracting numbers.

Use a rectal thermometer for infants. Place a dab of petroleum jelly on the bulb. Lay
your baby on his or her tummy. Carefully insert the bulb one-half inch to one inch
into your baby's rectum. Hold the bulb and your baby still for three minutes. Don't let
go of the thermometer while it's inside your baby. If your baby squirms, the
thermometer could go deeper and cause an injury.

Tests and diagnosis

Your doctor will likely diagnose the cause of your fever based on your other
symptoms and a physical exam. Sometimes you may need additional tests to confirm
a diagnosis.

If you have a low-grade fever that persists for three weeks or more, but have no other
symptoms, your doctor may recommend a variety of tests to help find the cause.
These may include blood tests and X-rays.
Complications
A rapid rise or fall in temperature may cause a fever-induced seizure (febrile seizure)
in a small number of children younger than age 5. Although they're alarming for
parents, the vast majority of febrile seizures cause no lasting effects.

If a seizure occurs, lay your child on his or her side. Remove any sharp objects that
are near your child, loosen tight clothing and hold your child to prevent injury. Don't
place anything in your child's mouth or try to stop the seizure. Although most seizures
stop on their own, call for emergency medical assistance if a seizure lasts longer than
10 minutes.

If possible, try to time the seizure using your watch or a clock. Because they're so
alarming, seizures often seem to last longer than they really do. Also try to note which
part of your child's body begins to shake first. This can help your doctor understand
the cause of the seizure. Take your child to your pediatrician as soon as possible.

Treatments and drugs

Medical treatment depends on the cause of your fever. Your doctor will likely
prescribe antibiotics for bacterial infections, such as pneumonia or strep throat. For
viral infections, including stomach infection (gastroenteritis) and mononucleosis, the
best treatment is often rest and plenty of fluids.

Over-the-counter medications
Your doctor may also make a recommendation about using over-the-counter
medications, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin,
others) to lower a high fever. Adults may also use aspirin. But don't give aspirin to
children. It may trigger a rare, but potentially fatal, disorder known as Reye's
syndrome.

The downside of lowering a fever

If you have only a low-grade fever, it's not advisable to try to lower your temperature.
Doing so may only prolong the illness or mask your symptoms and make it harder to
determine the cause.

Some experts believe that aggressively treating a fever actually interferes with your
body's immune response. That's because the viruses that cause colds and other
respiratory infections thrive at cool temperatures. By producing a low-grade fever,
your body may actually be helping eliminate a virus.

Prevention
The best way to prevent fevers is to reduce your exposure to infectious diseases. One
of the most effective ways to do that is also one of the simplest — frequent hand
washing.
Teach your children to wash their hands often, especially before they eat and after
using the toilet, spending time in a crowded public place, or petting animals. Show
them how to wash their hands vigorously, covering both the front and back of each
hand with soap, and rinsing thoroughly under running water. Carry hand-washing
towelettes with you for times when you don't have access to soap and water. When
possible, teach your kids not to touch their noses, mouths or eyes — the main way
viral infections are transmitted.

Lifestyle and home remedies

Because your body loses more water with a fever, be sure to drink plenty of fluids to
avoid dehydration. Water is a good choice for adults, but the best liquid for a sick
child under age 1 is an oral rehydration solution such as Pedialyte. These solutions
contain water and salts in specific proportions to replenish both fluids and electrolytes
in children. Frozen Pedialyte ice pops are also available.

Make sure that you or your child gets enough rest. Don't be concerned with treating a
fever just because it's a fever. Often, a low-grade fever is actually helping fight off an
infection. In addition, follow these guidelines for both older children and adults:

For temperatures below 102 F

Don't use any medication for a fever in this range unless advised by your doctor. And
don't give children aspirin because of the risk of Reye's syndrome. Instead, dress in
comfortable, light clothing and try bathing in lukewarm water. At bedtime, cover
yourself or your child with just a sheet or light blanket.

For temperatures between 102 and 104 F

Take acetaminophen or ibuprofen according to the label instructions or as
recommended by your doctor. If you're not sure about the proper dosage, be sure to
check with your doctor or pharmacist. Adults may use aspirin instead.

Be careful to avoid too much medication. High doses or long-term use of

acetaminophen may cause liver or kidney damage, and acute overdoses can be fatal. If
you're not able to get your child's fever down, don't give more medication. Call your
doctor instead. Side effects of aspirin and other nonsteroidal anti-inflammatory drugs
such as ibuprofen include stomach pain, bleeding and ulcers.

For temperatures above 104 F

Give adults or children acetaminophen or ibuprofen according to the manufacturer's
instructions or as recommended by your doctor. Adults may use aspirin instead. If
you're not sure about the dosage, check with your doctor or pharmacist. Be careful to
avoid too much medication.

Acetaminophen is available in liquid, chewable and suppository forms for children,

but it's often easiest to give medications in liquid form. For a small child, use a
syringe with measurements on the side and a bulb on the tip. Gently squirt the
medicine in the back corners of your child's mouth.
Sponge baths
Use a five- to 10-minute sponge bath of lukewarm water to try to bring your own or
your child's high temperature down. A sponge bath is most likely to help if it's used
shortly after a dosage of acetaminophen or ibuprofen, so that the medication can work
to keep the fever down after the bath takes effect.

If your child shivers in the bath, stop the bath, dry your child and wait. Shivering
actually raises the body's internal temperature — shaking muscles generate heat. If the
fever doesn't moderate or your child has a febrile seizure that lasts longer than 10
minutes, seek immediate medical care.