Does a fever help you fight infection? Does using a fever-reducer prolong your symptoms? How high is too high of a fever?
These are actual questions I searched for answers to while my kids were spreading the parainfluenza virus # 3 to our entire family.
This is the Sick Kids + Real Science series in which I explore how different aspects of being sick are affected by and can affect gut health, and I give practical advice based on nothing more than my own meandering failures. THIS. IS. NOT. MEDICAL. ADVICE. Always consult your real + actual doctor.
I LOVE modern medicine. I love how doctors keep tiny babies alive with ventilators and blood pressure medications. I love how science allows us to manage asthma with inhalers and treat kidney infections with antibiotics. What. A. Wonderful. World.
I also love not having to take medications because not having to take medications means there’s nothing wrong. I recognize there is a fine line between nothing wrong and denial, which is why we are going to talk about fevers; this is also the one where I am going to admit my most shameful parenting decision to date.
A fever is a sign your body is fighting something.
The fever may mean you’re fighting a bacterial infection. Common bacterial infections (especially in toddlers and small children) include strep throat, ear infections, staph infections, conjunctivitis, and urinary tract infections.
Bacterial infections may get better on their own, or they may require—GASP—antibiotics. A bacterial infection is kind of my worst nightmare, partly because I’m terrified of antibiotic resistance in my kids who have already been loaded up with antibiotics to keep them from dying AND because they annihilate the gut microbiome. This is actual irony: the very thing that can make you healthy again when you have a bacterial infection destroys the thing that keeps you from getting sick. The struggle.
John’s Hopkins All Children’s Hospital suggests two fantastic questions when your doctor prescribes antibiotics:
Do I ABSOLUTELY need antibiotics?
Is this the RIGHT antibiotic?
Antibiotics can be very specific—able to find and kill the very microbe causing your strep throat—or they can be broad and able to destroy every microbe that looks at them funny. The more specific your antibiotic is, the less likely you are to suffer the loss of bacteria you really need to help keep you healthy.
The fever may mean you’re fighting be a viral infection. Common viral infections are influenza, the no-longer-novel Coronavirus, RSV, hand-foot-mouth, and the cold (which is actually a catch-all term for a bunch of different viruses.)
Most viruses require you just ride them out—fever and all—taking acetaminophen or ibuprofen as needed.
So, back to fevers.
On a beautiful Friday morning, after two days of a low-grade fever (for which I ABSOLUTELY called our pediatrician who told me it was my call as to whether I thought my kid was uncomfortable enough to merit medication), my darling daughter Margot could not get herself moving. At two o’clock in the afternoon, she was very much alive, but very much still asleep.
I took that kid’s temperature a solid 7 times, and it was hovering around 100. She wasn’t crying. She was still getting up occasionally to drink and snack. I didn’t think medicating the fever was necessary, but then she started breathing rapidly. I don’t mess with breathing, so I gave that kid a dose of albuterol and drove her to the ER faster than the neighbor’s cat flees from a curious toddler.
And when they took her vital signs in the ER, her fever was over 103.
ONE HUNDRED AND THREE.
“Yeah, those under the arm thermometers aren’t very accurate,” the nurse told me. Logically—though clearly not logic I had taken any time to ponder—underarm thermometers are the least accurate thermometers, followed by forehead thermometers because they take the temperature outside the body. In my defense, they are usually only ONE degree off.
The nurse also said, “that’s probably why she’s breathing so fast,” because fevers in children can cause rapid breathing and increased heart rate.
And the most clueless mom of the year award goes to…ME!
They gave her a dose of Motrin and sent us back into the waiting room so I could spend 20 minutes thinking about what I had done and convince myself my cheap Vicks thermometer and I were responsible for my daughter’s certain brain damage.
So, my kid did not need a steroid treatment, nor did she really need the chest x-ray and the full viral panel I requested in the ER. She just needed Motrin, but since we were already the ER, might as well get a full workup and an exact diagnosis.
That day, I learned my kid’s lungs look great for a sick kid born 17 weeks too early and I learned the NICU takes babies’ temperatures under the arm because it’s abusive to stick a thermometer up a baby’s butt four times a day.
To ensure I never end up in the ER looking clueless with a shoeless toddler who is burning up, I didn’t want the learning to stop there. So I pulled together some surprising facts about fevers.
Fevers from infections don’t give you fevers high enough to cause brain damage. Contrary to the idea I had about fevers over 104* being a brain damage sentence, Seattle Children’s says only fevers of 108* or higher can cause brain damage, which can happen if you leave a child in a hot car in the middle of Florida summer, but won’t happen if your kid has, say, parainfluenza virus 3.
Seizures from fevers are (a) rare and (b) don’t cause any permanent damage. I am 147% good if I NEVER see my kids have a fever-induced seizure, but how much better does it make you feel that according to Seattle Children’s it’s not the end of the world if it happens?
The Mayo Clinic doesn’t recommend giving medication to children 2-years-old and up for fevers up to 102* F. Mayo has this great chart on what to do and when to call your doctor. I 10/10 recommend printing out and putting on your refrigerator; I also recommend LOOKING AT YOUR KID. It’s an old trick I learned in the NICU: watch the baby, not the monitor (or, in this case, the faulty thermometer). If your kid is warm and not acting right, call a real + actual doctor—or rush them to the emergency room, depending on what kind of drama you’re up for that day.
According to this 2018 article in the New York Times, evidence suggests there is neither a harm nor a benefit to treating a fever with medication. A raging fever is an indicator your body is fighting something, the fever itself is not the fighter. HOWEVER, medications are never without side effects, but that is a story about medications, not fevers.
There you have it friends, get yourself a good thermometer, don’t freak out too much about a fever, and always consult your health care provider because it’s just a really smart thing to do.
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