Back when I was in pediatric training, some years B.I. (before the Internet), there were a few givens. First, when we wrote hospital orders, we asked the staff to tell us of any patient with a fever. Second, each call would lead to the dilemma of whether to treat the fever (usually the strong preference of the caller) or withhold treatment to see what would happen. Third, in midwinter in particular, this scenario would repeat itself enough times over the course of the night that we spent most of our free time until our next call night catching up on our sleep.
Although the sleep issue has in recent years been helped a little with residency training reforms, the question of what to do for a fever, particularly in an infant, is still with us. Investigators continue to research the issue, and even COVID-19 has gotten into the act. Although baby fever has been discussed in these pages before, it’s time to see what the medical community is saying now about this always hot topic.
Fever Basics: A Review
It isn’t an article on our youngest fevers without trying to answer the burning question: “Why the fever?” Fever occurs because certain chemicals in the blood tell the brain to raise the body temperature. This generally occurs during a process known as inflammation.
So, why the inflammation? Most often this occurs because the body is trying to rid itself of infection and needs the cells and chemicals for this process to take place. While it is true that inflammation can occur without infection (in rheumatoid arthritis, for example, or as part of the vaccine immune response), and it’s also true that fever can occur for reasons other than inflammation (as with dehydration or overdressing), the great majority of significant fevers happen due to infection.
Now, keep in mind that any infection, serious or not, can cause fever. What’s more, the height of the fever doesn’t always indicate the seriousness of the infection.
To Treat or Not to Treat?
In a baby, providers usually want to try and find out what infection might be causing the fever. This tells them whether it’s likely to go away on its own (likely a viral infection) or whether, for example, an antibiotic might be needed (likely a bacterial infection). Whatever the cause, it’s important to know that treating the fever will not make the infection go away.
Although we’ve known for ages that treating fever doesn’t treat infection, is there any benefit to treating a fever? And is there a downside? A lot of this is up for debate. There’s some belief that letting a child have a fever helps the inflammation treat the infection better. And since vaccines can also cause a fever, research continues to examine whether not treating that fever helps the vaccine become more effective. There’s also a thought that some germs might not survive as well at higher temperatures. These arguments are put forth by some providers, who advocate not treating many fevers. (Some providers advocate not even taking the temperature!)
Many other providers do recommend treating at least some fevers. A baby with a fever is often irritable, and if she feels better when the temperature is down, we feel better about predicting she doesn’t have a serious cause of her fever. (Babies who are unusually cranky no matter what the temperature is usually need medical attention sooner rather than later.) Also, since high temperatures cause more fluid loss in the body, bringing down the temperature causes less fluid loss, which also keeps your little one feeling better.
…and….Treat With What?
Acetaminophen and ibuprofen are both easily obtained and usually effective against fever. More recently, some people have begun alternating the two medicines or even giving them at the same time. While you can see how your provider feels about alternating acetaminophen and ibuprofen, neither has been proven to make much difference in effectiveness. Most would not recommend combining the two at the same time
COVID-19 and Fever
Although it’s less common for babies to get sick with COVID-19, the emergence of the disease has caused researchers to study things that have implications for a lot of diseases. You guessed it: treating fever is one of those things. As with so much related to COVID-19, there’s nothing conclusive. Although the CDC says that there is no evidence that using ibuprofen, for example, to treat fever makes for a worse course, there is thinking by some members of the medical community that fever will let the immune system do its work here as well. On the other hand, researchers continue to look at ibuprofen for its anti-inflammatory properties, which might be useful in managing this often serious infection. It’s yet another work in progress on the COVID-19 front, and as with so many other aspects of this illness, we’ll have to stay tuned.
The Real Lessons Haven’t Changed
Babies will continue to get fevers, and parents will continue to worry about them. It’s best to chat with your child’s provider about how to handle fevers and to always call if any fever is concerning you. Some final pearls:
- Realize that for the most part, it’s not the fever that’s concerning; it’s finding the infection that might be causing the fever. Most childhood infections aren’t serious, but some are.
- The younger the child, the more concerning the fever. Most providers would consider any fever in a baby under 3 months of age a medical emergency. (Here are some additional reasons to call your provider if your child has a fever.)
- Looking at your child to see how sick he appears is more important than the actual height of the fever.
- Keep in mind that an unimmunized baby is more likely to have a vaccine-preventable bacterial infection. Parents who do not immunize need to be particularly watchful, and their baby may need tests for serious infection more often.