FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

[IT'S OFTEN BETTER NOT TO TREAT FEVER BELOW 104 ]

Question: My neighbor and I are confused about whether we should give our children something when they have fever. Her doctor has told her that she should always give her kids Tylenol or ibuprofen. Our family doctor has been less emphatic. She has advised giving them something if their fever is 103 or more. Otherwise, she recommends plenty of liquids and watching them. Why does one doctor advise the use of medicine for fever when another doesn't?

Answer: Let me start my answer with a definition of fever. Fever is an elevation of the body temperature, and the normal temperature is usually near 97.5 before arising in the morning and increases to an afternoon or early evening high of about 99.3. These numbers represent oral temperatures, which tend to be about one degree lower than rectal temperatures and one degree higher than those obtain from the arm pit.

Complex regulatory mechanisms usually keep the temperature within a narrow range. Elevation above the normal temperature range can be due to failure of the regulatory mechanisms, as in heat stroke, or from an upward adjustment of the body's thermostat, as occurs in illness. The identification of which type of fever is quite important because a failure of the regulatory mechanisms requires prompt cooling from sponge bath and large amounts of fluids, usually intravenously. Fever from an illness, the more common condition about which you have asked, can be treated in several ways, including doing nothing at all.

Fever as a consequence of illness causes shivering, increased metabolism, and constriction of the blood vessels in the skin and extremities. These actions increase the heat generated by the body and simultaneously reduce the amount of heat lost from the skin to the environment. There is no evidence that temperatures up to 104 degrees directly cause detrimental health consequences in those over 6 or under 65. Consequently, some physicians recommend that no treatment is necessary for those in this age range who have fevers. In fact, there is some evidence that suggests fever may intensify the "immune response" and, thereby, improve the body's ability to fight an infection. This is, perhaps, another good reason not to treat a mild fever.

There are, as I said earlier, exceptions. Because high fever in children younger than 6 can sometimes bring on a seizure, most physicians recommend treatment with ample liquids and Tylenol (acetaminophen) or ibuprofen. Also, the increased strain on the heart caused by fever may bring about a heart attack in an older person. Therefore, they too should take something for fever.

The aching and miserable feelings that go along with a fever are a consequence of the events that bring about the fever, not of the elevated temperature alone. Sometimes anti-fever drugs that also have pain-relieving qualities - like acetaminophen and ibuprofen - are used to treat the discomfort of an illness, and fever-reduction is only an incidental by-product.

Perhaps the doctors have given your families differing advice because of the ages of your children or because of a history of seizures. It may also be that they have opposing views about the use of generally safe medications to relieve discomfort in non-life threatening illnesses.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.