“Don’t Treat the Fever.”

By Russell J. Bunai, M.D.

The rational management of fever requires understanding the nature of fever.  With rare exceptions, fever is the body’s protective response to illness, most commonly infection.  This appropriate or PHYSIOLOGICAL FEVER is what the body is doing right!  Fever helps the body survive the illness.

Fever strengthens resistance to infection in a number of ways.  In order for a germ to cause infection it must reproduce.  With rare exceptions the germs that cause infection in man grow and reproduce best at the normal body temperature.  The rate of reproduction of the germ falls off rapidly with fever.  Some germs can’t survive at 104F.  Also, proportional to the increase in temperature, there is an increase in the rate of production of normal protective antibodies as well as an increase in the activity of the protective white blood cells.  Fever also reduces the body’s capacity to react allegorically.  Interfering with physiological fever can intensify, prolong, and/or complicate the illness.

The rare instance when fever may be harmful occur when there is a failure of normal temperature control, for example, when a tumor damages the temperature control center in the brain, or if in summer a child is left inside a closed, hot car.  These and other instances of PATHOLOGICAL FEVER are rare and require separate methods of treatment.

The commonly encountered fever does not get “too high;” it is a physiologically controlled response.  A high fever such as 105 or 106F can be serious, not because the fever is damaging but because it may indicate a serious kind of infection, such as pneumonia or meningitis.  It is common practice among physicians to mistakenly recommend treating fever if it exceeds a certain level, for example 102F.  In fact, the higher the fever the more important it is to let it do its job.  A very high fever may mean that in spite of its best efforts the body is losing its battle with the invading germs.  Such cases require prompt diagnosis and treatment.  Commonly an antibiotic or other antimicrobial agent is needed.

Physiological fever does not cause brain damage or convulsion sin otherwise normal children.  A very few children (less than 2%) between six months and six years of age have inherited disorder which may result in a convulsion with fever.  While frightening, especially to the parents, these seizures are not serious; they do not cause brain damage or death.  These febrile seizures are not prevented by fever medicines such as Tylenol or Aspirin or by sponge bathing to lower the temperature.

Many medications commonly used to treat symptoms such as fever, cough, vomiting, and diarrhea have no power to cure the illness.  Such symptomatic treatment may interfere with recovery and is usually best avoided.  Some symptomatic medicines, such as antihistamines, lower seizure threshold and increase the risk of seizures.  Vitamin C raises seizures threshold and reduces that risk.

The best and safest way to make a child with fever comfortable is to cure the illness.  Tylenol, given “to make the child feel better” compromises the natural defenses and puts the child at risk.  Vitamin C brings comfort by supporting the natural defenses.

In conclusion, the rational management of fever calls for  1. giving vitamin C in the proper amount 2. using an antibiotic, should be left alone to do its vital work.

(Russell Bunai, M.D. is a pediatrician who for twenty years has been in private practice in Rockville, MD)

Taken from Encouragement a publication by Angela DiCicco and Gail Signor; 1991

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