Fever is a
sign—not a disease in and of itself. It’s the body’s
reaction to an assault, most often an infection, and it serves
a good purpose. Why, then, should we fear a fever, especially
a high fever? Because it could, in some cases, signal pending
rare cases (such as rheumatic diseases or certain cancers), fever
indicates an infection. Infections are usually either viral or
bacterial (they could also be fungal, parasitic, etc., but let’s
stick to the basics here). In general, most viruses will run their
course and your child’s immune system will eventually deal
with and eliminate the germs that caused the fever.
In most cases,
you’ll see other signs and symptoms that will help you localize
where the infection is, and therefore what type of virus is causing
the illness. Is there a runny nose and cough
with the fever? This is usually an upper respiratory infection.
Is there vomiting and diarrhea, with mild abdominal pain? This
typically signals acute gastroenteritis, or the stomach flu.
If the fever
is a natural response of the body, when should we worry? This
often depends on the clinical symptoms and the age of the patient.
in a Newborn
baby simply can’t fight off a bacterial infection, and therefore
any fever above 100.4 degrees is an emergency if your baby is
less than three months old. Don’t wait for the morning,
and don’t just give Tylenol—call your pediatrician
immediately. The risk of a bacterial infection is just too great.
Bacteria that are normal for a woman to harbor (such as E. Coli
and Group B Strep) can be deadly for a baby.
as you once were, having a newborn
gives you license to be anal and neurotic. The hygiene hypothesis
debates the value of exposure to germs, to build our defenses.
That’s an interesting idea, but not for a newborn! You can
go outside with your baby, but not to a 1-year-old’s birthday
party or the mall. And everyone must wash their hands and refrain
from kissing the baby—that includes your partner, your doctor,
and that random stranger on the street who will try to touch your
What if mommy
gets sick? Breastfeed often and
love your baby. It’s just not realistic to separate mom
from baby. But if your best friend's 2 year old has a runny nose,
it’s just not worth it to see them this week. After the
third month, your baby’s immune system is much stronger,
and it will specifically be able to localize an infection.
that your pediatrician is there for you during these times, and
there is no such thing as a dumb or bad question. We have 24-hour
on-call systems and daily walk-in visits exactly for these reasons—to
help you care for your newborn.
in an Older Child
Fever in an
older child by itself is rarely an emergency. If your child complains
of localized ear or throat pain, pain on urination, or right lower
abdominal pain (don’t forget about that appendix), this
could signal a bacterial infection. Although antibiotic use should
be limited, there are times when you may need help to fight off
an infection, and you should see your pediatrician within 24 hours.
If there is any fast breathing, or if your child is lethargic
and just not looking right, it’s time to see the doctor
immediately. If there are any mental changes, or vomiting with
neck stiffness, it’s a definite trip to the emergency room,
to rule out meningitis.
As your child
grows, his immune system matures, and there are more clinical
cues to help us assess how sick the child is. The lack of clinical
cues is another reason we are forced to investigate fevers in
newborns with more rigor—babies can’t talk, play,
or even smile when they are first born, so how do we know if they
are very sick? An older child can look or act “out of it”
with a high fever.
of how high the fever is, the approach is the same: First, bring
the fever down with medicine, and then reassess (click here
for dosages). If after administering Tylenol or Motrin your child
is playful and happy and eating and drinking, this is a great
sign. The infection is most likely viral, and you may not need
to see your pediatrician. If, however, after the fever breaks
your child still isn’t interactive or happy, it’s
time to get him evaluated.
that with any situation, you know your child best, and there should
be a low threshold to making sure your child is okay. So if something
just doesn’t feel right and you are concerned, go see your
pediatrician. That is what we are here for!
Other Sickness Topics