Melomed Articles

13 February 2019 - Dr. Leana van Dyk

Fever. Friend of Foe to your child

Fever is one of the most common presenting symptoms in any child and the cause of up to 20% of all consultations in children. Through the years, we have tried to break a child's fever at all cost. Every household and medical facility has their remedies to break that fever, and very often too little emphasis is placed on what the fever is here to do.
A fever is a child's friend, but can become his enemy if not careful. Before I explain this statement, let's have a look at the origin of fever, and the benefits and disadvantages of a raised bodily temperature.

The normal body temperature in a human being is 36.5 - 37,2 degrees Celsius. It is maintained by the interaction between 
- receptors that detect thermal changes (Located in the skin, spinal cord and brain),
- the hypothalamus in the brain (maintain the temperature set point)
- the effector channels that either retain or release heat to maintain our temperature. (This is done via vasodilation or constriction of your skin vessels, sweating or shivering. )

Fever can be caused by:
1. Organisms from outside the body (e.g. Bacterial toxins, viruses, yeasts, protozoa, spirochetes)
2. One's own defence system (immune reactions)
For doctors, the severity, onset and pattern of a fever is often a guideline as to what the possible cause is. But we do depend on additional signs and symptoms to find the cause of the fever. Very high temperatures might indicate a bacterial infection, while lower grade fever might indicate a mild viral infection. This is not the rule and one always have to consider all the symptoms at hand.

Fever is thus one of the earliest signs to warn a parent that their child is not well. But is a better friend than just a warning sign. An elevated body temperature optimise the body's response to invading organisms, and limits the viability of the causative organisms themselves. Most organisms causing infection, function optimal at normal body temperatures, while raised temperatures is unfavourable for their functioning. 

For the above reasons, we should aim to find the cause of the fever, and treat the cause. In this manner, the fever will respond and be controlled.

So why the big effort to reduce a fever. A fever cannot harm your child. Guidelines as to when to treat are not clear, but generally aim to relieve discomfort.

Febrile seizures (convulsions caused by fever) are a concern, but this only occurs in 2-4% of the population. The young child's brain is very sensitive to very high temperatures. For this reason, very high temperatures can lead to febrile seizures. This most commonly occur in ages 6 month to 6-year-old. Although mostly innocent and uncomplicated, it can be very traumatic for the family and the aim is to avoid it by reducing a child's temperature. If your child had a febrile seizure before, keeping the temperature normal can prevent it from re-occurring. 

At the end of the day, fever must not be seen as the enemy, and should guide us to the real pathology. Treatment and antipyretics should be aimed to keep our children comfortable, as a low-grade fever might assist them fighting the real foe. 


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