When I was a pediatric resident a healthy looking one year old baby was brought to the emergency room dead! He was still warm, but dead. If you can believe it, CPR was in its infancy and none of us had had any kind of training in it, but we tried it anyhow, to no avail, the baby was dead!
As I spoke with the grieving mother the story unfolded. Baby went down for his nap with a little runny nose, but not sick. However, he awoke a couple of hours later with a temp of 104. She called her doctor and was told by his nurse to give the baby one baby aspirin (we were still using aspirin back then, we don’t use aspirin today, we would go for acetaminiphen or ibuprophen), a cool water enema, and an alcohol bath. Mother got a bit confused, this was her first child, and his first illness. She gave him a baby aspirin, filled the tub with cool water, and gave him an alcohol enema. A few minutes later he had a convulsion and died.
I had graduated from medical school a few years earlier, had completed a rotating internship at this very children’s hospital, spent two years in the USAF as a general medical officer and finished more than half of my pediatric training and had never seen a baby hurt by a high fever. I had seen quite a number of kids with menningitis present with high fevers and convulsions but the fever and convulsion were caused by the menningitis. Also many kids have fever and a convulsion as the presenting sign of roseola. And every parent knows that fever can also indicate strep throat, ear infection and flu.
After leaving this grief stricken family I went to the medical library and spent hours trying to find an araticle indicating that fever causes brain damage or other significant injury, but I found nothing to support that claim. On the spot I vowed never to treat a fever.
I spent the next fourty years trying to rid the world of fever phobia. Not only is fear of fever prevalent in parents, the myth is also held as true by a large number of doctors including pediatricians.
Now let me make one exception, a kid who plays football or other sports in the heat can develop hyperthermia (heat injury sometimes called heat stroke or heat sickness) which needs to be treated immediately by cooling. That is another story, and an important one. But even then it is not the fever that causes the heat stroke, but the combination of high air temperature and internal heat from the exercise which causes the fever and the injury. No illness that I have ever heard of produces a temperature of 107 or more like that associated with heat injury.
Of course there is an exception to that statement too; some rare head injuries can destroy the body’s temperature control mechanism – thermostat – and result in over-heating. In more than 40 years of busy practice I have never seen one.
In the March issue of the journal Pediatrics, an article decries fever phobia and recommends that fevers be seen as the bodies defense against an illness and while the illness may need treatment, the fever need not be worrisome. How the child looks, acts, and feels are better signs of a how serious an illness may be.
The idea is not to ignore a febrile child, but to look for other signs like alertness, rapid breathing, stiff neck, irritability, lethargy, vomiting, diarrhea, production of urine, or symptoms like sore throat, ear ache, head ache, stomach ache, or the like. These are the things your doctor will want to know if you call him or her with a sick child. You know how your child usually looks and acts, so you are the best judge of the seriousness of an illness. Just don’t panic about a fever!
One last word about the baby who died so many years ago. An autopsy was conducted and no illness was found. We did not have the ability to culture viruses at that time, so perhaps the child was getting the flu. In any event his over prescribing nurse (who learned her trade from the doctor with whom she worked) and the mother’s panic reaction took this beautiful baby boy’s life. May it never happen again.