'Fever Phobia': Doctors urge parents to stay calm, and get expert advice

When her 15-month-old son's temperature rises to anything above 100, Katie-Anne Gustafson becomes anxious. To Katie, a fever "that high" indicates something is wrong with her baby. "I fear seizures," Katie says, and "and I fear lasting damage if the fever doesn't come down."

But, such fears are unfounded, say experts. "Fever phobia," a phrase coined by prominent pediatrician, Barton Schmitt, M.D. in 1980, persists among parents today, according to a recent study presented to the American Academy of Pediatrics. Michael Crocetti, M.D., co-author of the study and director of pediatrics at Johns Hopkins Bayview Medical Center in Baltimore, says misconceptions about fever lead overly-anxious parents to over-monitor and over-medicate their children - behaviors that cause many doctors more concern than the fever itself.

The study revealed that, in relation to fever, parents today are no more knowledgeable than 20 years ago. "The majority of caregivers listed as fevers what experts consider normal temperatures, as fevers," says Dr. Crocetti, " and many parents thought a fever could rise out of control to lethal limits if left untreated, which really isn't true." Ninety-one percent of respondents worried that fever could harm their child, with 21 percent citing brain damage and 14 percent listing death as possible effects. A significant percentage administered anti-fever medication at too-frequent dosage intervals.

"Parental concerns arise, in part, because of the belief that fever is a disease rather than a symptom or sign of illness," adds Dr. Crocetti. "Fever is one of the most common things parents can encounter, yet many parents don't even know how to define it."

Queens pediatrician Jack Levine, M.D., in practice with Steven Goldstein, M.D. in Kew Gardens, agrees. "It's the other symptoms, if any, accompanying a fever," says Dr. Levine, "that would be more cause for alarm than the fever itself."

The age of the child is also a critical factor, experts say. Infants under 3 months of age have a normal temperature of up to 100.4. Yet, they can have serious infections with just minor fluctuations without showing the symptoms early on. "They don't fight infection well," says Dr. Levine, "so for them, any fever at all is of concern." Dr. Levine advises parents of new babies to call their pediatrician immediately if they detect any fever whatsoever.

For older babies and children, Dr. Levine focuses more on the child's behavior and temperament, than on the degree of fever, citing parental reaction to roseola as a prime example of fever phobia in action. Common in children ages six months to 2 years, roseola begins with a fever of 104 or 105, which lingers for three to five days. When it breaks, the child develops a raised pink rash on his face and upper body. There's no treatment for roseola, and by the time its diagnosis is confirmed, your child is already recovering. "You can have roseola and have a fever of 104, or you can have a really serious infection and have 101 or 102. So the height of the fever itself is not really an issue as much as how the child is acting," Dr. Levine explains.

The study also found many parents administering anti-fever medication to their children too frequently. Proper dosage for acetaminophen is no more than every four hours and ibuprofen should be given at six-hour intervals. "Tylenol (the brand name for acetaminophen) is not a totally harmless drug," says Dr. Levine, who advises parents to stringently follow dosing recommendations on the bottle, which are guided by the child's weight, not age.

Exceeding the proper dosage of any anti-fever medication can be toxic to a child's liver and kidneys, says Dr. Crocetti, who recommends parents consult their pediatrician to determine the proper dosage for any child under age 2.

And, experts agree, once you've administered the medication, "let your child be" for a while. "Many parents express concern when their child's fever doesn't dramatically drop after a dose of acetaminophen," says Dr. Levine. "It's part of the phobia." But it's important to understand why you're treating your child's fever in the first place. "The goal of the medication," he explains, "is to make the child feel more comfortable." He also cautions parents about trying too hard to bring the fever down. "One of the problems is that fever may actually help the body fight infection. If the child isn't terribly uncomfortable, many times we don't even tell the parents to treat it."

"Fever actually revs up the immune system," Dr. Crocetti explains. "It thwarts the growth of bacteria and viruses so it's actually a protective mechanism."

Many parents also use sponging as a fever reduction technique, but, according to the survey, two-thirds of them do it incorrectly - with cold water. "In defense of parents," says Dr. Levine, "a cool bath sounds like a good idea. As an adult, if you had a high fever, you'd want to cool down. What parents don't realize, though, is that if the water is too cool, the baby may start to shiver, which actually makes the fever rise." If you decide to bathe or sponge your feverish child, experts recommend lukewarm water, but if your child is uncomfortable, immediately discontinue the bath.

"And never use rubbing alcohol," cautions Dr. Crocetti, as "it's particularly dangerous to young children. It can cause low blood sugar, and the child can actually get alcohol-toxic because it's absorbed through the skin."

Dr. Crocetti suggests doctors and other health care providers could do a more thorough job of educating parents, as fever phobia is often passed down from one generation to the next. When in doubt about how to treat your child's fever, call your pediatrician. And don't hesitate to ask for clarification when you're confused. But avoid misconstruing your doctor's advice as cause for alarm. Fever plays an important role in the healing process and sometimes the best medicine is to just let it run its course.