MEDICAL MATTERS:Low-grade fevers are treated too aggressively, writes MUIRIS HOUSTON
" Fever in the morning, fever all through the night"
THAT CLASSIC song Fever, memorably sung by Peggy Lee and more recently covered by Michael Bublé, recounts the fever of love. But as the song's lyrics say, " fever isn't such a new thing, fever started long ago", the significance of a high temperature for human health has long been recorded. The term febrile is from the Latin word febris, meaning fever.
Our obsession with reducing fever also goes back a long way. Physicians are said to have immersed Alexander the Great in cool baths when he was struck with a febrile illness that eventually killed him.
This obsession has led to the term “fever phobia”. Coined in 1980 by US paediatrician Barton Schmitt, he defined the term after carrying out a landmark study of parents’ understanding of fever. All parents were inappropriately worried about low-grade fever – temperatures of 38.9 degrees or less. Most believed that fever with a temperature of 40 degrees or less could cause serious neurological side effects. As a result, almost all treated fever aggressively: 85 per cent gave anti-fever medications and 68 per cent sponged the child with cool water at temperatures well below 39.5 degrees.
Some 20 years later researchers found even greater levels of “fever phobia”. Of the 340 caregivers interviewed, 56 per cent reported that they were “very worried” about the potential harm that fever could cause their children.
Compared with 20 years earlier, more parents and guardians listed seizure as a potential harm of fever; they checked temperatures more often during febrile illnesses; and they gave medications or initiated sponging more frequently. Forty-four per cent considered 38.9 degrees to be a high fever, while 7 per cent thought that a temperature could spiral out of control if left untreated.
Almost all believed that even a low-grade fever could cause harmful effects. Their major concerns were brain damage and death. But if parents are confused, then so are medics. There is disagreement when it comes to defining a cut-off point for a high temperature. And you will find different advice about how best to treat fever in different books. One myth involves alternating paracetamol with ibuprofen in a belief that using just one type of medication will not work. This practice has been shown to increase the likelihood of overdosing a child with a high temperature.
However, there is agreement that only by measuring a temperature rectally can body temperature be truly assessed. Naturally, this is seen as somewhat distasteful by parents and children. It has led to the development of infrared skin thermometers and ear devices that measure temperature at the tympanic membrane. This device measures the amount of infrared heat produced by the tympanic membrane by means of a sensor probe. The tympanic membrane shares its blood supply with the hypothalamus, the thermoregulatory centre of the human body. With a skin thermometer, a sensor is used to measure the amount of infrared heat produced by the temporal arteries located at the side of the child’s head. These thermometers have to be used specifically according to instructions to obtain correct measurements. To measure tympanic temperature, the probe needs to measure the tympanic membrane directly by lifting up the ear. To measure skin temperature, the infrared skin thermometer needs to be slid along the forehead.
However, Dutch researchers who compared rectal measurements in 100 children with those obtained using the newer devices found that both were inaccurate, even when used by health professionals. They concluded that infrared skin devices are especially unreliable, with the tympanic method a poor substitute for a rectal thermometer.
So what’s a responsible parent to do? Instead of fixating on a thermometer reading, parents should focus more on their child’s overall demeanour. In my experience, a child with a roaring temperature who is distressed is less worrisome than an listless and irritable child with a mild fever.