Advancing Learners Pediatric Clinical Reasoning and Knowledge
Key Points
Fever not only makes children and teenagers feel bad. Parents really dread fevers because they worry about what is causing the fever, and kids being sick disrupts the entire household.
A true medical fever is >100.5F or 38C. Parents will often think that any temperature more than 98.6F or 37.5C is a fever, but this is a temperature elevation.
Most fevers are usually caused by an acute, self-limited illness, that can be treated at home such as a viral illness. Sometimes it is a bacterial illness such as an ear infection or strep throat that needs antibiotic treatment. Fever has a very large differential diagnosis and can always be the sign of a significant disease process.
Assuming that there is a self-limited illness parents can be educated saying something like the following:
Fever is a good thing. It is telling us that the body knows there is something wrong and is trying to take care of the problem.
But fever can make the patient feel bad. Patients do not want to drink, they are in pain, or they just have that non-specific, “I don’t feel good” or “oogly feeling”.
If fever is causing real discomfort then it can be treated with antipyretics like acetaminophen or ibuprofen. It will make the child feel better.
But just because the patient has a fever they do not have to be treated with antipyretics. If they are acting well, they can just be watched. Antipyretics are there for the patient’s comfort.
Explore Cases on PediatricEducation.org
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Cases By Disease – Fever
Cases By Symptom – Fever and Fever of Unknown Origin
DDX – Fever
DDX – Periodic Fever
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Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa