Stephanie Hays (Host): Welcome to Health Dose, your go-to source for quick and reliable health and wellness news. I'm your host, Stephanie Hays. And today, we'll be speaking with Dr. George Elliot, Emergency Department physician at MyMichigan Health. Today's topic is the truth about pediatric fevers and what parents should know. Thank you for joining me today, Dr. Elliot.

George Elliot, M.D.: Thank you.

Host: So first question is, are all fevers bad?

George Elliot, M.D.: No, not all fevers are bad. And, in fact, some people would say that no fevers are really that dangerous. Fevers are a normal defense mechanism that the body has. When we get an infection, the immune system senses that and it releases some components, things that are called pyrogens, and they tell the body that we would do better with a higher temperature. So, those signals go to an area in the brain called the hypothalamus, which is like our thermostat. So, that helps to set our temperature where the body needs to be. So when we get an infection, the body senses it, it turns up the thermostat. And what we get is a fever. It helps the immune system to work more efficiently. And they're really, in general, not very dangerous. What's more important is to look at the child and see, you know, how do they look? How are they acting? What are they doing? That to us is much more concern than what their temperature is if it's just a fever from an infection.

Host: Do all fevers need to be treated with fever medication then?

George Elliot, M.D.: No. In fact, some providers would say that a fever itself really doesn't ever have to be treated. I think that might be a little bit much, because we do want kids to be comfortable. We want them to be able to function and eat and especially to drink, to stay hydrated. So, not necessarily all fevers need to be treated. There's some studies that show there's no morbidity, mortality benefit to treating a fever, which means you can fix the temperature, but it's not going to really make the patient get better faster. It's not going to decrease their risk for the most part.

Host: It's always been said that you should rotate Tylenol and ibuprofen. Is that okay to manage a fever?

George Elliot, M.D.: There's a little controversy with that. It's certainly fine to do to rotate them. Some people will say, if you get both acetaminophen and ibuprofen at the same time, you're getting a bigger dose of a fever reducer, so it's going to work faster immediately. The other camp will say, "Well, if you alternate them like you give acetaminophen at noon, and then you give ibuprofen at 3:00, and then you go back to acetaminophen at 6:00, now you're getting something every three hours. So, you've got better long-term coverage to keep the fever down."

The more important thing is just to make sure that they're being dosed correctly, because we certainly see some kids come into the emergency department and we find that they were actually just underdosed on their fever reducer. And with a more appropriate dose, their temperature goes down, they feel better, and everything is fine.

So whether you want to give them both at the same time, you want to alternate them to stretch them out. Either one's fine, so long as you're staying within the dosing range for what the child needs for their weight. And all that information's on the packet insert. You can look up and they'll give a little bit of a range. But yeah, that's the more important thing, is making sure they're getting the right medication and not getting it too often.

Host: Okay. And do all fevers continue to increase without treatment?

George Elliot, M.D.: No. And this is a time where we can kind of define terms a little bit. So when we say a fever, that's the elevated temperature that you get when that hypothalamus says, "Oh, we got to crank up the heat in here. We got to turn our thermostat up," that's a fever. And in general, those temperatures won't get above 104, 105 degrees.

Now, the other thing is hyperthermia. So, hyperthermia is an increase in temperature that's not due to an illness. It's due to an increased heat source, basically. Like think of somebody that's sitting in a hot car in the summertime. The heat's coming in through the windows. The windows are up. There's no ventilation. There's really no way for them to get rid of that excess heat. So with a fever, thermostat says, "We should be here. Your body raises the temperature to there." With hyperthermia, thermostat says, "Here, but you've got so much heat coming in from an external source, the temperature gets up here." That is something that's completely different. It's treated differently. You can't take somebody out of a hot car, give them ibuprofen and expect their temperature to go down.

So, a fever, an elevated temperature from an infection that's going to top out around 104, 105 generally. If we're talking about hyperthermia, which is where you're getting too much heat in, you can't cool yourself down. There's really no limit to that. There was a patient that had a temperature up to, I think, it was about 117 degrees. But that's never going to happen from an infection, from a fever. That's from an external heat source and not having the ability to cool yourself down.

Host: So after administering medication or treating a patient, how many degrees would you expect the fever to come down then?

George Elliot, M.D.: Generally, about one to two degrees. But again, it's important that they're getting the right dose of medication. Just because your child is two years old, they might weigh 20, 30 pounds more than another child the same age. So, you've got to make sure they're getting the right amount of that medication for their weight, because that really makes all the difference.

Host: Can a body temperature above 104 cause brain damage?

George Elliot, M.D.: It can. Now again, that's generally from hyperthermia from that external heat source, not from an infection. But once you get up to around 105, 106 degrees, a couple things can happen. You increase the metabolic demands of the brain tissue, so they need more oxygen, more glucose, more things to stay alive. And if they're not getting that, then those brain cells can start to die. And that can cause certainly some injury, some damage. There's also something called the blood-brain barrier in the brain, and that helps to keep bad things out of the brain, and that starts to weaken as the temperature gets too high as well. And then, those bad things like bacteria and such can get into the brain. they. Can cause inflammation and other problems. And then, lastly, you know, we got to worry about seizures as well in basically febrile seizures, which is a little bit of a special case.

Host: So, would you say that the febrile seizures are harmful if they do occur?

George Elliot, M.D.: Well, there's kind of two different flavors of febrile seizure. There's a simple febrile seizure, and what that is it's a seizure that lasts less than 15 minutes, which I know sounds like an eternity. But that's what the guidelines and the definition is, less than 15 minutes; not more than one seizure in a 24-hour period and having it be what's called a generalized seizure, which means it starts everywhere, the whole body all at one time.

Now, to contrast that, the other one is called a complex febrile seizure. Those can last more than 15 minutes, more than one in a 24-hour period, and they can be what are called focal, which means it just starts on the left side or the right side. It's not the whole body. So, those complex febrile seizures, those are a little bit more concerning. And pretty much all kids that have a seizure end up in the emergency department at some point.

For the simple febrile seizures, less concerning. It doesn't mean that if you have a febrile seizure, oh, it's got to be a bad infection or it's got to be something else special. Most of them are from viruses. So, the seizure itself generally not dangerous, especially if it's a simple febrile seizure. Kids may have one or two of those in their lifetime. They generally go away.

Now, kids that have had a febrile seizure, they do have a slightly increased risk of a lifelong seizure disorder. But it's not like, "My kid has a temperature of 102, they have a seizure, now they have epilepsy. They're going to be on medicine forever." That's not the case. The majority of the time, they have one of these, maybe two in their lifetime, and they're done.

Host: Do all children with fevers need to be seen in the emergency department? And what would you say is the most critical part about caring for a child with a fever?

George Elliot, M.D.: The most critical part is definitely how are they looking, how are they doing? You know, are they just a little punky, a little rundown because their temperature's up, but they're still eating and drinking and playing and acting normally and talking? Those kids, I would say, try a doses of a fever reducer. Use a weight-based fever reducer. Try to get that temperature down, see how they feel. And if they feel back to their normal self and they're playing, then you're probably good. You know, you can always come into the emergency department or call your primary care physician and see what they say.

But the ones that we really get concerned about are the kids that aren't eating and drinking. They're not acting normally. They're confused. And especially if you treat them with a fever reducer and they're still acting that way, we definitely would want to see those kids either call their primary care physician or come into the emergency department for evaluation.

The emergency department's always there to help. But one thing I can tell you is if you call and ask for advice, really we can't give advice over the phone. The advice is going to be to call your primary care doctor or come in. We're always happy to see people. But unfortunately, we just can't give out advice over the phone.

To answer your question, what's most important: How are the kids looking? How are they acting? What are they doing? If they've got a temperature of 101 or 102 and they're playing and drinking and doing fine, they're probably okay. You know, if you get concerned, you can always come in or see their primary care doc. But most of those kids with a little bit of a temperature elevation, if they're acting normally, they don't necessarily have to come to the emergency department.

There's one other important thing that I need to add as to which kids with fevers need to come to the emergency department. There are some special cases, particularly any child that's immunosuppressed, meaning they're on some kind of a medication that makes their immune system less effective. So if they're on a chemotherapy for cancer, something like that, those kids, any temperature over a 100.5, we would want to see in the emergency department. Same thing for children less than three months old, they don't have a fully functional immune system yet. They're more susceptible to infection. So, those kids need to be seen as soon as possible.

Now once you get up to between three months and three years old, that's not quite as strict. They go up to about 102.2. Now, all these numbers are kind of generalizations. You know, if your doctor says, "Hey, if you have a temperature over whatever, you need to be seen," then we'd certainly want you to follow that recommendation. But those are some of the special cases, immunosuppressed kids, very young children, they have a lower threshold where we'd want to see them in the emergency department for evaluation.

Host: All right. Well, thank you, Dr. Elliott, for joining us on this latest episode of Health Dose. We appreciate your time.

George Elliot, M.D.: All right. Thank you.

Host: If you enjoyed this podcast, please share it on your social channels and explore our podcast library for more health-related topics.