FEVER PHOBIA

What is fever phobia and what are its consequences?

Fever phobia is the response of unrealistic fear and anxiety in parents to fever in their children, which may result in inappropriate over-management with anti-pyretics.  It has been estimated that about one-third of all outpatient pediatric consultations are prompted by fever as a dominant symptom.  There is a popular myth of fever in itself causing brain damage and death, if the fever is "high enough".  This belief is so widespread and so unshakeable that the exaggerated concern and anxiety it entails have negatively impacted on the doctor-parent-patient relationship, healthcare cost and the standard of care.

This phenomenon has resulted in an over-usage of fever-lowering medications which is not only unnecessary but may actually be harmful.  That's because lowering a fever can hamper or prolong the recovery process.  The medications used for fever-lowering may themselves suppress the production of antibodies and the ability of white blood cells to destroy bacteria, thereby increasing other symptoms of illness; or cause side effects like liver damage (paracetamol), gastritis (ibuprofen) or Reye's syndrome (aspirin).  Suppressing febrile symptoms may also lead to a premature return to normal activities and deprive the patient of rest required in the recovery process.

Some scientific facts about fever

1.  Fever is a signal of the natural immune response of the body to invasion by viruses and bacteria.
2.  In the absence of other symptoms of concern, the magnitude of fever does not correlate with the severity of the illness. 
3.  Fever is produced when the thermoregulatory centre in the pre-optic nuclei of the hypothalamus is stimulated by endogenous pyrogens to up-regulate its body temperature set-point.
4.  When the fever response is triggered, various mechanisms are activated to elevate the body temperature, including shivering, release of TRH hormone, increase in the metabolic rate, constriction of cutaneous blood vessels and the suppression of sweating by piloerection.
5.  Fever is beneficial because it increases the number of white blood cells and the production of antibodies and interferon, the high temperature directly destroys microbes, it improves the killing ability of white blood cells and impairs the replication of viruses and bacteria.

How then should we manage childhood fever?

First, we must exclude the following categories of cases which will need attention by a doctor:
1. Fever at any magnitude in infants younger than 3 months old.
2. Fever higher than 39 degrees Celsius in children between 3 months and 3 years old.
3. Fever higher than 40 degrees Celsius.
4. Fever in a child with a seizure.
5. Fever in a child with a chronic illness.
6. Fever in a sickly child.

The rest of the childhood febrile cases can be safely managed by ensuring hydration and adequate rest.  The fever, which should not last for more than 3 days, can be allowed to run its course without the use of antipyretics.