Fevers Can Be Good for You

A growing body of research says they’re mostly beneficial — especially in young kids.

“Give me a fever, and I can cure any disease.”

Hippocrates

Fever is one of the most misunderstood defense systems in the human body. Many people worry that fever is a sign of something dangerous. Parents give their kids Tylenol and ibuprofen the instant they spike a temperature and then flock to doctors to make sure their child does not have a serious infection. In fact, fever accounts for a whopping 20% of pediatric emergency department visits each year. As an emergency physician, this is a huge part of my clinical practice. And I am here to tell you fevers aren’t all bad.

Hooray for evolution. It turns out that increasing our body temperature is one of the great innovations of all time.

There is a significant body of growing evidence that suggests the benefits of fever are to be praised, especially in young children. Further research shows that most fevers are not the result of something serious, but are instead our body’s way of ridding itself of infection. Hooray for evolution. It turns out that increasing our body temperature is one of the great innovations of all time.

The benefits of a fever

Fever is a symptom — a physiologic response to an illness. Fever is not an illness unto itself, but rather a mechanism that our bodies use to fight off infection.

There is ample evidence that suggests fever is beneficial for children. It has been shown to slow the growth of bacteria as well as enhance immune system response. In a recent article in Immunity, Jianfeng Chen and colleagues from the Shanghai Institute of Biochemistry and Cell Biology found that fever enhances the function of specific white blood cells, like a heat-seeking missile finding its target to destroy the infection. Even for the sickest of the sick who require time in the intensive care unit, fevers have been found to be advantageous.

There is ample evidence that suggests fever is beneficial for children. It has been shown to slow the growth of bacteria as well as enhance immune system response.

So, why mess with evolution by trying to get a fever to come down? We get fevers for a reason. This is what we want for our children, isn’t it? A healthy body that can throw an uppercut when needed is the ideal.

Decreasing fever may worsen an infection

There is growing evidence to suggest using medication to decrease a fever can be detrimental to fighting off infection. Antipyretics such as ibuprofen and acetaminophen were shown to prolong influenza infection in one study. And in another, they caused worsening symptoms during the common cold. In a separate clinical trial, researchers showed that antipyretics delayed the resolution of illness in children with chickenpox. While multiple studies have surfaced contraindicating the benefit, clinicians still recommend antipyretics for a fever to help children remain comfortable during illness.

It’s hard to change this mindset in a culture that has become so scared of fever. The biggest parental fears I witness in the ER are concerns about bacterial illness requiring antibiotics, worry that a child will begin seizing, or fear that a high temperature will fry a child’s brain.

These are simply not real threats in most cases. We’ve taught parents to be so afraid of an elevated temperature that they don’t hesitate to reach for Tylenol and Advil as soon as one appears. What’s more, Dr. Google has created a new form of hypochondria (known as cyberchondria) that fuels parental anxiety. An internet search for pediatric fever is sure to unearth the most serious illnesses that can cause fever. Who wouldn’t be scared?

Should we cast blame?

In defense of the medical community, it’s easy to understand why we started broadcasting the dangers of fever. Children can get very ill, and there are certain infections that require antibiotics. In truth, appealing to parental fear was, arguably, a good way — in an earlier era — to make sure serious infections weren’t necessarily missed.

However, with the advent of immunizations in the past 50 years, rates of serious illness have dropped drastically. And instead of embracing fever as a healthy sign that your child is fit to fight off their infection, we’re unfortunately now quick to fear they need medication to reduce the fever and kill the invader. Or worse, we imagine fever to be a sign of impending doom. Has the pendulum swung too far?

The 4-step strategy when fever develops

Education can change society for the better. You don’t need to worry about fever when you understand it and know what to do when it strikes. This is the process I follow whenever my own kids are sick. I call it the 4 C’s.

Step #1 Confirmation

If your child feels warm, take their temperature and then, DO NOT take it again. In my opinion, oral thermometers are the most accurate, while rectal thermometers should be used exclusively in infants. Tympanic (ear) or skin thermometers are notoriously inaccurate. Most parents know when their child has a fever. Either they feel warmer than normal or they act differently. The actual number does not matter. Whether the temperature is 100.4°F, 101°F, or 103°F, your child has a fever and you need to follow steps 2–4. Checking over and over again is not going to change anything, I promise.

Step #2 Comfort

See how your child feels. Fever can make children less active and feel achy. It can snuff out their appetite or cause them to sleep more often. When the fever breaks, kids frequently return to completely normal behavior like the fever was never there in the first place.

Because decreasing a fever may worsen the immune system response to help fight infection, giving children Tylenol or ibuprofen to normalize temperature may not always be necessary. However, when a fever causes uncomfortable symptoms for children, such as body aches, fatigue, or decreased appetite, experts recommend using antipyretics to improve comfort and I would agree. It’s amazing to see a child perk up once the temperature starts to drop.

I recommend giving antipyretics based on a child’s overall condition rather than a number on the thermometer — to ensure that fever without symptoms can remain beneficial for your child.

Step #3 Critical

This is the step where you decide whether it’s worth seeing the doctor, or if necessary, going to the emergency room. This has been well-studied and there are some telltale signs and symptoms that should increase your suspicion that a more serious illness might be at play.

1. First, if a child is less than two months old and has not had their first set of immunizations, all bets are off. You should visit the doctor for any fever. While there is more concern within the first month of life, serious infections can occur up to two months. Any child with other health issues that could predispose them to a lower immunity should seek care.
2. Persistent fever despite the use of antipyretics should be evaluated. If a child has a fever and they are given an appropriate dose of ibuprofen (and perhaps also acetaminophen) but the fever doesn’t budge, this could mean the child has something more serious. Fevers lasting beyond four or five days could also mean something more serious is happening. Your child should see the doctor.
3. Certain signs of bacterial illness require a doctor’s visit. Examples include ear pain, significant sore throat, painful urination, abdominal or chest pain, shortness of breath, or a concerning rash. If there is any doubt, it’s always advisable to see your child’s doctor for an evaluation.
4. Finally, parents can usually tell when something seems off. If the child is listless or confused, or if they are significantly short of breath, there may be a problem, and it would be prudent to see a doctor urgently. Most parents have an inherent ability to determine when it’s time to see the doctor.

Step #4 Cruise

Once you’ve determined that your child has a common illness (likely viral) that does not require major intervention, you can enter cruise control. This means decreasing the temperature when your child feels awful, monitoring for critical findings that may develop, and waiting for resolution within seven to 10 days.

At this step in the process, you are supporting your child in the healing process. The waiting game is not easy. Most illnesses peak around four to five days and some last up to two weeks. I see a number of patients around the three- to five-day mark because parents expected the illness to resolve by then. This is almost never the case. Time is the best medicine. Our bodies are miraculous machines but they take time to get the gears in working order.