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How should you treat a fever?

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A fever is a common occurrence when you or a loved one gets an infection but when should you treat it with over the counter medications, when should you call the doctor, and when should you just leave it alone?

There is a place in the brain called the hypothalamus which regulates our body temperature and keeps us around that magical 98-99 degrees F.  If you get a viral or bacterial infection, the hypothalamus does its part to fight the infection by increasing your desired body temperature.  You start shaking and that raises your temperature.  When you don’t need the fever anymore, the desired temperature is reset in the hypothalamus and you sweat to cool you off.  In studies in Ferrets infected with influenza virus, they know that as the body temperature rises that the virus replication and shedding rate slows.  That means your body can fight the infection faster and you are actually less likely to spread the disease around.

If a fever is a good thing, why do people want to suppress it with over the counter fever reducers?  It may be right but it feels so wrong.  Shivering or cycling between shivering and sweating is scary, especially when you are caring for a child or an elderly loved one.  If the fever is a symptom of the infection, some people falsely think they are fighting it by reducing the fever.  Finally, if your temperature rises too high, it can cause febrile seizures or can damage the brain, the muscles, and the kidneys.  So you want to allow the right amount of fever but not let it get out of hand.

So what temperature is ok and what is not? Infants are fragile so up to 3 months, call the pediatrician for any fever above 100.4 degrees F.  From 3 months old until adulthood, a fever up to 102 degrees F is considered a normal response and could be helpful, unless you are immunosuppressed in which case you want to call your doctor.  Just give fluids because fevers can cause dehydration.

Children from 3-6 months can take Tylenol if their temperature is above 102 degrees F and the doctor can be called but Motrin should be avoided until the child is over 6 months old and no child under 18 years should get aspirin because it can cause a rare disease called Reye ’s syndrome.  For children 6 months to 2 years, you should call the doctor if the fever doesn’t respond to the Tylenol or Motrin, if it rises above 105 degrees F, or if it lasts longer than one day.  For everyone else with a temperature above 102 degrees F, you should contact the doctor if the fever doesn’t respond to a fever reducer, if is goes above 105 degrees F, or lasts longer than three days.

If you follow these simple guidelines, you can get the benefits of a fever and speed your way to better health.

If the patient is 0-3 months of age, and the fever is greater than 100.4, call the doctor immediately.
If the patient is 3-6 months of age, and the fever is greater than 102.0,  treat with Tylenol (acetaminophen) and call the doctor immediately.
If the patient is  6 months to 2 years old, and the fever is 102.0, treat with Tylenol or Motrin (ibuprofen); Call the doctor if the temp more than 105F, or doesn’t respond to Tylenol or Motrin, and lasts more than 1 day
If the patient 2 to 17- years-old , and the fever is 102.0, treat with Tylenol or Motrin; Call the doctor if the temp more than 105F, or doesn’t respond to Tylenol or Motrin, and lasts more than 3 days.
If the patient is older than 17 years and the fever is more than 102.0, treat with Tylenol, Motrin,Aleve (naproxen), or Aspirin; Call the doctor if the temp more than 105F, doesn’t respond to Tylenol or Motrin, and lasts more than 3 days.

This chart assumes that the patient is stable and has the specified rise in temperature.  People who are very ill should contact their doctor regardless of their body temperature.  Your doctor knows you best and if you are on cancer chemotherapy, take immunosuppressive or biologic therapy for diseases like rheumatoid arthritis, lupus, or psoriasis, or have been told you have a problem with your immune system; follow your doctor’s instructions.  If your fever is due to drug abuse (methamphetamine, cocaine, bath salts), prescription drug use (antipsychotic medications), or for an unknown reason, call your doctor.

Dr. Michael White from the UConn School of Pharmacy