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Thursday, April 24, 2014
Fever of 105 in a 1 year old
My grandson has a fever of a 105 and my daughter took him to see the doctor and they say there is nothing really to worry about. They said that children can with stand a much higher temperature than adults. He has been sick with sever cold like systems for a while and just had tubes put in his ears this past Thursday. I normally have a lot of faith in our medical field but this just doesn`t make common since to me. They did give a breathing treatment but pretty much said just to watch his breathing, either from his stomach or ribs. I`m guessing he is supposed to be breathing from his chest area? I really haven`t given it much thought as to what part goes up and down when we breathe
A fever of 105 degrees F is a significant fever. It's a good thing your grandson's parents consulted a doctor, especially if he is under two years of age, a period when children are most vulnerable to sepsis and meningitis. The fever clearly indicates that his immune system is fighting back against a bacterial or viral invader. Viruses and bacteria actually thrive at normal body temperature or lower temperatures, so one of the innate processes the healthy person has to kill these invaders is to raise body temperature in order to suppress the multiplication of the microbes. However, a really high fever does not mean a really severe degree of illness. It also is true that harm to the body does not occur until the fever is 107 degrees Fahrenheit or 41.6 degrees C or higher. Remember, too, that fever is a symptom not an illness. So treating a fever is not treating the underlying cause of the illness.
In addition to suppressing the multiplication of bacteria and viruses, fever does many helpful things to fight infection. It activates the first responders among the white blood cells and enhances their killing ability. Fever decreases glucose use in the body. Glucose is the favored fuel of bacteria. Without it, they cannot multiply quickly. Fever also overall activates many components of the inflammatory response to effectively kill microbes infecting the body. So actually, we should be careful about choosing to use medications to lower fever because as we knock out the fever, we also knock out its beneficial effects in combating infection.
A reason to treat fever would be the child's discomfort. Medications should be carefully dosed as directed on packages based on the child's weight. Acetaminophen or Tylenol is the only fever medication approved for children under 6 months of age. Even though it tastes sweet, as does ibuprofen syrup (Advil, Motrin), these are medications whose overuse can be harmful to the child's liver and kidneys. Cold or cool baths should not be used. They increase shivering and discomfort. Tepid baths are OK.
The doctor was also suggesting that your grandson's parents observe closely for signs of respiratory distress, a problem that can lead to respiratory arrest and death in young children. These signs include nasal flaring with inhaling, a grunting sound on expiration, a respiratory rate over 60 breaths per minute when at rest, and retractions or tugging in of the skin between the ribs, under the diaphragm and breastbone, and around the collar bones. These are all signs that the young child's lungs are working hard and young children's bodies cannot do this for long without significant risk of stopping entirely.
The doctor also tried using a breathing treatment to see if it would help your grandson breathe more easily. If it works, that's great and parents can continue to provide the treatments at home. However, breathing treatments do not work for all types of respiratory infections or for all children. Then it is senseless to continue providing medications that do not work and have the potential for harm.
It's not always a good idea to hospitalize a child who is able to drink fluids well and who has attentive parents and grandparents, who can be relied upon to watch the child closely and recognize when urgent care is needed. Hospitals contain many virulent bacteria that can secondarily infect the child, never mind the distress of the unfamiliar surroundings and many strangers approaching the young child that can be a very scary experience. So, when a child really needs hospital care, it is appropriate to use their services, but not using them until the real need arises is also good medicine.
I hope this helps in understanding the care provided to your grandson. As always, Children's Hospitals' emergency rooms and urgent care centers are the best choice for care for a very sick child since they have professionals best prepared to evaluate the ill child of various ages as well as equipment of the appropriate size. Parents know their child best. If they believe a change has occurred in the child's condition about which they are concerned, seeking further care is very appropriate. I hope your grandson is better soon!
Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University