Medicine: Friendly Fever?

When children get sick, the commonest symptom is fever, and the first thing that most physicians do is try to get the temperature down. Despite the prevalence of this practice, it may be all wrong, says Stanford University’s Dr. Alan K. Done in Pediatrics. When they rush to prescribe one of the hundreds of anti-fever drugs now marketed, physicians are attacking the symptom, not the underlying disease, and may be interfering with one of nature’s defense mechanisms, says Pediatrician Done. And although some youngsters’ miseries seem to be the result of, fever, other children with a high temperature are as happy as clams, so in their case the treatment is “more for the benefit of the parents or the physician than the child.”

Unless the temperature goes above 106° F. (which it rarely does), says Dr. Done, it is unlikely to do any harm; he doubts that 104° will cause any damage even over several days. And there are definite disadvantages in fighting the fever. Left alone, the temperature and its fluctuations are valuable clues to what ails the child. Diagnosis is hampered by antifever drugs, which may conceal important signs—most notably in rheumatic fever—and prove actually detrimental. Always present are the dangers of allergic reactions and overdosage.

The habit of bundling up a feverish child in flannel pajamas under heavy blankets in an overheated room to make him “sweat it out” is also bad, Dr. Done suggests. It makes no sense when anti-fever drugs are being given, because their effect is to promote heat loss—which the bundling prevents. A moderate room temperature and light covering that allows the heat to escape are better. Often it is equally important and more effective to make sure that the feverish child gets plenty of liquids to make up what he loses by sweating.

There are some cases where a carefully chosen antifever drug is what the doctor should order after thorough diagnosis, Dr. Done concedes. But in general he agrees with Manhattan’s late Physiologist Eugene F. Du Bois: “Fever is only a symptom, and we are not sure that it is an enemy. Perhaps it is a friend.”