Even outside the era of COVID-19, childhood fevers can be concerning — and sometimes downright confusing — for parents and caretakers. In this episode of Parentalogic, hosts Alok Patel and Bethany Van Delft answer all of your burning questions: What do you do if your kid has a fever? When should you call your doctor, bring your child to a hospital, or just stay home? Do ice baths actually work? And what exactly is a fever?
Together, the duo rebrands fever’s bad image — “So basically, [childrens’] immune systems are setting up the right scenario to go to battle,” Alok, who’s a pediatrician, says — and explains exactly what happens to your child when they get sick.
First, pyrogens make their way to the brain’s hypothalamus, which acts like a body’s thermostat. Pyrogens are chemicals either from invading pathogens, like influenza or SARS-CoV-2, the virus responsible for the current pandemic, or triggered from the immune system. Once in the hypothalamus, pyrogens drive up the body’s temperature.
But what’s the point? Experts believe that at a slightly elevated temperature, the chemical reactions used by the immune system are more efficient. This gives the immune system a competitive advantage over the virus or bacteria it’s fighting: Lots of microorganisms, it turns out, can’t take the heat. (Microorganisms aren’t the only things that can cause a fever, however. Autoimmune or autoinflammatory conditions, chronic or rheumatologic disease, pneumonia, ear infections, certain medications and vaccinations can all cause fever, too.)
And if your child shivers with the onset of a fever, not to worry! It may seem counterintuitive, but shivering is the body’s response to its new, hotter, “set point.”
But can fevers get out of control? Can acetaminophen, ibuprofen, and/or ice baths successfully — and safely — reduce your child’s fever? And are fevers in young babies, especially infants less than 3 months old, ever OK?
Watch and learn how to best help your child feel better from a fever and keep others around them healthy and safe (hint: stay at home, social distance, and encourage frequent handwashing). Bethany and Alok are here to spill the tea on this hot topic.
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When to Worry (and not Worry) About Your Child's Fever
Published: August 17, 2020
Alok Patel: Babies just sit there and they’re like...
Bethany Van Delft: And the babies are like, “Yeah, man, Dr. Patel, gimme that spinal tap!”
Alok Patel: They’re like, “Gimme sugar water and my pacifier, and you can do whatever you want. I don’t care.”
Bethany Van Delft: So what’s happening in my kids when they have a fever? Like what’s happening in their little bodies?
Alok Patel: In their little bodies, so basically, their immune systems are setting up the right scenario to go to battle. Pyrogens—pyrogens are these chemicals that are released by either the foreign invaders—bacteria or viruses themselves—or triggered from the immune system to the hypothalamus…
Bethany Van Delft: Sound like pyromaniacs.
Alok Patel: Kinda like that, right, fire, fever. But pyrogens will go to your hypothalamus… Pyrogens will go to your hypothalamus and drive up the body’s temperature. Now, experts think that at a slightly elevated temperature, the chemical reactions used by the immune system are more efficient. And so the immune system almost gets a competitive advantage over foreign invaders, like some microorganisms, which don’t fare so well at higher temperatures.
You see a lot of this in the animal kingdom. Lizards will sometimes even crawl to a place where they can elevate their body temperature to fight off infections.
Bethany Van Delft: Like a hot rock?
Alok Patel: Like a hot rock.
Bethany Van Delft: What about when my kids are shivering and shaking from fever, what’s happening there?
Alok Patel: Basically, your body’s internal thermostat has a new setpoint. Your body’s like, “This is where I want to be.” The rest of your body is not quite there yet. The body will react by also trying to generate heat. And so shivering, feeling the chills, so you go and grab blankets because your body is basically trying to warm itself up to get to the new setpoint. Everything is whacked but it’s all in the name of competitive advantage for your immune system over the foreign invaders.
Bethany Van Delft: Competitive advantage. Dude, that’s a good rebranding of fever.
Alok Patel: Competitive advantage, but while your body’s achieving this...
Bethany Van Delft: Like if fever got a PR company and fever was like, “I don’t know, I kinda have a bad image. Could we do something about that?” And a good PR person would be like, “How about competitive advantage to defeat invaders? Fever’s like, “Yeah!!”
Scene 2: On Call
Bethany Van Delft: So this I feel is a mixed message that I’m always hearing. On the one hand, fever is a sign that your body is doing what it’s supposed to fight an infection.
Alok Patel: Totally.
Bethany Van Delft: On the other hand, we’re told to reduce fevers. Like, which is it? What am I supposed to be doing? Letting the fever do its job, which is what I do? Or reduce the fever?
Alok Patel: I don’t think it’s a bad thing to let fevers do their jobs because again, fevers have a certain protective measure to them. Again, there’s a threshold. We want to make sure we understand the underlying reason why your kid has a fever, and that it’s safe to let it run its course…
Bethany Van Delft: What are some methods to reducing fever? I know you can use ibuprofen or acetaminophen. How about ice baths? My grandmother used to threaten me with ice baths. Is that still a thing, or is that like back in the day? Is that Model T Fords and ice baths? Do you do that anymore? No more?
Alok Patel: I don’t know if we do the full-on professional football player ice bath but it’s certainly okay to try a cooling towel to lower the temperature. Just to make things a little more comfortable.
Bethany Van Delft: A cooling towel. That’s a nice compromise.
Alok Patel: Because here’s the thing: if you’ve checked in with your doctor and you feel like it’s safe and it’s okay to drop the fever, I get it—fevers make children uncomfortable, their heart rate’s a little faster, they seem fussy. And you may want to make them feel more comfortable. Experts think acetaminophen may work directly at your body’s thermostat, the hypothalamus, to drop the core temperature. And ibuprofen may block the chemical signals which go there. So they both essentially work in the same endpoint. They tend to work differently in certain children.
Bethany Van Delft: When is it super serious? Like, when do you really, really have to worry about a fever?
Alok Patel: I know I’ve harped on this 15 times, but if your child looks sincerely ill or is not acting like themselves, I don’t even care what the temperature is. You should check in with the doctor. But specifically talking about a fever, any fever, any fever in young babies, especially under 3 months, is serious unless proven otherwise.
And I say serious because in young babies, they’re at a higher risk for getting really bad infections that can affect the brain. It might necessitate blood tests, or even a spinal tap. Which is not a big deal in babies—they take it like champs.
Bethany Van Delft: How do you know that?
Alok Patel: I’ve done them. And babies just sit there and they’re like...
Bethany Van Delft: And the babies are like, “Yeah, man, Dr. Patel, gimme that spinal tap!”
Alok Patel: They’re like, “Gimme sugar water and my pacifier, and you can do whatever you want. I don’t care.” Cause here’s the thing, here’s the thing.
Bethany Van Delft: What’s the thing?
Alok Patel: If people were to call doctors for every single fever, we would get called nonstop. Because kids get fevers all the time. And the majority of infectious fevers, meaning fevers caused by an infection are from viruses. These are mostly things like the common cold—not very serious. But some virus infections can be dangerous, so it’s always best to keep a child with a fever at home, and to protect yourself with basic hygiene, especially hand-washing.
The fever, a fever, temperatures, they’re all a symptom. They’re not themselves…
Bethany Van Delft: They’re not the illness, it’s not the thing you’re worried about.
Alok Patel: It’s not the disease—it’s a symptom.
Bethany Van Delft: Okay.
Alok Patel: So the things that are gonna cause a fever, so you’re talking about infections like ear infections, pneumonia, UTI, things like that. You also have chronic disease, rheumatologic disease, autoimmune, autoinflammatory conditions. Even certain medications, vaccinations. These can all cause fevers.
Bethany Van Delft: A love fever, that’s not legit fever.
Alok Patel: Not a legit fever.
Bethany Van Delft: What about spring fever?
Alok Patel: Not spring fever.
Bethany Van Delft: Okay, go back to real fever. Go back to real fever.
Alok Patel: Also, not teething. You can get a slightly, maybe a little bit of an elevated body temperature. But you’re not going to get into fever category.
Bethany Van Delft: No, teething is because the baby’s teeth are real busy coming out, right? That’s more like, the teeth are trying to come out, and so they are a little bit warmer.
Alok Patel: But it’s a cool process inside the body where your immune system actually needs to tell you to get a fever.
Bethany Van Delft: Alright. I like when you’re like, “I’m just gonna keep talking Bethany because you are not making sense.” Alok, stop, stop doing yoga. Stop with the yoga. You just came back. Stop with the yoga.
Alok Patel: I’m just in the mood. It’s just like, my body’s flowing, I got good energy.
Bethany Van Delft: It’s just good.
Alok Patel: Yeah.
Bethany Van Delft: Sounds like it was good. You can’t stop. Can’t stop, won’t stop those yoga poses.
Alok Patel: Addicted to hot yoga.
Hosted by: Alok Patel and Bethany Van Delft
Producer/Director: Ari Daniel
Producer/Camera: Emily Zendt
Production Assistance: Diego Arenas, Christina Monnen, Arlo Pérez, Drew Powell, Madeline Weir
Digital Editor: Sukee Bennett
Rights Manager: Hannah Gotwals
Business Manager: Elisabeth Frele
Managing Producer: Kristine Allington
Coordinating Producer: Elizabeth Benjes
Director of Audience Development: Dante Graves
Director of Public Relations: Jennifer Welsh
Legal and Business Affairs: Susan Rosen and Eric Brass
Director, Business Operations and Finance: Laurie Cahalane
Executive Producers: Julia Cort and Chris Schmidt
Fatma Dedeoglu, MD
Jonathan S. Hausmann, MD
GregorQuendel / CC BY 3.0
JohnsonBrandEditing / CC0 1.0
smand / CC0 1.0
tommccann / CC0 1.0
Alissa Eckert, MS; Dan Higgins, MAMS
Thermometer by Dev Patel from the Noun Project
thermostat by Nikita Kozin from the Noun Project
© WGBH Educational Foundation 2020