Are You Afraid of Fever?

Old wives’ tales and suburban legends don’t die easily, but the American Academy of Pediatrics has decided to tackle one of our most deeply embedded ... fever phobia.

It’s easy to understand how fever acquired its fearsome reputation. In the days before antibiotics – and even in the 1970s before the Haemophilus influenzae vaccine – there was a good chance that a child with a fever might be developing meningitis or pneumonia.

The Fever was indistinguishable from the illness. Instead of being seen as a nonspecific symptom, it became part of the problem. When medications were discovered that seemed to lower the fever, it became something to treat. This further distracted the focus of both parents and physicians.

As fatal febrile illnesses became less prevalent in developed countries, the phobia persisted because the frightening, but usually benign, phenomenon of febrile seizures persisted. It is hard to reassure anyone who has witnessed a febrile seizure for the first time that fever is nothing to worry about. Another reality, unique to the United States, is the threat of a malpractice suit. Even though almost every febrile illness will end happily, some physicians can’t see past the fear of litigation and act irrationally when the patient has a fever.

The academy’s recommendations in its clinical report, "Fever and Antipyretic Use" (Pediatrics 2011;127:580-7) certainly state the case for shifting our focus from fruitless attempts at battling temperature to helping sick children be more comfortable. But they stop short of suggesting that we add our actions (or in this case inactions) to our words.

Do your assistants take temperatures on every sick patient? Why? If we want to help parents refocus their attention away from fever, then we need to demonstrate that our focus has shifted.

For 25 years, I rarely used a thermometer in the office. Babies in the first 3 months of life deserved special attention if the history suggested any hint of illness. A child with a swollen joint and a vague or nonexistent history of trauma had his temperature taken. But otherwise, I assumed that if a parent said his child had had a fever, it was so. Whether I could document it in the office was irrelevant. There were occasional situations in which my diagnostic algorithm reached a branch point and I needed to know whether a fever was present. But for the most part, my thermometer (maybe I had two) sat in the drawer.

When I joined a larger group, I lost a bit of control over the setup procedure, and recording a temperature on every non-well patient became the standard. I’m not sure whether this was out of fear of malpractice suits or whether it was believed that a more complete set of vital signs made it easier to argue for a certain level of coding.

Regardless, I don’t like it because it makes it appear that I believe fever is something to worry about. But I try to be a team player. The good news is that with the new gadgetry, taking a temperature (forget about accuracy) requires very little of my assistant’s time. And if a parent asks about the temperature, it gives me the opportunity to launch into a mini-lecture about fever that I have honed over the last 35 years.

If my tutorial is successful, my hope is that the parents will have the fortitude and good sense to stop taking temperatures at inappropriate times. I wonder if we can all have the same courage and let our inactions speak with our words.

Dr. William Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. E-mail him at [email protected].

Old wives’ tales and suburban legends don’t die easily, but the American Academy of Pediatrics has decided to tackle one of our most deeply embedded ... fever phobia.

It’s easy to understand how fever acquired its fearsome reputation. In the days before antibiotics – and even in the 1970s before the Haemophilus influenzae vaccine – there was a good chance that a child with a fever might be developing meningitis or pneumonia.

The Fever was indistinguishable from the illness. Instead of being seen as a nonspecific symptom, it became part of the problem. When medications were discovered that seemed to lower the fever, it became something to treat. This further distracted the focus of both parents and physicians.

As fatal febrile illnesses became less prevalent in developed countries, the phobia persisted because the frightening, but usually benign, phenomenon of febrile seizures persisted. It is hard to reassure anyone who has witnessed a febrile seizure for the first time that fever is nothing to worry about. Another reality, unique to the United States, is the threat of a malpractice suit. Even though almost every febrile illness will end happily, some physicians can’t see past the fear of litigation and act irrationally when the patient has a fever.

The academy’s recommendations in its clinical report, "Fever and Antipyretic Use" (Pediatrics 2011;127:580-7) certainly state the case for shifting our focus from fruitless attempts at battling temperature to helping sick children be more comfortable. But they stop short of suggesting that we add our actions (or in this case inactions) to our words.

Do your assistants take temperatures on every sick patient? Why? If we want to help parents refocus their attention away from fever, then we need to demonstrate that our focus has shifted.

For 25 years, I rarely used a thermometer in the office. Babies in the first 3 months of life deserved special attention if the history suggested any hint of illness. A child with a swollen joint and a vague or nonexistent history of trauma had his temperature taken. But otherwise, I assumed that if a parent said his child had had a fever, it was so. Whether I could document it in the office was irrelevant. There were occasional situations in which my diagnostic algorithm reached a branch point and I needed to know whether a fever was present. But for the most part, my thermometer (maybe I had two) sat in the drawer.

When I joined a larger group, I lost a bit of control over the setup procedure, and recording a temperature on every non-well patient became the standard. I’m not sure whether this was out of fear of malpractice suits or whether it was believed that a more complete set of vital signs made it easier to argue for a certain level of coding.

Regardless, I don’t like it because it makes it appear that I believe fever is something to worry about. But I try to be a team player. The good news is that with the new gadgetry, taking a temperature (forget about accuracy) requires very little of my assistant’s time. And if a parent asks about the temperature, it gives me the opportunity to launch into a mini-lecture about fever that I have honed over the last 35 years.

If my tutorial is successful, my hope is that the parents will have the fortitude and good sense to stop taking temperatures at inappropriate times. I wonder if we can all have the same courage and let our inactions speak with our words.

Dr. William Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. E-mail him at [email protected].

Old wives’ tales and suburban legends don’t die easily, but the American Academy of Pediatrics has decided to tackle one of our most deeply embedded ... fever phobia.

It’s easy to understand how fever acquired its fearsome reputation. In the days before antibiotics – and even in the 1970s before the Haemophilus influenzae vaccine – there was a good chance that a child with a fever might be developing meningitis or pneumonia.

The Fever was indistinguishable from the illness. Instead of being seen as a nonspecific symptom, it became part of the problem. When medications were discovered that seemed to lower the fever, it became something to treat. This further distracted the focus of both parents and physicians.

As fatal febrile illnesses became less prevalent in developed countries, the phobia persisted because the frightening, but usually benign, phenomenon of febrile seizures persisted. It is hard to reassure anyone who has witnessed a febrile seizure for the first time that fever is nothing to worry about. Another reality, unique to the United States, is the threat of a malpractice suit. Even though almost every febrile illness will end happily, some physicians can’t see past the fear of litigation and act irrationally when the patient has a fever.

The academy’s recommendations in its clinical report, "Fever and Antipyretic Use" (Pediatrics 2011;127:580-7) certainly state the case for shifting our focus from fruitless attempts at battling temperature to helping sick children be more comfortable. But they stop short of suggesting that we add our actions (or in this case inactions) to our words.

Do your assistants take temperatures on every sick patient? Why? If we want to help parents refocus their attention away from fever, then we need to demonstrate that our focus has shifted.

For 25 years, I rarely used a thermometer in the office. Babies in the first 3 months of life deserved special attention if the history suggested any hint of illness. A child with a swollen joint and a vague or nonexistent history of trauma had his temperature taken. But otherwise, I assumed that if a parent said his child had had a fever, it was so. Whether I could document it in the office was irrelevant. There were occasional situations in which my diagnostic algorithm reached a branch point and I needed to know whether a fever was present. But for the most part, my thermometer (maybe I had two) sat in the drawer.

When I joined a larger group, I lost a bit of control over the setup procedure, and recording a temperature on every non-well patient became the standard. I’m not sure whether this was out of fear of malpractice suits or whether it was believed that a more complete set of vital signs made it easier to argue for a certain level of coding.

Regardless, I don’t like it because it makes it appear that I believe fever is something to worry about. But I try to be a team player. The good news is that with the new gadgetry, taking a temperature (forget about accuracy) requires very little of my assistant’s time. And if a parent asks about the temperature, it gives me the opportunity to launch into a mini-lecture about fever that I have honed over the last 35 years.

If my tutorial is successful, my hope is that the parents will have the fortitude and good sense to stop taking temperatures at inappropriate times. I wonder if we can all have the same courage and let our inactions speak with our words.

Dr. William Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. E-mail him at [email protected].