In Defense of Fevers

Every cold and flu season, I have a little fantasy running through my head. I envision myself possessing the powers of the tooth fairy. In my fantasy I use these powers to remove every thermometer from every home containing children under the age of 18. In each thermometer’s place I leave a little note saying, “Calm down. Take a deep breath. Everything will be fine in a few days.”

As a primary health care provider with a focus on pediatrics, I believe home thermometers do much more harm than good. Fever phobia is rampant in our culture, as is the mass drugging of the population. Many children are given drugs that can cause liver damage, blunt empathy, and are linked to autism and ADHD because their parents are more afraid of childhood fevers than they are of liver damage and behavioral disorders. From my perspective, it looks like most American children are being given Tylenol every time the home thermometer reads over 98.9.

These days I brace myself for a barrage of vitriol when I advocate for staying calm in the face of illness and when I critique the over-medication of children. I’ll head off the inevitable chorus of “whatabouts” by saying yes, there are unique and rare situations where it might be important to measure a child’s exact temperature with a thermometer. (Parents raising children with uncontrolled seizure disorders, sickle cell disease and cancer, you have my love and compassion.)

The truth is the vast majority of children don’t have a medical condition that necessitates knowing their exact body temperature during routine childhood illnesses. And the vast majority of parents throughout human history did not need thermometers to tell them if their children had fevers. The back of a mother’s hand or a grandmother’s kiss to the forehead should be all the technology we need to discern if an otherwise healthy child has a fever. “You feel warm” versus “you’re burning up” actually is an adequate classification system for home fever management.

Parents know when a child has a fever. You don’t need a thermometer to confirm this. And no matter what number registers on the thermometer, you have the ability to determine if your child is very sick. I routinely tell parents that I am less concerned about the child with the 105 degree fever who is talking coherently, drinking fluids and getting up to use the bathroom every few hours than I am about the child with the fever of 101 who is lethargic, inconsolable or dehydrated.

The number on the thermometer makes very little difference to me when I am assessing a child with a fever. But parents get fixated on the number on the thermometer. And they tend to freak out. Studies have shown that most American parents believe that fevers are dangerous to children and that fevers cause brain damage. With the exception of heat stroke (fever caused by prolonged exposure to excess heat) and fever induced seizures in children with epilepsy, fever cannot hurt a child.

Fever is not illness or pathology. Fever is a normal and important immune response. The increase in body temperature mobilizes the immune system allowing our body to fight against and recover from illness. Fever activates neutrophils and macrophages, types of white blood cells that destroy and eliminate viruses and unfriendly bacteria in our bodies. Fever provokes antibody response, prompting the body to make T-cells and B-cells which will recognize and fight off invading pathogens in the current illness and in the future. Fever shortens the duration of a viral illness, and suppressing fevers with drugs will actually make an illness last longer (i.e make the illness worse).

Every few years the American Academy of Pediatrics pays some lip service to the fact that parents should not fear fevers. Medical authorities like the Mayo Clinic advise that it is not medically necessary to treat fevers with drugs. Fever reducing medication reduces discomfort but does not help hasten recovery from illness. Children over four months who do not have epilepsy or other rare medical conditions do not medically benefit from fever reducers.

So why are American parents still so afraid of fevers? Well, it might have something to do with the fact that the global acetaminophen (AKA Tylenol) market was worth $9.44 billion in 2021 and is projected to be worth $15.2 billion by 2033. Compared to the $1.3 trillion total market value of the global pharmaceutical industry, acetaminophen’s share of revenue may seem relatively small. But Tylenol serves a very important role in our drug dependent culture. In a society where people reach for a pill every time they feel out of sorts and 70% of people take at least one prescribed pharmaceutical every day, Tylenol is a gateway drug.

Getting sick is part of the work of childhood. Kids get sick, and they get sick a lot. The average school age child endures five to eight viral illnesses a year, and the symptoms of each of these illnesses can last up to two weeks. So some years it can seem like a particular kid is sick all the time. This is not a bad thing. Children need to encounter and successfully recover from many different illnesses in order to develop into healthy adults. Childhood viral illnesses create strong adult immune systems.

In addition to the physical benefits of building a strong immune system, childhood illnesses can strengthen a child emotionally and psychologically. How we sit with our children during illness creates a template for how they will meet other physically and emotionally intense situations throughout their lives. Holding space for discomfort helps children build an understanding that life is not always easy but they are strong and capable of moving through adversity. Attempting to turn off all discomfort with drugs leads to, well, a culture of people who attempt to turn off all discomfort with drugs.

Parenting is hard work, and one of the most difficult things for a parent is to witness your child suffering. It is so tempting to intervene and try to make things easier for our children. But as Greg Lukianoff and Jonathan Haidt explain in their brilliant book The Coddling of the American Mind, parental attempts to make childhood safer and less dificult are creating generations of fragile adults ill-equipped to deal with adversity.

Drugging childhood discomfort gives our children the message that they cannot cope with discomfort. Sitting with your children and trusting in their ability to move through illness and recover without medication will give them the understanding that they are not fragile and they can survive uncomfortable experiences without pharmaceutical help.