12

Parents and pediatricians rush to treat low grade fever with acetaminophen and other powerful pain killers. Medical researchers refer to the over zealous treatment of non hazardous fever as fever phobia.

In his book, How to Raise a Healthy Child in Spite of Your Doctor, Robert S. Mendelsohn, MD writes that fever under 106 F is not dangerous in children 3+ months of age:

Most fevers are caused by viral and bacterial infections that the body's own defense mechanisms will overcome without medical help..

The common cold and influenza are the most common sources of elevated temperatures.. they can generate fevers that range all the way up to 105 degrees, but even at that level they are not a legitimate cause for alarm..

Untreated fevers caused by viral and bacterial infections do not rise inexorably and will not exceed 105 degrees.. (I suppose this includes anything below 106 as he explicitly states in next paragraph)

Only in the case of heatstroke, poisoning, or other externally caused fevers is this bodily mechanism over-whelmed and inoperative. It is in those cases that temperatures reach and exceed 106 degrees..

Is there any evidence that suggests that fever (from viral or bacterial origin) below 106 F has any long term negative effects in otherwise healthy children/toddlers/adults?

Similarly, in a report entitled Fever and Antipyretic Use in Children the authors write that:

Hyperthermia should be addressed promptly, because at temperatures above 41°C (105.8 F) to 42°C (107.6 F), adverse physiologic effects begin to occur. Studies of health care workers, including physicians, have revealed that most believe that the risk of heat-related adverse outcomes is increased with temperatures above 40°C (104°F), although this belief is not justified.

Note:

To be clear, it doesn't matter if you think fever is pleasant or not. Or if the benefit of reducing the pain caused by fever outweighs the benefit that fever provides in helping fight infection.

My question is simply: Are there any dangers associated with fever within the above mentioned range?

DenisS
  • 22,355
  • 8
  • 95
  • 95
alpha1
  • 221
  • 1
  • 6
  • I would guess that, if you wait until *after* it reaches a critical temperature, you risk unneeded irreversible damage being done. You also run the risk of acting too late to stop it if you wait until it's a very good possibility that it will get there, since most interventions are not instantaneous. Plus, running a fever is an unpleasant experience for the afflicted, so they treat it, early. I don't think too many parents or physicians (or their insurers) are willing to risk that versus the possible benefits of the body using a lower-grade fever as part of fighting a pathogen. – PoloHoleSet Jan 21 '19 at 16:43
  • 1
    @sumelic @ TheWanderer I updated the original quote with more direct support of my statement. I removed Wikipedia link and added another quote to support the core idea. – alpha1 Jan 21 '19 at 18:49
  • 1
    Well, with the modifications, it looks like the initial stated concerns about the question have been addressed. – Ben Barden Jan 21 '19 at 22:28
  • @sumelic - I'm talking about why it might be difficult to get any kind of volume of information on above/below threshold data. Parent are leery about putting children (the segment of the population more likely to run a high fever) through suffering or risk for the sake of gathering knowledge. Actually, human beings, in general, are leery about that, as well, and are generally not able to take an objective, cold-blooded "lab rat" perspective when it comes to human children. Adults are more inclined to over-treat when children are involved. – PoloHoleSet Jan 22 '19 at 17:14
  • Could you please clarify what's the specific claim that you are sceptical of? – Konrad Rudolph Jan 27 '19 at 23:40

1 Answers1

2

Your source claims that

The common cold and influenza are the most common sources of elevated temperatures.. they can generate fevers that range all the way up to 105 degrees, but even at that level they are not a legitimate cause for alarm..

According to the CDC:

On December 9, 2016, CDC posted estimates of seasonal flu deaths from more recent seasons in the United States. CDC estimates that from 2010-2011 to 2013-2014, influenza-associated deaths in the United States ranged from a low of 12,000 (during 2011-2012) to a high of 56,000 (during 2012-2013). Death certificate data and weekly influenza virus surveillance information was used to estimate how many flu-related deaths occurred among people whose underlying cause of death on their death certificate included respiratory or circulatory causes.

In addition to the number of deaths, the flu causes hundreds of thousands of hospitalizations each year. Is that a legitimate cause of concern? Considering that children under 5 are a high risk group for serious complications, and that high fever is one of the symptoms that physicians consider in deciding if the patient has the flu or more benign viral infections, I think high fever is indeed a red flag that needs to be taken seriously.

Another part of this claim appears to be that regardless of the underlying condition, fever up to 105 degrees should be left untreated:

Untreated fevers caused by viral and bacterial infections do not rise inexorably and will not exceed 105 degrees..

This is more difficult to answer. There is certainly a body of evidence that suggest that parents tend to overstate the risks of fever and over-treat it. There have also been some studies that suggest that fever might have positive effects on the underlying infection.

While leaving fever untreated won't have any long term negative effects on the patient, and might indeed have some positive physiological effects, we have to consider other factors, such as the well being of the patient. The modern Hippocratic oath that is widely used in US medical schools states:

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

Considering all of that, I think the answer is:

Leaving fever untreated will not cause long term negative effects on the health of the patient, but high fever is a red flag that could indicate serious illness and as such should be taken seriously. A doctor can decide to treat the fever in order to make the patient or their family comfortable and there is nothing wrong with that.

Skippy le Grand Gourou
  • 224
  • 2
  • 8
ventsyv
  • 7,136
  • 2
  • 27
  • 44
  • 2
    I personally start frequent checks at 102, getting concerned at 103, and calling or going to see the doctor at 104. The complications that can arise after high fever can arise quickly, so this protocol seems reasonable to me. –  Jan 22 '19 at 16:15
  • @sumelic - Why does his comment have to conform to a quoted passage that OP is asking to verify? It almost sounds like you are accepting that as fact. – PoloHoleSet Jan 22 '19 at 17:38
  • @PoloHoleSet: I've asked a separate question to address that claim, since I am interested in learning whether it is correct: [Will a fever caused by infection never exceed 105 degrees?](https://skeptics.stackexchange.com/questions/43274/will-a-fever-caused-by-infection-never-exceed-105-degrees) – paradisi Jan 22 '19 at 17:56
  • @sumelic - and fredsbend's comment had nothing to do with bacterial or viral causes, I'm not sure why you even mention it. He stated that he starts paying closer attention at 102, and worrying at 103, checking with the doctor at 104, which is in line with standard, official medical recommendations. Your telling him he doesn't have to worry about it when he does accepts the premise, as true, that we are being asked to evaluate. Is that why you said that? You are accepting that claim as true and proven? ***THAT*** is what I'm asking you. – PoloHoleSet Jan 22 '19 at 18:14
  • @sumelic - Your comment isn't asking him "do you have information to the contrary?" You are saying "unless you have evidence to the contrary, you are out of line with the quoted passage" which has a very different connotation to it. Which is why I asked. – PoloHoleSet Jan 22 '19 at 18:15
  • @sumelic You never know what kids do when you're not looking. 104 sounds reasonable, on the off chance it's not flu. And I've never seen 104, by the way, so I don't think it's unnecessarily burdening emergency rooms. –  Jan 22 '19 at 18:23
  • My son was admitted twice to the hospital for pneumonia with fever of 103 - 104. First time he was 2 and a half and the second time 3 and a half. He was unresponsive, his breathing was heavy, he was sweating, didn't want to eat or drink, and was vomiting. All of that is attributed to the fever by the way. I'm not a doctor, but anecdotally, this kind of fever is very serious, especially for young kids. – ventsyv Jan 22 '19 at 21:28
  • 1
    The last paragraph seems to be what the author cited in the OP is missing or at least completely failing basic logic: very high fever is a marker for serious treatable illness. It's completely moot whether or not fever at that level by itself is dangerous. – Bryan Krause Jan 22 '19 at 22:08
  • 2
    Fevers can also trigger febrile seizures. – Eric Jan 22 '19 at 23:02
  • 2
    @BryanKrause - the author had a bit of a reputation as a contrarian quack, being one of the early anti-vaxx "authorities," apparently. – PoloHoleSet Jan 23 '19 at 22:51
  • 2
    @PoloHoleSet Indeed, it would be appropriate to dismiss everything he's ever written or said from a skeptic's perspective. – Bryan Krause Jan 23 '19 at 23:01