Summary: Fever is a natural response to an infection, but it makes us feel sick and it may cause seizures in children. Yet many physicians believe that fever is somehow beneficial. Since it is natural, it must have some hidden benefit. Natural is not necessarily better. It is not convincingly proven that fever is routinely beneficial. There are some modest benefits of controlling fever. Until it can be proven that fever is our friend, it may be better to control it, but this should be discussed with your child's physician since this is controversial.
Fever is a normal response to infection. Fever is often worrisome because it may be difficult to distinguish a serious infection from a minor infection. Fever is feared for this reason and it is one of the most common reasons to call a pediatrician or family physician. Pediatricians often refer to this as fever phobia. Some suggestions on treating fever and distinguishing serious causes of fever from minor causes of fever are discussed in two earlier chapters on fever.
Assuming that your child's fever is due to a non-serious cause such as a flu-like illness, does the fever need to be treated? There are many physicians who believe that fever is good for the body because it helps the body fight the infection. Such physicians believe that fever is your friend. To most of us, fever does not seem very friendly and it makes patients feel sick. Why could fever be good for us? There are three reasons why some believe this: 1) Fever is natural, therefore it must be good. 2) Fever is associated with the release of chemicals which affect the immune system, so this must mean that fever helps the body fight the infection faster. 3) There are some studies in animals and humans that suggest that fever may be beneficial in fighting certain types of infection.
These reasons are not fully convincing that fever is good.
1) It is true that fever is natural, but this doesn't necessarily mean it's good. For example, cancer is natural and this is not good. Pneumonia is natural but this is not good. Being struck by lightning is natural, but this is not good. It's true that through evolution, most of our natural body responses are good, but this doesn't guarantee that all natural processes are good.
Did you know that the chance of dying during childbirth was as high as 25% at one time. This means that one out of four pregnant women died during childbirth. It is natural to die one-fourth of the time during childbirth, but this is not good. Today, with modern obstetrical care, the death rate for mothers and infants is very low. The frequency of C-sections in most hospitals is about 20% (one out of five). Although C-sections are very unnatural, it is done to minimize the chance of a complication during the childbirth process such as the tearing of internal organs and infant brain damage. These complications are natural because the childbirth process is naturally prone to complications. Many of these natural complications can be prevented by performing a C-section. A natural childbirth is great if there are no complications. But if there are complications, it would be preferable to prevent these complications, often with unnatural medications or surgical procedures. Would you prefer that your baby be born naturally with brain damage or unnaturally by C-section with a normal brain? I would take the unnatural case with the better outcome. A home birth might be more natural than birth in a hospital, but there is a limited ability to intervene at home if a complication develops.
Remember that all kinds of natural events are not necessarily desirable. Most deaths are natural. If this can be prevented or delayed by using unnatural (artificial, synthetic, man-made) medications or surgical procedures, this would usually be preferred over the "natural" course.
2) Fever causes the release of chemicals into the bloodstream that may help fight infections. Chemicals such as interleukin and interferon are released into the bloodstream. But it is unclear whether fever alone is responsible for this and whether the release of these chemicals is actually beneficial. While "interleukin" and "interferon" sound like powerful chemicals that must help the immune system fight infection, do they actually help the patient get better faster? As of the writing of this book, there is no convincing study that demonstrates such a universal benefit of fever. To be convincing, patients with fever would have to be randomly assigned to a fever control group (fever is controlled with anti-fever medications such as acetaminophen) and a non-fever control group (no fever medications). The duration of illness in each group would have to be compared between the two groups. If fever is beneficial, then the duration of illness should be shorter in the non-fever control group. There are some studies showing higher virus counts from patients who were given anti-fever medications compared to those who were not given anti-fever medications. But does this mean that the illness is actually shorter when fever medicines are not used? Are these studies convincing enough for doctors to stop recommending fever control measures? It doesn’t seem to be convincing enough, since most physicians still recommend fever control measures routinely.
3) There are some studies in lizards and rabbits which demonstrate that for the type of infection studied, the presence of fever helped the animal fight the infection better. Human studies demonstrating this convincingly are lacking.
In essence, the evidence supporting the theory that fever is good, is not convincing enough at this time. In fact, there are a few bad things about fever, but these should not be overemphasized either because these are actually not that serious. Fever makes you feel more ill. When I have fever, I feel very sick. When I take medication to bring my fever down, I feel much better. When children have fever, they may similarly feel more ill. They will be fussy, less active and they won't eat or feed very well. Since they feel sick and they appear more ill, they are more likely to be assessed as more ill. They are more likely to have unnecessary blood tests ordered as part of their medical evaluation if their fever is high and they don't look well. If their fever is controlled, they will most likely feel better, be more active and eat better. Their appearance will be less worrisome and they are less likely to warrant aggressive medical intervention.
As discussed in the chapter on fever convulsions, high fevers sometimes cause seizures (convulsions). While these are not medically serious, they are frightening, often prompting a 911 call and an ambulance ride to the emergency room, where some lab tests will probably be ordered. If the fever were controlled, none of this would have happened.
The benefits of fever control measures are limited to those described above. Controlling fever does NOT shorten the course of the illness; rather, it merely suppresses the symptoms while the illness is present.
There are some modest reasons why fever is NOT a friend and some information suggesting that fever is a friend. I personally believe that it is better to control fever and feel better than to preserve fever and feel worse. However, this is certainly not an opinion that all experts agree upon. Feel free to discuss this with your doctor since this entire subject is very controversial.