Complications of Fever and How to React

As parents, we all know situations like this: Your kid had been running around with seemingly never ending energy reserves when quite surprisingly his behavior changes – he is faint, whiny and refuses to eat. Your clinical thermometer proves you right: a fever. And the temperature is rising. And so does your fear for your child. Seeing the number on the thermometer increasing can be quite disturbing. But what could actually happen? Is this a serious condition or are parents of a feverish child more likely to have to deal with complications induced by a fever?

Generally, a fever is not dangerous in itself, as it is only a symptom. The body temperature rises to fight harmful invaders, like bacteria, parasites and viruses. The defense mechanisms kick into action releasing, among others, pyrogens, which trigger the temperature to rise up. A higher core temperature creates an inhospitable climate for pathogens. Thus, a fever is a healthy reaction of the human body which aims for effectively destroying intruded pathogens. A fever therefore supports the healing process. Usually, it is the underlying illness that might pose a hazard, not the fever itself. The level of the temperature does not allow to draw a conclusion about the hazardousness of the pathogen.‚The higher the temperature, the more dangerous the underlying illness‘ would be a false conclusion.

A fever can be caused by different pathogens. Most of the time, when a child does have a fever, it has been induced by a common cold and the parents do not have to worry. But could a fever, could the rise of the core temperature also evolve into a danger?

Fever and Symptoms

It is not an easy task to look at a fever detached from the causal illness, because a fever always occurs within the scope of a complex inflammatory reaction, which can vary in its symptoms, forms and courses. The entire symptomatology is affected by the underlying disease, which is why individual symptoms often cannot be directly attributable to a fever.

What parents worry most about, when they see their kids temperature rising, is that the fever might reach spheres where the child’s body might ‚burn up‘. They fear that the temperature might reach unchecked heights where vital body functions stop working or proteins get damaged.

Protein protection

It is true, the structure of the body’s own proteins alter at high temperatures, comparable with the solidification of egg white in hot water. The body protects itself against this structural change by forming heat-shock proteins. But a temperature higher than 106 F (hyperpyrexia) is life-threatening. When the temperature exceeds a certain threshold, the walls of the small blood vessels, the capillaries, become more permeable. The inner coating of these vessel walls, the endothelium, regulates the exchange of substances between blood and tissue. When the body temperature is too high, endothelial cells contract and gaps occur. Fluid from the blood vessels can then leak into the brain, which results in life-threatening brain edemas. The consequences might be severe brain damages or death.

Epileptic seizures often come with considerable risks and can lead to accidents with fatal injuries. Therefore, it is crucial to detect epileptic seizures early enough to apply appropriate safety measures. Moreover, an automatic and reliable seizure detection is fundamental for an effective medication of patients. As no technical solution for detecting seizures on the market, they are documented by the patients using a hand written protocol. Unfortunately, these protocols are not reliable enough and are prone to errors. The Earconnect Technology from Cosinuss seeks to revolutionize epileptic seizures detection.

With a fever, the fluid requirement of the body is increased. At the same time the child sleeps more and might be too exhausted to remember to drink. Therefore, the risk of a dehydration is heightened for a febrile child.

The following applies: The younger the child, the higher the risk of a dehydration.

Signs of a dehydration

First symptoms:

• Dry mouth and lips
• Dark and concentrated urine, decreased urination
• Listless, but not apathetic

Later symptoms:

• Little or no urine
• Crying without tears
• Skin wrinkles made by gently pinching the skin are slow to disappear or do not disappear
• Sleepy and apathetic

If your child develops any of these later symptoms, you should bring him/her to hospital quickly.

Dehydration can have serious consequences: A fluid loss of 12- to 15-% results in a shock. Poor circulation and disturbances of consciousness like lethargy, confusion and delirium occur, in very serious cases it can extend to a coma.

So parents should ensure that their feverish child gets enough fluids. For really sick children it might not be sufficient to put the drinks within the child´s reach. Parents should actively offer beverages to their children when they are awake.

Hallucinations can emerge in febrile states due to an increased irritability of the brain cells. A fever accelerates metabolism which makes the body more active and lets brain cells respond more sensible to stimuli. These hallucinations are basically harmless, even if they might appear alarming for a parent. The child dreams with open eyes and often does not recognize its own parents. These vivid and realistic dreams could make the child react to them. Thus, it might happen that the child walks around or flails his arms, similar to sleepwalking and might hurt himself.

A doctor should check the child for a meningitis and an encephalitis, otherwise parents can assume that febrile hallucinations are not alarming.

A febrile seizure is a particularly disturbing complication that can occur during fever episodes. Approximately 4 % of all children experience a febrile seizure at least once in their life, usually between 6 months and 4 years of age. Febrile seizures are due to a predisposition of the brain to react with seizures to a fever, or rather to a quick rising or falling of the body temperature. It is not known yet, whether it is the fever only, or the fever inducing infection, that causes the seizure.

Often the body temperature rises so fast, parents only become aware of their child having a fever when the febrile seizure shows. Most of the time, a febrile seizure develops at a body temperature higher than 102 F, but it could also occur at an increased temperature only. Generally speaking, febrile seizures are harmless and do not cause consequential damages. Most cases are ‚simple febrile seizures‘: The child loses consciousness, the lip area turns blue and muscular tensions or muscle twitching or atony do appear. Simple febrile seizures last for 2 – 10 minutes and occur only once during a febrile illness. As alarming as this incident is for a parent, the child usually recovers fast.

25 % of all febrile seizures are atypical (‚complex febrile seizures‘), meaning that the seizure lasts longer than 15 minutes, multiple episodes occur within 24 hours or other abnormalities arise. 

What parents should do in the case of a febrile seizure:

• remain calm
• never shake your child!
• note the start time and keep an eye on the duration of the seizure
• do not give your child food or beverages (danger of suffocation)
• loosen clothing, if necessary
• seek immediate medical attention, call an ambulance or your pediatrician
• take the temperature after the seizure

Febrile seizures do not result in a brain damage, almost all of the patients develop normally afterwards. The risk of being diagnosed with epilepsy is only slightly increased (from 0,5 % of all healthy kids without febrile seizures to 1 %).

Febrile seizures cannot be reliably prevented. Most physicians suggest to consequently bring down temperatures higher than 101 F. However, the effect of such measures is rather controversial.

Febrile seizures often appear when the temperature is rising and therefore can only be anticipated when continuously taking the temperature, e.g. with degree°. Thanks to newest technology advances there´s again a spark of hope to be able to foresee seizures and taking action in time to prevent them.