Q: I have a new baby and am worried about the damage fevers can do to her. Can you explain what I can do to keep fevers from hurting my child?

A: Fever is often the first sign of an illness and is commonly caused by an infection. Fever also is the body's way of helping the ill individual fight infection. In the days before antibiotics were available, physicians sometimes induced fever to help fight off infection.

Fever itself is not a disease but rather a byproduct of the body's reaction to an attack by a virus, bacteria or other biological or toxin event.

A normal child usually has a temperature of less than 100.4 degrees Fahrenheit, taken rectally. Elevation of temperature above 100.4 degrees Fahrenheit is considered a fever.

There are several methods for taking a child's temperature, but the most accurate way is still by the rectal route. Ear thermometers and fever strips are not as reliable although they usually do give evidence of the presence or absence of fever. An oral thermometer can be quite reliable in a cooperative child more than 6 years of age.

One of the biggest fears that parents have with regard to a fever is that it can cause brain damage. This rarely happens unless the temperature is in the 106-107 degrees Fahrenheit range and is unremitting. It is true however, that a rapidly rising temperature can elicit a seizure. These "febrile seizures" are short lived, usually less than 60 seconds, and not believed to cause nervous system damage. Seizures brought on solely by fever do not usually occur above the age of 6 years.

The best method of fever control is a combination of cooling measures and an antipyretic medication such as acetaminophen (Tylenol) or ibuprofen. Aspirin should not be used in children because of its association with an entity called Reyes syndrome. Reyes syndrome results in both liver and brain toxicity.

Cooling measures include dressing the child lightly, being in a cool environment, cool or tepid baths, but not ice baths. Sponging a child with alcohol as has been done in the past should be avoided as the alcohol can be absorbed through the skin, converted to acetone, and induce a coma.

Tylenol (acetaminophen) can be given orally or, if necessary, rectally in the form of suppositories. I recommend giving Tylenol only for temperatures greater than 100.5 degrees Fahrenheit taken rectally (orally if the child is over 6). I generally switch to ibuprofen if the temperature is greater than 102.5 degrees Fahrenheit for a nighttime fever control. Ibuprofen lasts 6-8 hours and therefore is better suited for over night. Tylenol is effective for approximately 4 hours. It takes 1-2 hours to achieve maximum effectiveness of either of the medications.

In summary, don't be afraid of fevers. Fever is a sign not a disease. Temperature control is usually quite effective and should be instituted for comfort while the etiology or cause of the fever is being determined.

Kenneth R. Keer, M.D., is a board certified pediatrician who has been practicing medicine in Southern California for more than 35 years. The information provided in his columns is general information that is not intended as individual advice for a particular child. Please consult your own pediatrician for advice on treating your child. To send questions to Dr. Keer, write to drkeer@familymanonline.com.