A child who has a cold, flu, or other acute illness may be what parents often call “fussy”: irritable, teary, and clingy. Such changes in behavior and mood, or “sickness behavior (SB),” are usually thought to be linked to fever. Actually, those symptoms are the immune system’s reactions to invasion by a pathogen, say French researchers—and they may be present whether the child has fever or not. The researchers’ say their multicenter study is the first to show dissociation between SB and the severity of the fever.
The researchers evaluated 6 parameters over the 2 hours preceding consultations with the parents of 200 children with and 200 without fever. Children with particularly painful illnesses and chronic diseases were excluded from the study. Parents used rating scales to report degrees of change in the time the child spent playing, the distance covered (ie. how far from the parent the child roamed), time the child spent seeking comfort, time spent whining or crying, time spent in a state of irritation or anger, most distorted facial expression (on a chart). The researchers also assessed time spent sleeping and appetite in the 24 hours before the consultation. Sickness behavior can’t be reduced to the observation of those 8 behavioral parameters, the researchers note, but they were easy for parents to use and assess.
The mean values of the 8 parameters differed significantly between the 2 groups but were independent of the height of fever in the febrile children. That independence suggests that SB and fever are expressions of 2 autonomous metabolic pathways that are activated simultaneously in febrile conditions, the researchers say, which is in accordance with current pathophysiologic knowledge.
Their findings are in harmony with current treatment recommendations, the researchers say. Because it’s hard to know when behavior changes are due to SB, pain, fatigue, or something else in a febrile child—especially one who is too young to talk about it—it’s more important to focus on relieving the discomfort than in reducing the fever.
Source:
Corrard F, Copin C, Wollner A, et al. PLoS One. 2017;12(3): e0171670.
doi: 10.1371/journal.pone.0171670.