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In Your Head

Fever pitch

It's normal for parents to fret when their child is sick. Here's how to cope with the panic.

By Carey Goldberg
Globe Staff / March 30, 2009
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I was a cool hand, before I had children. Now, I'm a full-fledged phobic.

Whenever a child of mine gets sick, even with only a routine flu or stomach virus, and even though they are now at the robust ages of 4 and 7, my heart flutters in my throat. Every cough means "Alert! Alert!" My mind turns into a racing hamster wheel.

Of course I know that almost all these bugs pass harmlessly. But that doesn't help me calm down. The stakes are simply too high. And I'm far from alone in this: One otherwise sane mother I know still sleeps on the floor by her 14-year-old son's bed when he gets the flu, to be sure he's breathing. Another, a college professor, says that three different pediatricians have prescribed a stiff drink -- for her -- whenever her child gets sick.

So I turned to some experts to help me -- and other solicitous mothers or fathers who roil inside as they bring the Motrin and a thermometer -- understand this painful panic, and learn better how to cope.

First, says anthropologist Sarah Blaffer Hrdy, understand that this fear reaction is common and appropriate - that is, it was appropriate for most of human history, in which half or more of all children would die.

Even now, among primates in the wild, 40 percent infant mortality rates are not uncommon, said Hrdy, author most recently of "Mothers and Others: The Evolutionary Origins of Mutual Understanding."

Traditionally, childhood is "a time of great peril," she said, and maternal anxiety runs so deep that even the "nesting" instinct that hits many mothers-to-be - the compulsive room-painting and layette-buying - likely stems from the ancient need to make sure the environment is safe for the coming baby.

When she had her first child, Hrdy said, she was sometimes strangely afflicted by an image flashing into her mind's eye of her beloved baby falling off her home's bannister. It made no sense, she said, until a psychiatrist recently told her that most mothers have such catastrophic images, as expressions of concern over safety.

"This is completely natural," she said.

Natural it may be, but a hard-wired response to a perceived threat also needs to be tuned to the modern age, with its greatly improved knowledge base, medical care, hygiene, and nutrition, said Dr. Mark C. Poznansky, an infectious disease specialist at Massachusetts General Hospital.

He routinely tells parents who are worried about their sick children that "it's good that you're vigilant but the overwhelming majority of children get better on their own or with help from medications." Fear should be replaced with medical facts about prevention and care, he said, and if in the slightest doubt, you should call your child's pediatrician.

From Poznansky's perspective as an immunologist, once a child is 5 or 6 years old, the immune system performs like a top-of-the-line Ferrari, and most childhood illnesses are performing a service in a way, helping it build defenses for the future.

An ill child may seem helpless in bed, he said, but the human immune system has evolved over millions of years "and the fact is that in some ways, their defense system is better than yours. It's brand new."

Dr. William Coleman, chair of the American Academy of Pediatrics' committee on psychosocial aspects of child and family health, said that "feverphobic" parents should keep in mind that "it is the natural state of the child to be ill with minor acute illnesses." They should know, too, that experienced pediatricians pay more attention to "the general state of the child" than the number on the thermometer: Is the child inconsolable? Unresponsive? Unable to drink? Those are the biggest warning signs of something possibly more serious. A fever, up to a certain extent, is just a "normal and healthy response" to infection, he says.

Still not comforted? Time and experience may help, said Peter J. Norton, coauthor of "The Anti-Anxiety Workbook" and director of the University of Houston's Anxiety Disorder Clinic.

"Most parents tend to figure these things out by trial and error," he said. "They may freak out during the first winter virus, but may readjust afterward."

(So each illness might be a bit like "exposure therapy" for someone who has a phobia of spiders, for example - if the patient handles a tarantula, the phobia's power may fade.)

Norton and others also strongly suggested reaching out for social support to a more experienced parent - a neighbor, a friend, your mother. And most pediatricians' offices have a nurses' line for semi-urgent questions, such as whether a fever is high enough to be cause for concern.

Some parents may also want to consider using physical methods of calming the body, such as deep breathing, or tensing and then relaxing muscles, Norton said. His workbook includes a variety of techniques "good for helping your brain get away from waiting-for-the-worst-to-happen mode and putting yourself into a more relaxed mental place."

It is hard to define when parental concern should be considered "abnormal," Norton said, but one sign might be an unwillingness to rely on experts, to believe a pediatrician's reassurances. Another would be a debilitating level of insomnia, obsessive monitoring, and general distress.

Anxiety treatment aims to help patients do "cognitive reframing" - focusing more on the 99-plus-percent chance that a sick child will recover on their own or with good medical care than on the small chance that things will go awry. It calls attention to the thoughts that drive anxiety. (See box on this page.)

The goal is to develop the ability to live in a world where any of us could die at any moment, by recognizing that "some risks are so unlikely that we can't go on worrying about them," Norton said. "In fact, we should be more worried about space debris than about sniffles turning out to be Ebola virus."

Janna Malamud Smith, a Cambridge therapist and writer, explored the emotional terrain of maternal fear in her 2003 book, "A Potent Spell." Asked what one thing she would tell an anxious mother, she said: "You're not alone. And don't be embarrassed to speak your worry if you feel it."

Carey Goldberg can be reached at goldberg@globe.com.

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