Fever in Children: A Blessing in Disguise

                  By Linda B. White and Sunny Mavor

[Special thanks to Mothering.com for this article - CA]

Fever is not a disease but rather a symptom of an illness. We have devoted
this section to fevers for three reasons. First, childhood fevers frighten
grownups. Second, fever is maligned and misunderstood. Finally,
controversy surrounding the management of fever causes anxiety for
parents, because they are not completely sure what to do when their child
has one.

It may help parents to remember that fever is only one part of the picture of
an illness. In fact, for children under eight years of age, and especially for
infants, the severity of a fever is an unreliable indicator of the severity of
the childís illness. For example, infants and toddlers can be very sick with a
low or even subnormal temperature. Conversely, children three to eight
years old can be running about quite cheerfully with a fairly impressive
fever. The important thing is how your child is acting, not the thermometer
reading.

 

Defining Fever

First, letís define normal body temperature. Most people say 98.6ºF (37ºC) is
normal, but this doesnít account for individual variations or the fact that
kids tend to run slightly hotter than adults. You can think of anything
between 97º and 99.4ºF (36º and 37.4ºC) as normal. Consumption of hot
food, recent exercise, overbundling, hot weather, or an overheated room
can drive body temperature up a degree or two. Body temperature also
varies during the course of the day, and, with teenaged girls, the menstrual
cycle.

Fevers usually hit their highest point in the late afternoon. Conversely, kids
often have their lowest temperature of the day early in the morning. So
donít panic at 4 p.m. when your childís fever rises slightly; this does not
necessarily forebode a raging fever. On the other hand, if your child has a
low-grade fever upon awakening, you may want to keep him home.

 

How Fever Happens

Infections most commonly launch fever, especially in children. Other
triggers include transfusion reactions, juvenile rheumatoid arthritis,
tumors, inflammatory reactions caused by trauma, medications (including
some antihistamines, antibiotics, or an overdose of aspirin),
immunizations, and dehydration. Most physicians do not believe that
teething directly causes significant fever, but we have seen it happen.

When infectious "bugs" stimulate white blood cells in a specific way, they
release a substance called endogenous pyrogen, which signals the brainís
hypothalamus to raise the bodyís thermostat setting. In turn, the body heats
up by increasing its metabolic rate, shivering, or seeking warm
environments. It also minimizes heat loss by restricting blood flow to the
skin, giving it a pale appearance. Once body temperature rises, the skin
flushes and sweats. A fever sufferer may lose appetite and feel lethargic,
achy, and sleepy. When these phenomena happen to our children, we just
tuck them into bed and let them sleep.

A basic fever, one due to minor bacterial or viral illness, can be an
expression of the immune system working at its best. Given that most
animals (vertebrates anyway) mount a fever in response to illness, itís likely
that humans have preserved this evolutionary response because it
improves survival. Some research supports this theory; animal studies
show when fever is blocked, survival rates from infection decline.

Fever increases the amount of interferon (a natural antiviral and anticancer
substance) in the blood. A mild fever also increases the white blood cells
that kill cells infected with viruses, fungi, and cancer, and improves the
ability of certain white blood cells to destroy bacteria and infected cells.
Fever also impairs the replication of many bacteria and viruses.

Bottom line: A moderate fever is a friend, but not one you want to spend a
lot of time with. So it makes sense to avoid suppressing moderate fevers
with drugs, while continuing to monitor your child for dramatic increases
in temperature and worsening of any other of his symptoms.

 

Can Fever Do Harm?

                               Any time body temperature increases, salt
                               and water are lost via sweating, and stores
                               of energy and vitamins, especially the
                               water-soluble ones, are burned up. During
                               moderate fevers, we can compensate for
                               these losses by drinking appropriate fluids,
                               ingesting nutritious foods, or taking
                               vitamin supplements.

                               Replacing water-soluble vitamins (chiefly
                               C and Bs) makes sense. However, during
                               fevers, the body makes some minerals
                               unavailable for a good reason ­ bacteria
                               need them to thrive. In terms of energy
                               stores, our bodies switch from burning
                               glucose (the favorite meal of bacteria) to
                               burning protein and fat. This means a few
                               days of poor appetite is probably adaptive.
                               In other words, donít cajole or coerce your
children into eating during fevers if they donít feel hungry; they will likely
regain any lost weight quickly after the illness ends. You do, however, need
to encourage fluids, because dehydration alone can drive up fever.

Very high fevers ­ those above 106°F (41°C) ­ can harm the heart and brain.
Some authorities, however, say that fever is unlikely to cause brain damage
in a previously healthy child. During most infections, the brain keeps body
temperature at or below 104°F (40°C). So in most ­ not all ­ cases, you donít
need to be afraid that your childís temperature is going to continue to rise
above that point.

 

What About Febrile Seizures?

First, letís define them. These abnormal jerking movements occur in
children between the ages of three months and five years in association
with a fever, but without evidence of infection of the nervous system. The
seizure lasts no longer than 15 minutes (usually five minutes or less) and
causes twitching all over. About 3 percent of kids get febrile seizures.

The reason some children have this susceptibility isnít well understood. Of
those kids who have a first-time febrile seizure, about one-third have a
recurrence. Risks for recurrence go up with younger age at the first seizure
(16 months old or less) and a family history of febrile seizures.

Frightening as these seizures are for parents, theyíre benign; once they pass,
the child continues to develop normally. Often pediatricians can help
parents learn to block high temperatures by giving ibuprofen or
acetaminophen when fevers start. For the few children who have recurrent
febrile seizures, anticonvulsants or sedatives may be used.

 

What to Do If Your Child Has a Febrile Seizure

Try to stay calm. Thatís a tall order, but your child needs you to be collected.
Take a deep breath. Let it out. Tell yourself that the seizure will not last long
(although it may seem like forever) and that your child will likely be fine
afterward.

Look at your watch to time the length of the seizure. This sounds like a big
demand, given the anxiety a parent naturally feels. However, you will
otherwise overestimate the time, and the duration of the seizure is
important information for the doctor. If it exceeds five minutes, call 911.

Turn your child on his side. This reduces his risk of gagging on or inhaling
secretions.

Make sure the immediate environment is safe. Remove objects your child
might hit.

Do not restrain your child.

After the seizure is over, comfort and reassure your child, then call your
doctor for an immediate appointment. He or she will want to evaluate your
child for any abnormalities (other than fever) that may have triggered the
seizure. If the seizure lasted longer than five minutes and/or your child
seems to be very sick, your physician may tell you to go to the emergency
room right away.

 

Over-the-Counter Medications for Fevers

It makes sense to us that if fever helps defend against infection, giving
fever-reducing medications may make things worse. In addition, some
fever medications can have undesirable side effects. On the other hand, no
one likes to watch a child suffer. And fever can deplete a childís energy.
Hereís a profile of over-the-counter medicines for reducing fever and
discomfort.

Acetaminophen reduces fever and pain but not inflammation. Follow the
package instructions. Because of the risk of liver damage, do not dose more
frequently than every four to six hours or for more than five consecutive
days. There is no need to awaken your child to give her a dose; sleep will do
far more good.

Ibuprofen (Childrenís Motrin, Pediaprofen, Advil) reduces fever, pain, and
inflammation. Follow the package instructions. Do not give more often
than every six hours unless your physician advises otherwise. This
medicine can cause stomach upset.

Aspirin reduces fever, pain, and inflammation, but pediatricians rarely
recommend it.

Use of aspirin in children during viral illness has been linked to Reyeís
syndrome, a disease characterized by severe liver dysfunction and brain
swelling. Symptoms include effortless and repeated vomiting, then a
change in the level of consciousness (lethargy, stupor, combative behavior,
delirium, seizures, coma). No one knows what the cause of Reyeís is, but it
seems to be linked with aspirin use during viral illnesses. For this reason,
authorities have recommended that children under 21 years with
symptoms of viral respiratory illness or chickenpox do not take aspirin.
Sometimes herpes outbreaks and viral gastroenteritis (marked by vomiting
and/or diarrhea) are included in the list of illnesses during which aspirin
must be avoided.

Unfortunately, it is often difficult to be certain of the cause of an illness
when it starts. Aspirin is a component of many cold and flu
over-the-counter medications, so avoiding it requires careful label reading
on your part.

Medications for fever can act as a screen. Here are some pros and cons to
giving your child over-the-counter medication to ease a fever.

Medication such as acetaminophen can help sort out whether your child
feels miserable because of a fever or because of an infection. Some
physicians use a trial of acetaminophen as a screen. If, after the drug kicks
in, the child looks and acts better, it is less likely that he has a fever or that
his infection is a serious one.

Fever medications can make your child feel better. He may be more likely to
drink fluids, nibble food, and sleep. All can help him recover.

Fever medications can mask symptoms. In other words, your child acts as
though his health has improved, but it really hasnít.

Fever medications may actually prolong the illness. This opinion of some
practitioners is backed by a few studies. Assuming the response of the body
to illness (fever, inflammation, sleepiness) is adaptive, it seems reasonable
to assume that interfering with the process may do more harm than good.
The following are some examples that support this theory.

ï A study of adults with colds found that aspirin and acetaminophen
suppressed production of antibodies and increased cold symptoms, with a
trend toward longer infectiousness.

ï In a study of children with chickenpox, acetaminophen prolonged itching
and the time to scabbing compared to placebo treatment.

ï In test-tube studies, therapeutic levels of aspirin suppressed the ability of
human white blood cells to destroy bacteria. Acetaminophen did not have
this effect. Another study found that a host of pain relievers, including
aspirin and ibuprofen, inhibited white-cell production of antibodies by up to
50 percent.

The bottom line. Use these medicines sparingly when your child is in pain
or suffers discomfort from a fever over 102°F (38.8°C). Ask yourself whether
you are administering the fever-reducing medicine to make your child
more comfortable or to decrease your own anxiety.

Nondrug approaches can go a long way toward helping your child feel
better. If the situation does not seem urgent, you might want to consider a
trial of herbal treatment before you pull out the acetaminophen.

 

Home Management of Fevers

Do give your child lots to drink. Fever increases fluid loss, and dehydration
can drive up your childís temperature. Kids with fever often do not feel
thirsty, or by the time they do, theyíre already dehydrated. So keep offering
fluids. Small, frequent sips are often best, especially if the child feels
nauseated. If necessary, use a plastic medicine dropper to gently insert water
into your childís mouth. The type that holds several ounces is best to use.

If your child craves cold foods, you can make her a frozen treat of diluted
juice and/or herb tea. Pour the fluid into an ice cube tray, pop in the freezer,
and later let her suck the frozen cubes. To make herbsicles, insert sticks
when the solution is half frozen. Good herbs to try include lemon balm,
peppermint, elder flowers or berries, oat straw, or chamomile; you can also
freeze diluted ginger ale or lemon water.

Dress lightly or bundle? The answer depends on your childrenís perception
of temperature ­ follow her cues. If your child looks pale, shivers, or
complains of feeling chilled (things that tend to happen in the early stages
of fever), bundle her in breathable fabrics so that sweat will evaporate, but
make sure she can easily remove the layers. If she is comfortable and her
fever is low, dress her snuggly and give warm liquids to assist the bodyís
fever production. If she sweats and complains of heat, dress her lightly and
let her throw off the covers. Older kids will take care of these needs
themselves.

Donít push food. People with fevers generally donít have much appetite. Let
your child determine when and what she eats. Just bear in mind that
consumption of sugary foods could delay the natural immune response.

 

Herbal Remedies for Fevers

A rule of thumb that herbalists like
to use during minor illness with
fever is: "First, do nothing,"
meaning that a short period of
observation ought to precede any
action against the illness. Follow our
guidelines above for seeking medical
assistance for feverish children
under the age of two, and encourage
fluids. For older children, give
liquids, make them comfortable, and
observe closely.

Is your child drinking fluids well? Urinating at least once every eight hours
(ideally, every three to four hours, or wetting eight to ten diapers per day)?
Does your touch console her? Is she playing normally? If the answer to
these questions is yes, she is probably not seriously ill.

This observation time can also help you figure out which of the following
herbs are most indicated and effective.

Boneset. We cannot find much current research on this herb, but folklore,
historical medical texts, and personal experience tell us it works. Consider
the opinion of Drs. John Uri Lloyd and Harvey Felter from 1898, two of the
most respected herb doctors in American history: "In influenza, it relieves
the pain in the limbs and back. Its popular name, ëboneset,í is derived from
its well-known property of relieving the deep-seated pains in the limbs
which accompany this disorder."

And that is exactly what we have found boneset best for: relieving
discomfort during that achy, feverish stage of the flu. Limit a 40-pound
child to three-quarters of a cup of hot boneset tea three times a day for three
days; adjust the quantity of tea for children of differing weights. Caution:
Large doses can cause vomiting, so watch the dosage here.

Echinacea. This herbís immune-enhancing, bacteria-killing, virus-fighting
abilities all justify its use during childrenís fevers. In glycerite form,
echinacea is tasty, and itís easy to give to kids several times a day. Youíll be
providing much-needed fluids as well if your child will drink echinacea tea.
Give your normally healthy child good-sized doses of echinacea three to
five times a day.

Catnip is the classic traditional herb for babiesí fevers. Again, we want to
make clear that infants under three months old with a fever need to see a
healthcare practitioner. But if your six-month-old teething child is also
running a mild fever, think about catnip tea as your remedy of choice.
Although catnip stimulates cats, it has a very safe and calming effect on
humans.

Oregon graperoot contains large amounts of berberine, a superb infection
fighter. While many herbalists consider berberine a purely antibacterial
chemical, it also works as an anti-inflammatory for lowering fevers. With
kids, the trick is disguising the taste of this bitter root. Try making an herbal
glycerite, or look for a flavored variety in stores.

Other herbal tips for fevers. Sometimes your child just needs rest, and a
dose of herbal sedatives can help. Herbs to try include chamomile and
catnip for children under three years old, and skullcap, passionflower, or
valerian for older children.

Willow bark. Because we get so many questions about the safety of willow
bark, letís talk a bit about it here. Willow bark, as many people know, is
called the "original aspirin," even though aspirin actually borrowed its
name from the botanical name of another plant, meadowsweet (Spiraea).
Willow contains salicylic acid, which is the naturally occurring version of
manmade acetylsalicylic acid, or aspirin.

Because of the connection between aspirin and the serious childrenís illness
Reyeís syndrome, willow has been a little suspect, too.

According to Varro Tyler, PhD, Lilly Distinguished Professor of
Pharmacognosy at Purdue University, a typical dose of willow bark may
contain 60 to 120 mg of total salicin, yielding approximately one-fifth that of
an aspirin tablet. He theorizes that it is tremendously unlikely, although
not impossible, for that small amount to cause Reyeís syndrome. In
addition, there is not a single recorded case of willow bark ­ or any herb
containing natural salicylates ­ being associated with Reyeís syndrome.

However, we prefer to err on the side of caution, so we donít recommend
willow or other salicylate-containing herbs during kidsí fevers. And frankly,
willow bark tea tastes so bad, itís hard to get any down a child.

Herbal water spritzes can also help send a feverish youngster off to sleep.
Combine 2 drops of essential oil of chamomile, lavender, thyme,
ylang-ylang, or rose with 4 ounces of water in a spray bottle. These oils
provide some antibacterial action along with a sense of tranquility. Spritz
liberally on arms, legs, back, and chest, but keep this spray away from eyes
and out of the reach of small children. Itís best to use these in a warm,
steamy bathroom so that your child doesnít get chilled.

For more information about herbal remedies for children, see the following
articles in past issues of Mothering: "The Scent That Soothes," no. 80;
"Natural Remedies for Childhood Diseases," no. 77; "Natural Immune
Boosters," no. 73; "Natural Remedies for Winter Illnesses," no. 69, and
"Childhood Fevers," no. 51.

Linda B. White, MD, is the mother of two and the author of The
Grandparent Book. She is a national natural health writer.

Sunny Mavor, AHG, is a professional member of the American Herbalists
Guild and lectures nationally on botanical medicine. She is the mother of
two and the founder of Herbs for Kids.