Pediatrics

UNDERSTANDING AND MANAGEMENT OF FEVER

Any time a child is sick, we as parents or caregivers instinctively want to intervene on their behalf. In the case of fever, however, our efforts may be counterproductive. Your child's ability to generate a fever is an eloquent demonstration of her body's innate self healing potential. The immune system's response to infection, is an amazing process which includes the following events:

•    Additional white blood cells are manufactured. These cells destroy bacteria and viruses and also remove damaged tissue and irritating materials from the body.
•    The activity of the white blood cells increases, and they move rapidly to the site of infection.
•    Antibody production increases by as much as 20 fold.
•    You get sleepy and loose your appetite. This conserves energy for natural defense and repair.
•    The elevated body temperature kills bacteria and viruses.
•    Iron is being removed from the blood and stored in the liver. Many bacteria need iron for survival.

An elevated body temperature is integral to this process. Hippocrates knew this when he said, “give me a fever and I can cure any disease.”   Suppressing the fever may interfere with healing and prolong the infection.


FACTS ABOUT FEVER
1.     Fever is part of the body’s normal response to infection. Fever is a symptom not a disease.
2.     A child may be lethargic or flushed, may have a rapid and strong heart beat, and may even hallucinate during a fever.
3.    Fevers generated in the course of an illness are not in and of themselves dangerous. The underlying cause of the fever and how sick your child looks are more important than the height of the fever.
4.    Fevers due to infection do not rise above 106 degrees and cannot harm your child.
5.    Fevers of 107 or 108 degrees can cause brain damage and usually result from heat stroke or accidental poisoning. Routine infections do not produce fevers of this degree.
6.    It is normal for one out of twenty healthy children under the age of five to have a fever convulsion. These seizures usually last only a few minutes and produce no lasting or harmful effects.
7.    Fevers can result from overdressing. Dress your child in as many layers as you find comfortable.


MISCONCEPTION ABOUT FEVER
1.     It is not true that routine fevers can be dangerous. The underlying cause of the fever or dehydration from inadequate fluid consumption are the source of any potential problems.
2.     You cannot judge the severity of the condition by the height of the fever. Above all else, how your child looks and acts determines the likelihood of a serious problem.  A child with a temperature of 10 1 who is abnormally quiet with a vacant stare is much sicker than a child with a fever of 104 who is playing and fully engaged in his environment.
3.     It is not true that a normal fever convulsion can cause brain damage.
4.     It is not true that high fevers are more likely to result in seizures than low ones.
5.     It is not true that treating a fever early will prevent a convulsion.



MANAGEMENT AND SUPPORT OF FEVER

Fevers do not require any medical attention except as described on the following page. You can help support your
Child’s  immune system and speed recovery in the following ways:

•    Feed lightly with broth, pureed vegetables and cooked fruits.
•    Drink plenty of fluids to prevent dehydration. A good rule of thumb is to give 4 ounces per hour in young children and eight ounces per hour in older ones. Water, broth, dilute juices are preferable. But in lieu of risking dehydration, give her whatever she will drink.
•    Give vitamin C and echinacea in amounts appropriate for your child's age and weight.
•    Give appropriately selected homeopathic remedies.
•    Use warming socks at bedtime.

Your child may feel more comfortable if you take the edge off the fever, and this is the only reason to suppress a
routine fever. If you decide to lower the fever use the following guidelines.

•    Use a tepid or lukewarm bath or sponge bath. A common mistake is using water which is too cold. Chilling the child which will cause shivering and in turn raise the temperature.  Another mistake is to use rubbing alcohol. It is no more effective than tepid water and the fumes may be toxic to a small child.
•    Don’t bring the fever down below 102 degrees. The ideal level for fighting infection is 103.5 degrees.
•    If you choose to use Tylenol, dose it according to your child’s weight and age. Remember, Tylenol is poisonous if too much is taken. Be sure to keep it out of the reach of children.
•    Never give aspirin. It contains salicilates and has been linked with a potentially fatal condition called Reyes Syndrome. Just to play it safe, it would extend this precaution to salycilate containing herbs like white willow or feverfew.

WHAT ABOUT FEBRILE CONVULSIONS?

If the fever rises at a very rapid rate, your child may experience a seizure. Remember, it is the rate at which the fever rises, not the height of the fever, which initiates the seizure. As difficult as it may be, try to remain calm. It may help if you remember that seizures due to fever are normal, will usually pass in a few minutes, and do not result in any permanent damage or lasting effects. A febrile seizure does not predispose your child to a seizure disorder late in life. Simply position your child safely and turn him slightly to the side so that mucus or saliva can safely drain from his mouth. After the seizure is complete, call your doctor for further instruction. If the seizure does not stop within 10 minutes, call your local emergency number.


WHEN TO SEEK MEDICAL ASSISTANCE

Call your local emergency number if

•     Your child is having a fever convulsion that does not stop in ten minutes
•    Your child does not resume normal breathing after a fever convulsion
•    You have any reason to suspect the fever is due to poisoning or heat stroke


See your doctor or report to the emergency room immediately if your child

•    Is less than 2 months old with a fever greater than 100 degrees (taken on two occasions one hour apart)
•    has a Temperature greater than 105 degrees
•    Has a fever convulsion, twitching or other strange movements
•    Exhibits constant crying, inconsolable crying or has a weak cry
•    Is difficult to arouse, has a vacant stare or is in a state of delirium
•    Acts as though it hurts to move or to be moved
•    Has a stiff neck or persistent pain in joints
•    Has small bruises or purple spots on skin
•    Is drooling or has difficulty breathing that is not due to a stuffy nose
•    Has a chronic medical condition such as diabetes or severe asthma
•    Was exposed to a serious illness such as meningitis
•    Looks or acts very sick

Call your doctor for advice if your child has a fever and

•    Is 2-6 months old
•    The fever has lasted longer than 72 hours
•    The fever cleared for 24 hours then returned
•    It is associated with a red rash
•    It lasts more than 24 hours without an obvious cause
•    It is associated with painful urination
•    It is accompanied by vomiting or diarrhea
•    It is accompanied by a persistent or severe sore throat
•    Has an inability to drink, lack of thirst, a dry mouth, dark urine or decreased amount of urine



RESOURCES

Wade Boyle, ND and Andre Saine, ND, Naturopathic Hydrotherapy; Buckeye Nautropathic Press, 1988. Agatha Thrash, MD, Home Remedies; Thrash Publications, 198 1. Robert S. Mendelsohn, MD, How to raise a healthy kid in spite of your doctor; Ballantine Books, 1984. Barton D. Schmitt, MD, Pediatric Telephone Advice; Little, Brown and Company, 1980. Loraine M. Stem, MD, When do I call the doctor?; Doubleday, 1993. Lendon H. Smith, MD, How to Raise a Healthy Child, Evans and Company, 1996.  Bastyr University Clinical handout.