Fever in Children: A Blessing in Disguise

November 14, 2001

http://www.mothering.com/10-0-0/html/10-5-0/10-5-fever95.shtml

Issue 95, July/August 1999

By Linda B. White and Sunny Mavor

Excerpted from Kids, Herbs, and Health: A Parents’ Guide

to Natural Remedies by Linda B. White, MD, and Sunny Mavor, AHG, $21.95,

with permission from Interweave Press, 1999. To order, call 800-645-3675.

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 child’s 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, let’s define normal body temperature. Most people say 98.6ºF (37ºC)

is normal, but this doesn’t 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 don’t panic at 4 p.m. when your child’s 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 brain’s

hypothalamus to raise the body’s 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, it’s 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, don’t cajole or coerce your children into eating during fevers if

they don’t 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 don’t

need to be afraid that your child’s temperature is going to continue to rise

above that point.

What About Febrile Seizures?

First, let’s 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 isn’t 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, they’re 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. That’s 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 child’s energy. Here’s

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 (Children’s 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 Reye’s

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 Reye’s 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 hasn’t.

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.

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.

In a study of children with chickenpox, acetaminophen prolonged itching and

the time to scabbing compared to placebo treatment.

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 child’s temperature. Kids with fever often do not feel thirsty,

or by the time they do, they’re 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 child’s 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 children’s 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 body’s 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.

Don’t push food. People with fevers generally don’t 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, ‘boneset,’ 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 herb’s immune-enhancing, bacteria-killing, virus-fighting

abilities all justify its use during children’s fevers. In glycerite form,

echinacea is tasty, and it’s easy to give to kids several times a day. You’ll

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 babies’ 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, let’s 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 children’s illness

Reye’s 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 Reye’s syndrome. In addition, there is not

a single recorded case of willow bark – or any herb containing natural salicylates

– being associated with Reye’s syndrome.

However, we prefer to err on the side of caution, so we don’t recommend willow

or other salicylate-containing herbs during kids’ fevers. And frankly, willow

bark tea tastes so bad, it’s 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. It’s best to use these in a warm, steamy bathroom

so that your child doesn’t 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.