Fevers - What is a Parent to do?

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Fevers - BASICS

It's that time of the year, so let's clear up a few basic things like FEVER in healthy children who do not have pre-existing medical conditions

1 - There is no number on the thermometer that corresponds with a trip to the emergency department or urgent care. No not even 104.

The severity a fever does not generally correspond with the severity of illness. Fever is just a number on the thermometer. We must look at the child not the thermometer to really assess the severity of illness. A child with 101 laying around, crabby, listless, devoid of energy, vomiting, is sicker then a child with 103, walking around,playing, a little achy, drinking fluids with rosy cheeks.

2 - Fevers do not need to be treated with medications generally.

Fever is the body's way of fighting infection. To put it simply, a virus invades the body. It comes in with 50 copies of itself. It then starts using your body as a copy machine to make more copies of itself and invade your body further. The body gets very upset by this. The temperature rises. When the temperature is rising and your body has a fever, it stops the virus from making more photocopies of itself. If you don't give medication the fever will keep the virus at having only 100 copies of itself, let's say. The body can easily take over the 100 viruses and fight back. You get better quicker. Verses, giving Tylenol and Motrin around-the-clock, suppressing the fever response. The virus can now replicate to millions and billions of copies, because there is nothing stopping it. Now you end up being sicker for days and days.

Moral of the story:

Let the children understand that they will be sore, they will have a headache, they will have a bellyache, they will not feel good, but you will not give them any medications. Unlimited screen time, fluids, chicken noodle soup, cold smoothies, and unlimited love is the prescription. Cold compresses and lukewarm (not cold) baths are a great choice as well. The fever will be done in 24 hours. The illness will be done in 2 to 3 days max.

If you cannot stand it, and you are dosing your children around the clock with Motrin and Tylenol you'll be dealing with this illness for 7 to 10 days at least. The body now has to get rid of million/billion virus particles. That takes some time. That is a lot of days missed from school and work.

Exceptions: ••if the child refuses to drink and he is in danger of getting dehydrated or laying around like a dish rag (not just tired which is a normal response to fever) please use medicine to reduce fever. •• If child is less then 3 months old, has a fever > 100.4, discuss with pediatrician immediately.

Meds: •• when using medicines please choose dye free meds

Fever - FEARS

Fear of fever for causing brain damage.

- In a normal child with a normal functioning brain it is not possible for fever to cause brain damage. The brain protects itself. The brain starts the fever to protect the body from invading viruses/bacteria. It will not raise the temp enough to hurt itself. - Brain damage occurs only with external factors such as hyperthermia from heatstroke or other external sources where the brain is not in control.

Fear of febrile seizures.

- The risk of febrile seizures in the general population is 2-5% in children 6months to 5years. Usually the febrile seizure occurs before you even know the child is sick. They're usually playing doing fine and all of a sudden they are having a seizure. As the seizure progresses it will be noted that the child is febrile. - It is not the height of the temperature, it is the rate of rise. For example, when the fever goes from 98.6 to 103 in a less than 20 minutes it can lower the seizure threshold. Meaning, the speed with which the temp goes up causes irritation to the brain, thus seizure. It is NOT that the fever is 104 or going to 105 OR that the fever lasts for 1-2 hrs that is the problem. In a healthy child with a normal brain, NOT the number, and NOT the duration of fever, but The Rate of Rise causes seizure. - Out of fear of a child having a febrile seizure parents will alternate Tylenol and Motrin. Many studies have been done on this topic. Yes, even in kids know to have febrile seizures. No study has ever shown that alternating Tylenol and Motrin reduces the risk of a seizure. Alternating these medications only leads to overdosing and stressing kidneys and liver in an effort for parents to make themselves feel better.

Why I don’t use Tylenol or Panadol

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There is an association between acetaminophen/tylenol (paracetamol/panadol) use and rise in asthma symptoms & severity!!

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Read below. 

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Journal of Pediatrics 2011

The association between acetaminophen use an asthma prevalence and severity in children and adults is well established.  (What?????). A variety of observation suggests that acetaminophen use has contributed to the recent increase in asthma prevalence in children. 

(Raise your hand if you knew this)

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Recommendations of this article: 🤢Until future studies document the safety of this drug, children with asthma or at risk for asthma should avoid the use of acetaminophen

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Mechanism of action is hypothesized to be glutathione depletion in airway mucosa with resulting inflammation 

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Data available:

122 centers, 

54 countries 

520,000 children 

6 to 14 years old 

Increase use of acetaminophen correlates with increased prevalence and severity of asthma. (Acetaminophen used between once a year to once a month)

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Ethiopian study of children 1 to 3 years old with high rates of the acetaminophen use had high risk wheezing later in life

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In New Zealand, use of more than 10 doses of acetaminophen per year was associated with an increased risk of asthma symptoms

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A prospective study (meaning they gave kids ibuprofen/acetaminophen as necessary and observed asthma rates) - 

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data on :

84,000 children

6months - 12 yrs

Double blind (for my science nerds)

Dose dependent relationship - the more doses of acetaminophen the higher the asthma rates. 

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Citation: http://pediatrics.AAPpublications.org/content/128/6/1181

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Moral of the story:

  • Normal brains do not damage themselves with the fever they created.

  • Febrile seizures, though horrible, are generally benign, and CANNOT be prevented with alternating doses of Motrin or Tylenol. And are rare occurrences !!!!!!!

  • Infants under 6 months old cannot use ibuprofen.

  • Always speak with your doctor if you are concerned. This blog is for educational purpose only, it is not medical advice.

In Good Health, Ana-Maria Temple, MD