Leveraging The Fever As Medicine: Effective Fever Management Guide

Who likes fever?

Well, I do! I think it’s one of the coolest things our body’s designed to do. But fever gets such a bad rep.

Perhaps because it is usually the first sign of illness that forces the body to rest, makes babies more clingy, keeps kids out of school, and puts our busy life on hold, creating disruption and inconvenience.

But also because of this pervasive fear due to the lack of understanding about why fever rises in the first place and what fever really does inside our body.

You are here today because you and your ancestors had fever.

Let that truth sink in…

All warm-blooded animals (including us humans) get fever. It is something that has been passed down through hundreds of millions of years through natural selection.

Why? Because those who mounted a good fever response SURVIVED while others who didn’t have fever didn’t survive. Because fever provided them with a survival advantage by allowing them to recover more readily and fully from infections.

Nature makes no mistakes!

Fever is NOT a fire that needs to be put out.

Fever is the proof of our body’s innate intelligence.

Fever is medicine.

When your immune cells detect a bacteria or virus, they immediately launch their fever activator, prostaglandin E2 (PGE2) that tells the whole body to bring on fever. The brain continues to release more PGE2 via cyclooxygenase 2 (COX2) enzyme to get this fire going. [1]

Not only that your brain will continue to recruit these messengers such as norepinephrine to tell the fat tissue to crank up the heat by burning it off, blood vessels to constrict to prevent heat loss and acetylcholine to stimulate muscle cells to induce shivering to add more fire. [1]

Temperatures in the febrile range (40–41°C) cause a greater than 200-fold reduction in the replication rate of virus and increase the susceptibility of bacteria to die. [1]

Fever recruits more innate immune cells and enhances their potential to destroy pathogens. This helps the body to recover faster and may result in fewer complications. [1]

Your body takes infections seriously. It is doing its best to prevent the bad bugs from multiplying and damaging your cells and DNAs by launching a fever.

Fever is like your cool friend who has your back when you get in trouble. It is happening for you, with you, and because of you.

Why giving antipyretic medication is counterproductive.

Taking antipyretic medication at the first sign of fever is like dumping water to the campfire you’ve just started to roast the marshmallows.

While your body’s busy trying to contain the spread of infection, tylenol lobbies COX2 enzymes to stop making PGE2 and instead to take a break and go on a vacation.

As you can see, it actually interrupts the body from doing its job.

That’s why fever tends to go up again because the body is still trying to get a hold of these buggers.

Like we’ve previously discussed, when your child gets a fever, their body is doing everything it can to mount this fever. To SAVE your child.

According to British Medical Journal’s systematic review of pediatric guidelines on fever management that looked at guidelines from US, Italy, United Kingdom, Australia, South Africa, and WHO, the only reason to give fever lowering drugs is to reduce discomfort NOT the temperature. [2]

Accidental, unconscious overdosing of acetaminophen is quite common when parents use it too much or too frequently to manage fever. [2]

Higher doses of acetaminophen is toxic to liver. The appropriate dosage of acetaminophen in children is 10-15mg/kg/dose every 4-6 hr not exceeding 75-90mg/kg/day (I would stick to the lower range). [2]

Fever meds should be considered as an absolute last resort to relieve discomfort when other tools fail to help kids feel better.

What to do when your child has a fever:

The number one objective in effective fever management is to keep the child comfortable.

The parent’s job is not to lower the temperature. The temperature will naturally come down once the child’s body has effectively contained the spread.

Your job is to provide adequate support so that the child’s body can mount a good fever, fight off infection, and break the fever.

Effective Fever Management Guideline:

1. Hydrate. Prevent dehydration by continuously offering water, coconut water, herbal teas (chamomile, elderflower, yarrow, peppermint), and bone broths.
2. Cool off the steam. Use various methods of hydrotherapy such as wet compress, wiping forehead and neck with water to provide some cooling relief. This will not bring down the core temperature but will give enough comfort until the fever breaks. There are some homeopathic remedies (like belladona, aconite, ferrum phos, etc) that can also provide some relief while preventing complications like febrile seizures. Consult a naturopathic doctor or homeopath.
3. Instil trust. Every time my kids get a fever I remind them to send loving messages to their body because they are working hard to fight off the baddies to get them well again. The kind of things that they will tell themselves will melt your heart and make you think about how you relate to your body.

What NOT to do when your child has a fever:

1. Do NOT use ice or rub alcohol to cool down temperature. This has not be shown to be effective. Plus, the cold sensation can potentially increase the core body temperature further, which is not what we want.
2. Do NOT force feed the child. The appetite will naturally go down with fever because the body is busy fighting off bugs. Fasting during this period has actually shown to speed up recovery time. Continue encouraging fluid intake during this time. And don’t you worry! Once they break the fever, their appetite will soar and make up for the loss.
3. NEVER give a child or teen aspirin. Aspirin has been linked to Reye’s syndrome which can cause liver and kidney damage in kids. Stick to acetaminophen or ibuprofen if you need to provide extra comfort.

When to go to the hospital when your child has a fever:

1. When the child looks ill = non-blanching rash, neck stiffness, no response to social cues, lethargic, continuous cries, relentless irritability, vomiting, urinary frequency or pain, pale blue skin, nasal flaring, seizure but above all, WHEN YOU FEEL IT’S TIME! You know your child best and trust your instincts.
2. Infants < 6 week old with temp > 38 C (100.4 F)
3. Infants 1-3 months with temp > 38 C (100.4 F) if they appear ill
4. Babies 3-6 months with temp > 39 C (102.2 F) if they appear ill
5. Anyone with temp > 41 C (105.8 F)
6. Fever lasting longer than 5 days
7. Child shows signs of dehydration = dry mouth, sunken fontanelles, sunken eyes, reduce urine output, no tears when crying

Best advice: Focus on the child’s behaviour NOT the temperature.

Clinginess, loss of appetite, tiredness, some irritability and tantrums are normal behaviours for a sick child.

Whether the temperature is 37.5 C, 38.5 C, 39.8 C… as long as your child is playing, engaging with you, and does not look ill (not showing any symptoms listed above), you keep calm and continue supporting the fever.

Signs of Victory

The moment you’ve been waiting for.

When the child breaks out into a cool sweat, that’s when you know the fever has run its course and the body has won the battle.

Training the body’s immune system in such a way without the use of fever-lowering medications requires a lot of work, patience, trust and prayers.

I’m not going to lie. I did not sleep at all when my oldest had his first fever. I was too anxious and worried. But I trusted the process and followed the guideline mentioned above to keep him comfortable.

Things have gotten easier as I’ve witnessed again and again how capable their little bodies are of mounting and breaking fever. Over time, this gave me the confidence in my fever managing abilities.

Fever still gets me excited every time. Because I know when my child breaks this fever, his runny nose is going to stop and his immune system will get a natural boost.

Fever is medicine.

So let down your fear and learn how to support it well while minimizing discomfort.

You’ve got this!

xo,

Dr. Ji Woon Min, ND

References:

[1] Evans SS, Repasky EA, Fisher DT. Fever and the thermal regulation of immunity: the immune system feels the heat. Nat Rev Immunol. 2015; 15: 335-349.

[2] Chiappini E, Bortone B, Galli L, de Martino M. Guidelines for the symptomatic management of fever in children: systematic review of the literature and quality appraisal with AGREE II. BMJ Open. 2017; 7: e015404.