The Fever Debate

With the extended and extreme winter weather that has struck the lower mainland of BC, comes an unusual predominance and persistence of colds & flus, sinusitis infections and various other “bugs” that have affected several of my patients - young, old and middle-aged. What prompted me to write this article, is the number of cases of concerned and confused parents who bring their young children to me and don’t know what to do when they develop fevers when falling ill. When their child is ill and has a high fever, parents are naturally very concerned and simply want their child to feel better - quickly. Reaching for the acetaminophen (aka Tylenol) is so easy, so simple...and the scenario inside the parents’ head goes something like this: “my child is suffering with this fever, he/she is not eating, not sleeping well...if I give the acetaminophen he/she will feel better and (most importantly) the number on the thermostat will go down and guess what....I will feel better as a parent because I won’t have to watch my child suffer!!!”

That last statement is really key - often the child themselves is tolerating the fever just fine, but the parent on the other hand is definitely not. We call this parental “fever phobia” which has lead to the overuse of anti-fever medications (acetaminophen is the drug of choice for most parents) without a complete understanding of its consequences - both short and long term. My hope is that this article will accomplish 3 tasks: explain the significance of fever, how to manage a fever and side effects of overuse or misuse of anti-fever meds.

The Significance of Fever

Whether it is due to an upper respiratory infection, gastrointestinal infection (i.e. “stomach flu") and whether it is viral or bacterial in origin, the general rule is the same: FEVERS ARE GOOD. DO NOT SUPPRESS THEM. Many of you have probably heard this statement, but do not fully understand why. To facilitate the understanding of fevers, here are a few key points to remember:

1. A fever is not a disease, it is a symptom.
   It is generally a sign that a person’s body is fighting an infection. In adults, the height of the fever generally indicates the severity of the disease. In children under 8 yrs of age however, a little fever may be associated with a serious infection or a high fever may be associated with only a simple cold. Therefore, it is important to evaluate their appetite, hydration, mood, level of activity, facial color, quality of cry, responsiveness and ability to be consoled in order to determine how sick they are. This is also known as “The Yale Observation Scale” and is used by most pediatric departments in North America as a guideline for assessment of fever in children aged 3-36 months.
2. A fever helps the body fight infection.
   This is the body’s natural way of inhibiting the growth and even killing some disease-causing organisms. Fever increases the production of interferon - a chemical that inhibits viral replication - and increases the body’s metabolic rate, thereby allowing the body to get rid of waste products more quickly.
3. By taking anti-fever medications (i.e. acetaminophen) you are effectively reducing the body’s ability to fight infection and prolonging the disease process thereby delaying recovery.
   The anti-fever meds may lower the temperature and reduce fever but that means the infection will linger longer and weaken the immune system, making it more susceptible to infection immediately or shortly after. Children and adults who are continually “catching colds” or suffering from recurrent ear infections are perfect examples of this.

How To Manage a Fever

There are times when you should actively work to lower a fever. A fever between 38.5 degrees C (101.5 degrees F) and 39.5 deg C (103 deg F) is helpful in overcoming infection. This is a good time to be using supportive therapies such as vitamin C, Echinacea, Goldenseal, acidophilus, etc. along with plenty of rest and fluids and only simple foods (i.e. chicken noodle or miso soup, applesauce, toast, herbal teas, breast feed whenever possible). Do not force feed them. Make note of any rashes, pulling of the ears or other signs that may be clues as to what is causing the fever, as this is helpful information for your physician to know in order to better treat the root cause of the fever. You should work to lower the fever if any of the following apply:

• The temperature is 40 deg C (103.5 deg F) or higher for more than 1 hr
• The fever climbs 40.5 deg C (105 deg F) at any point
• The patient is a child who has had febrile seizures in the past
• The patient is really exhausted or uncomfortable because of the fever, possibly delirious

Here are some ways to bring the fever down at home (in addition to what was mentioned above):

• Sponge baths in tepid (lukewarm) water - will reduce the fever by 3-4 degrees. Repeat this process if fever goes up again and continue until stable.
• Homeopathy and Botanicals (herbs) - there are many remedies that will support the immune system rather than suppress it. Consult with your naturopathic physician for the appropriate remedies and dosages.
• Essential oils - 4-6 drops of lavender, rosemary or eucalyptus oils into the bath or rubbed into the neck, chest and shoulders with some olive oil can be helpful to relieve congestion, ease muscle tension and open up the airways

A fever over 41.5 deg C can potentially damage the central nervous system, although this is a very rare occurrence. A child should be seen by their MD or ND for intervention. Of most concern to parents, is the idea that their child may suffer a febrile (fever-induced) seizure if the fever runs too high, resulting in damage to the child’s brain function. A study published by the Journal of Neurology (July 10, 2001) found that febrile convulsions affect up to 4% of children by the age of 5. The study concluded that children with a history of fever-induced seizures actually outperformed other kids in tests of memory and learning capacity, thereby providing reassuring data that fever-induced convulsions have no lasting impact on most children’s memory.

Side Effects of Anty-Pyretics

Acetaminophen and ibuprofen are absorbed in the gastro-intestinal tract and can be very harmful to the liver when used frequently or in high dosages. A tepid bath is just as effective, if not more, in reducing the fever. The alternating use of acetaminophen and ibuprofen is discouraged as this may perpetuate the damage inflicted on the liver, resulting in severe toxicity and even death. Remember to NEVER give aspirin to a child with a fever, as it has been associated with Reye’s Syndrome which is a rare but potentially fatal condition when a child is given aspirin for a viral infection.

Concluding Remarks

Of key importance is to understand the difference between supporting the immune system in dealing with the fever vs suppressing the immune system, which will not speed the resolution of the illness. A fever is our body’s natural defense mechanism in fighting off infections. Statistics show that children who experience fevers and childhood illness without the intervention of anti-pyretic drugs and/or antibiotics are less likely to develop chronic illness (i.e. eczema, psoriasis, allergies, asthma, ADD, ADHD, etc.) in their teen and adult years. Remember that antibiotics are very powerful drugs that should be reserved for conditions that are serious or even life-threatening. Most of the time, the body is able to fight off infection with just the right type of support using natural remedies and plenty of rest.

For more information, contact Dr. Sharon Gurm ND at 604-949-0077.