Treating Fever Symptoms in Children
Having a feverish child or baby can be scary and really put a damper on things. But the more we understand fever’s role and uncover how it works, the less scary it is and the more we’re able to navigate fever without fear and possibly even embrace it!
Fever is a symptom, not an illness
The body has a physiological set point around which there is a normal, fluctuating range. A fever happens when the body’s temperature exceeds the limits of this range. It’s a normal bodily response, usually to an infection. An important distinction to emphasize is that fever is a symptom of an illness, not the illness itself. Its cause is the important determinant in whether we need to worry, and may include, but isn’t limited to, the following:
Most fevers disappear in 1-3 days and require no special treatment besides rest and fluids to prevent dehydration, which is the most common adverse effect of a fever. Seeking help from a trusted healthcare practitioner is a must when you’re not sure what’s causing a fever.
Fever helps your immune system to fight infection
It may seem hard to believe but our very survival depends on the ability to mount a good fever in response to illness. When a fever occurs, it stimulates the circulation of specialized immune cells to help to fight infection, and the increase in body temperature helps to burn off and kill the invading microorganisms. During a fever the body will also protect its stores of iron and vitamin B12, which invaders like to feed on—pretty smart, right?
As infants approach six months of age, the antibodies they’ve acquired from mum, both in utero and in breastmilk, begin to drop off and they start to develop their own immune responses. These developing immune responses are put to the test as growing children face more exposure to germs, like those found in daycare settings. And any parent who’s had to live through that first year of daycare will tell you that the uptick in illness is a real challenge!
That said, all those bugs children pick up are not all for naught. According to a 2002 study, babies who do not develop fevers in the first year of life are more likely to develop asthma and allergies later on.1 Perhaps not unrelated, another study found that when antibiotics are given in the first year of life, allergies and asthma are also more prevalent.2 Furthermore, a third study found that children given antibiotics or acetaminophen before age four were twice as likely to develop asthma.3 As inconvenient and disruptive as it can be, illness and fever are the body’s way of becoming more resilient. We want to allow that immune system to mount a response and do its job!
Fever Facts and Myths
Let’s bust open some commonly held myths and clarify what we should and shouldn’t be doing when there’s a fever going around.
Myth: Fevers are bad.
Fact: Most fevers are good! Temperatures between 100–104oF/37.8–40oC are a good range for little bodies to fight off infection. In general, at these temperatures there is not a lot of discomfort and most children will still play normally (although maybe a little less actively) and they may want to sleep more.
Myth: Fever above 104oF is dangerous and can cause brain damage.
Fact: Only temperatures above 106–108oF/41.1–42oC can cause brain damage and in a normally well child this temperature is very rare. A high fever of 108oF/42oC would generally only happen if the air temperature is very high, for example if a little one is left in a closed car in hot weather. Don’t ever do this.
Myth: All fevers need to be treated using anti-pyretic medicine.
Fact: In most cases, fever-lowering medicines like ibuprofen and acetaminophen are counterproductive because when you suppress the fever, you suppress the immune response which then allows the actual illness to flourish. Pragmatic use of these medications includes saving them for times of discomfort—usually when their temperature goes above 102–103oF/39–39.5oC—such as cases where there’s an ear infection, headache, or body aches.
Many parents mistakenly believe they are treating the illness with fever-lowering medicine and while having your child bounce back quickly seems great, what they likely need more is rest and fluids to let the fever do its job and conserve energy for recovery.
Myth: Without treatment, fevers will keep increasing.
Fact: The brain knows when it is too hot. Most fevers from infection don’t go above 103–104oF/39.5–40oC, and only rarely go to 105–106oF/40.6–41.1oC. While this seems high, it is, in fact, normally harmless. Remember, it’s the source of the fever that is more or less worrisome, not the fever itself.
Myth: With treatment, fevers should come down to normal and stay down.
Fact: When we give fever-lowering medicine, most fevers come down by 2–3oF/1–1.5oC, but as the medicine wears off the fever will often come back up. It’s very normal for fever to last two to three days and resolve on its own, without returning, once the body overpowers the illness, most often on day three or four.
Myth: If you can’t break the fever, the cause is serious.
Fact: The body’s response to fever-lowering medicine doesn’t tell us anything about the cause of the fever. Fevers that don’t come down to normal can be caused by viruses or bacteria, and the way the baby or child is responding to the fever (see causes for concern below) gives us far more information about the cause, and its seriousness, than their response to the medicine does.
Myth: If the fever is high, the cause is serious.
Fact: The number on the thermometer has nothing to do with the seriousness of the illness. In many cases, a child or baby can run a very high fever due to a very benign cause, like a common virus. On the other hand, one can have a low-grade fever from a very serious illness. The bottom line is that if your little one looks and/or acts sick, the cause is more likely to be serious.
Myth: Oral temperatures between 98.7–100oF/37.1–37.8oC are low-grade fevers.
Fact: These are in fact within the normal range of temperatures around the set point. Body temperature changes throughout the day and peaks later afternoon and evening. True low-grade fever is anywhere from 100–102oF/37.8–39oC.
Myth: Anyone can have a febrile seizure.
Fact: Only about four percent of children experience febrile seizures and are genetically linked: if an older sibling or parent has had one or more, they are more likely to also have them. Febrile seizures are most common between the ages of six months to three years but can occur up to age six.
Myth: Febrile seizures are harmful.
Fact: Although they may signify a more serious illness and do warrant a full neurological work-up, most febrile seizures themselves are benign, usually stopping within 5–10 minutes. While they might be scary to watch, take care in knowing that they typically don’t cause any permanent harm or indicate a serious health problem. The risk of suffering from epileptic seizures increases slightly (about 0.5 percent) for those who have febrile seizures compared to those who don’t.
Fever and febrile seizure
Febrile seizures are convulsions brought about by a high fever, usually due to infection, and are typically experienced by children from three months to three years old.
High fever (over 100.4oF)
Loss of consciousness
Convulsions and limb twitching
Confusion/tiredness after seizure
Simple febrile seizures occur once in a 24-hour period, with the episode lasting from a few seconds to up to 15 minutes.
Complex febrile seizures last for more than 15 minutes and occurs more than once in a 24-hour period with the potential for multiple seizures to take place within a 30-minute period, and often affects one side of the body.
If your child does have a seizure, be sure to apply your first aid skills to ensure their safety and take them to see your healthcare provider. Call 911 if the seizure lasts longer than 5 minutes or the child stops breathing.
The risks of fever-lowering medicine
Giving medicine to lower fever interrupts the body from doing its job and may even prolong the illness. According to one study, flu sufferers who took acetaminophen or aspirin were sick an average of 3.5 days longer than those who took neither. Further, a systematic review of paediatric guidelines on fever management in The British Medical Journal found that guidelines from the US, Italy, UK, Australia, South Africa, and the World Health Organization all agreed that the only reason to give fever-lowering medicine is to reduce the discomfort, not the temperature.
Unfortunately, many parents rely on acetaminophen when they see their little one in discomfort, inadvertently dispensing it too often or giving too much. Overdosing acetaminophen is the number one cause of liver failure so always pay close attention to the recommended dosing: 10–15mg/kg every 4–6 hours, and never exceeding 75–90mg/kg/day.
Bottom line: Overmedicating for fever is often more dangerous than the fever itself, so reserve the use of fever medicine for when and if the fever is causing discomfort. It can’t be said enough: Suppressing the fever doesn’t treat the illness, it simply suppresses the immune system’s ability to fight it. Promote the fever!
Fever do's and dont's
As always, individualized treatment advice is best, so see your healthcare provider to find out which plan is right for your specific situation.
Snuggle! Babies, who are still learning to regulate their temperatures, will especially benefit from extra cuddles including skin-to-skin contact.
Rest! Ensure they are as comfortable as possible so their little bodies can devote energy to fighting off the illness effectively and efficiently.
Hydrate! Offer small sips often. Coconut water, herbal tea, electrolyte preparations, bone broth, or breastmilk are all great choices.
Feed! Offer easily digestible foods like soups, stews, or applesauce, but never force feed.
Get spicy! Add fever-friendly foods like ginger, cinnamon, garlic, and onions.
Herbal helpers! Elderberry, echinacea, ginger, catnip, lemon balm, and chamomile are all wonderful herbs that support immunity and fever. See your healthcare provider for safety and appropriate dosing.
Aspirin avoidance Never give aspirin to a baby, child, or teen with a fever. It has been linked to Reye’s Syndrome, an illness that can cause damage to the liver and spleen.
Icy reception Don’t attempt to cool little ones down with ice, a cold bath, or rubbing alcohol as this can potentially increase core body temperature.
Sugary lows Since sugar feeds bacteria and lowers white blood cell production, it’s best to avoid sugar in all forms, including fruit juice. Whole fruit, on the other hand, is encouraged—purées and smoothies are sweet, cooling, and soothing and offer nutritional support.
When to seek help with a fever
Although most fevers are fairly benign in nature, the following situations do warrant a trip to the doctor or hospital:
Infants less than 3 months old with a temp above 100.4oF/38oC
A baby or child with a fever over 104oF/40oC
Anyone with a fever over 105.8oF/41oC
Fever that lasts longer than four days
Child or baby showing signs of dehydration: dry mucous membranes (nose, mouth), reduced urine output, sunken fontanelles, and no tear production when crying
Fever accompanied by a rash, lethargy, excessive sleepiness, unrelenting irritability, projectile vomiting, neck stiffness, lack of response to social cues, urinary frequency or pain, difficulty breathing or swallowing, pale blue skin, nasal flaring, seizure, or weak, high-pitched, or continuous crying
Fever is just one of the many childhood woes that I coach parents through and have been in the trenches with myself! It can feel a bit scary to watch, but hopefully you’re better armed with more knowledge about this natural and even wonderful process. Training the immune system to fight off illness takes a lot of patience, trust, and support. Tune in to your little ones and pay attention to how they appear and are behaving, rather than the number on the thermometer—a really sick-looking child is really sick, no matter what the temperatures is. Trust your instincts—if they tell you something is definitely not right, take your little one to see their healthcare provider.