Monday, February 13, 2012

Pediatric Fevers: "The Good Fight"

It's hard for parents to watch our children suffer through cold and flu symptoms like congestion, runny nose, sneezing, coughing, achiness and malaise. But a fever in our babies or small children can be downright scary.

As part of my series on colds and flu, I wanted to include an article on pediatric fevers to help alleviate parents' and caregivers' fears and to provide a resource for caring for fevering children and babies.

As you scroll down you'll find:
  • How Can Fever Be Good?
  • Facts About Fever
  • Guidelines for Caring for a Fevering Baby/Child
  • Danger Signs/When to Call Your Doctor
  • Cautions about Over-the-Counter Fever-Reducing Medications
  • Holistic Home-Treatment Methods for Fever

Most of this information is drawn from Randall Neustaedter, OMD's book, The Holistic Baby Guide. Neustaedter is pediatric acupuncturist, herbalist and homeopath working in the South Bay Area. I recommend this book to new parents as an accessible, reader-friendly guide to dealing with a range of common pediatric health conditions holistically.

Whether by conditioning or by instinct, we tend to feel worried and afraid when our baby or child has a fever. In most cases, pediatric fever is a good and important thing. If we know the facts about fever (see below), it is easier to care for a fevering bay with more calm and reassurance.

Fevers fight infections. When animals are deprived of their ability to fight infections with fever, they die. A fever speeds up metabolism and heart rate, increasing blood circulation. It increases white blood cell production to fight bacteria and viruses, and it increases production of interferon, a natural antiviral chemical in the body. Babies get fevers to exercise their immune systems so they can build their own immunity to the pathogenic microbes they encounter.

For all these reasons, fevers represent a healing process and a healthy body defense. Generally, it is better not to suppress them, but to let them do the important work they "are meant" to do.


1. Know the facts about fever
  • A fever is a temperature above 100.5 degrees F. Anything below that is just a normal variation in temperature.
  • Any baby under three months of age should be seen by a doctor. Infants do not have the ability to fight off infections on their own, and even simple infection can quickly develop into a serious, invasive illness. The cause of an infection may not be visible through symptoms, and doctors may want to do lab tests to screen for invasive illness in a fevering newborn.
  • Children fever higher than adults. They are naturally hot and reactive, responding quickly and vigorously to pathogens. Some children are more prone to fever than others--and that's natural and ok.
  • Most pediatric fevers are not dangerous. Brain damage does not occur until body temperature rises to 108 degrees F. The body has good mechanisms for keeping the temperature under 106 degrees F. So, even when your child's temperature is rising, you can be assured that your child's body has mechanisms to stop it before it gets dangerous.
  • A child can fever safely to 105 degrees F without need to call your doctor or health care provider. At 105 degrees, it is recommended to check in with your health care provider. This does not necessarily mean that you will take measures to reduce the fever, but it is important at this point to seek medical consultation.
  • Fevers can sometimes lead to seizures--and that's ok. Febrile seizures are actually fairly common. Although they are frightening to parents, they are usually harmless to parents. If your baby begins twitching or jerking with a fever, stay calm, turn your baby on his/her side, and do not retrain him/her. If the seizure lasts more than five minutes, or if the baby becomes unconscious, call 911. There is no reason to seek emergency care, however, if your baby has a short seizure with a fever and remains conscious. After the seizure is over, call your doctor to see if an exam is needed to discover any other causes, such as meningitis. Giving fever-reducing drugs does not prevent febrile seizures.
2. Know the Cause of the Fever
A fever with localized symptoms such as runny nose, ear pain, or diarrhea is less worrisome than a fever without apparent causes. This is because babies or children with no obvious focus of infection (or no obvious cold or flu symptoms) may be harboring a more serious internal infection.

That being said, many illnesses in babies begin with a fever as the first sign, signaling that the body is mounting an immune response. Other symptoms may appear in the next day or two.

If the cause of the fever is obvious, it is safe to monitor the baby at home without checking in with a health care provider. If the cause is not obvious, it is a good idea to check in with with your trusted health care provider.

3. How Your Child Looks & Acts is More Important than the Number on the Thermometer
With any illness, the most important indicator of the need for medical care is your child's level of energy, not the level of the fever. A baby who appears weak and lethargic and who has little energy to cry and nurse may have a worrisome condition. A screaming baby may have pain with an illness, but the level of energy indicates a robust reaction. Babies who are weak may not be fighting off an illness adequately.

You should consult with a trusted professional health care practitioner if:
  • Your baby/child's fever persists for more than one day and there is no apparent cause. Persistent fever can be an indication of an infection that warrants professional evaluation and treatment.
  • Your child's fever is accompanied by vomiting, listlessness, extreme lethary (i.e. they are difficult to wake up). Meningitis is often accompanied by these signs and symptoms.
  • Your child's fever persists for more than two days.
  • Your child gets a fever after having a cold or cough for several days. This may be a sign that his/her immune system is not managing the infection well on its own. A deeper infection could take hold in these circumstances.
  • Your baby seems very sleep, unresponsive to stimulation, unable to generate lusty crying.
  • Your baby is under three months of age and develops a fever.


It is best not to reach for Tylenol (acetaminophen) and Advil (ibuprofin) at the first sign of fever in your child as these drugs do carry some potential risk.

Tylenol has been shown to be potentially toxic to the human liver, and this risk would be amplified in babies and small children who have small, underdeveloped livers. There is also some research that shows that suppressing fever with acetaminophen increases the length of viral illness. Additionally, suppressing fevers with acetaminophen in the first year of life may increase the risk of allergies, eczema and asthma in later childhood.

Advil (ibuprofin) also has some attendant risks; but this drug is the safer choice for those times when your baby simply needs some relief from pain. A dose of ibuprofin can provide a much needed good night's sleep in a truly distressed baby.

Aspirin should never be given to children with fevers. Aspirin given during a viral illness can cause Reye's syndrome, severe liver dysfunction and brain swelling.

Following the theme that fevers are a natural, healthy and almost always safe response to infection and illness, there are several safe, gentle home remedies you can use when caring for your fevering child. The goal of home treatment is to encourage healing and stimulate a strong immune response. Reducing fever is not necessarily the goal, as the fever will do what is necessary to fight the underlying illness.

1. Fluids:
Keep your child/baby hydrated. If your child still nurses, have them nurse as much as they are willing. For bigger kids, keep offering water or diluted juice. You might want to supplement their fluid intake with electrolytes to help the body stay hydrated. The company that makes Emergen-C packets also sells a product called Electromix, specifically for rehydration after exertion, which comes in single packets and is free of sugar and artificial additives.

2. Homeopathic remedies:
There are several homeopathic remedies which effectively treat pediatric fevers. The first and easiest remedy to try is Belladonna. Classical indications for Belladonna are fever with sudden onset, radiating heat, flushing and redness of the skin. Homeopathic remedies do not suppress the fever. Rather they help the body process through the illness more quickly and effectively. They can be extremely effective in reducing the severity of illness.

I think it's a good idea for new parents to invest in a home-treatment homepathic remedy kit. These kits come with about 30 commonly-used remedy, along with an easy-to-use instruction manual.

3. Western Herbs:
Echinacea and black elderberry are two immune-supporting herbs known to shorten the duration of viral illness and help to prevent more serious illness. They are available in health food stores in the form of tinctures or syrups and are usually well-tolerated by babies.

4. Chinese Herbs:
An acupuncturist specializing in pediatrics can provide you with kid-friendly Chinese herbal tinctures to keep on hand during cold and flu season. Chinese herbs in appropriate combinations serve to boost the body's immune system and to stimulate the body's own healing mechanisms in the case of cold or flu infection. Appropriately-selected Chinese herbs can help reduce fever while also helping the body kick out pathogens causing the fever.

Yin Chao Junior (by Health Concerns) and Windbreaker (by Kan Herb Company, Gentle Warriors product line) are two pediatric Chinese herb tinctures that useful in relieving heat and pathogens when taken at the first sign of illness.

5. Lukewarm Sponge Bath:
A lukewarm sponge bath can temporarily bring the fever down enough to relieve your child's discomfort. (But sponging does not reduce fevers because the body's thermostat is unaffected by external manipulation of temperature.)

Simply seat your child or baby in a few inches of lukewarm water and/or sponge them off with a lukewarm wet cloth.

DO NOT USE COLD WATER. This will only make your child shiver which has the effect of elevating body temperature. Not to mention, cold deters the immune system. You don't want that.

6. Pediatric Massage:

Here is one massage technique for gently easing fever and comforting your little one:

On the inner surface of the forearm, rub in a straight line from the elbow crease toward the wrist. Rub in one direction only, rapidly, 100-300 times.

This technique is appropriate when the child is fevering and agitated. It will help release heat and pathogens from the body and calm the fever.

Apply an evaporative medium like rubbing alcohol or water (or even a dab of cooled-off peppermint or ginger tea) when you do this technique to help the body vent heat. DO NOT USE MASSAGE OIL in the case of fever or illness because oil traps heat and pathogens in the body.

See my related articles for more information on pediatric massage:

Pediatric Massage Techniques for Cold & Flu Season

Do-It-Yourself Pediatric Massage: An Introduction for Parents & Caregivers

7. Acupuncture & Herbs
An acupuncturist who specializes in pediatrics knows multiple protocols for gently reducing fever and supporting a child's immune system to fight infection more efficiently using modalities including acupuncture, needle-less acupuncture such as shonishin, pediatric massage, and herbal treatment.

8. Round-the-Clock Support
Parent need and deserve support when caring for sick and fevering children, especially when making choices about whether to use or forego fever-reducing medications.

Find a pediatrician you like and trust. Have the phone numbers of your pediatrician and 24-hour medical advice resources in a readily accessible place. Find a holisitic pediatric health care provider who is available to answer kid-related health care questions on a round-the-clock basis. I am available to take calls from parents on a 24-hour basis and there are others like me.

I hope this information helps you to be more at ease when dealing with your child's next illness.