Fever

When we talk about health fevers are one of the most common childhood occurrences. A fever is a sign that the body is fighting off an illness and is in fact a sign that the immune system is functioning well. A fever is an indication that we are unwell, but is not in fact the illness.

Common practice has been to suppress fevers with a febrifuge such as paracetamol (acetaminophen) or ibuprofen. This is because common medical practice believed until recently, that the fever was the illness and by suppressing the fever we were helping the patient heal. This is not in fact the case.

The fever process works like this: the child develops an infection, to which the body responds by making additional leukocytes (white blood cells). These cells fight the infection by destroying the bacteria and viruses then removing the dead tissue. The activity level of the white cells is also increased as they move rapidly to the site of the infection. This is called leucotaxis, and it is activated by the release of pyrogens which raise the body temperature. As the fever progresses the metabolic rate and oxygen consumption increases. The key here is that the raise in temperature is what stimulates the leucocytes to respond. An increase in body temperature simply means that the process of healing is speeding up.

 

Also, iron, which bacteria need to survive, is removed from the blood and stored in the liver. This reduces the rate at which the bacteria multiply. As this whole process progresses, a substance called interferon becomes more effective and aids in the fight of the infection. Because a fever is regulated by the body, it rarely, if ever, reaches a level that would be hazardous to the child.

People worry about fevers because we believe that fevers can cause brain damage, again this is very rarely the case. Fevers of a temperature high enough to cause damage in human cells (41.5 C+) are rare and are usually caused by poisoning, heatstroke or brain damage (specifically to the hypothalamus) even very high temperatures up to 39-40 degrees Celsius will not harm your child in and of themselves. Obviously if the fever is a result of a serious illness then the illness might be doing damage but the fever is actually fighting the illness and by suppressing it you allow the illness to take an upper hand. A correctly functioning hypothalamus will not allow the body to reach dangerous temperatures when a normal illness is present.

Another concern is the incidence of febrile convulsions. Febrile convulsions are scary and can leave parents feeling scared and helpless as their children seize. Febrile convulsions occur in children who are predisposed to them and are not specifically a result of a high temperature but instead occur when there is a rapid increase or decrease in temperature. Again febrile convulsions are really unpleasant to witness but in themselves do no harm, the usually only affect 3-4% of the population and cease occurring at approximately 3yrs of age.

Personally I only offer paracetamol or ibuprofen if the fever is interfering with sleep as sleep is an important part of healing. Using a febrifuge may make your children feel more comfortable but it slows and suppresses the immune system. I would only consider emergency treatment if my boys had been exposed to poison or showed no signs of improving after 3 days of relentless temperatures - also young babies 0-3 weeks old should be checked out if they present with a fever.

The most important thing is to watch your baby. If they are limp, floppy and appear seriously ill then get them checked out. If they are chipper or alert or even just tired and cuddly then they are probably fine.

So how do we treat a fever if we don’t use febrifuges? The key is to keep your child hydrated, allow plenty of skin to skin time and warm baths can help. NOT cool baths or cold sponging as they can trick the hypothalamus into maintaining a higher fever. Remember the body WANTS to have a fever - it's the failsafe protective system. Unnaturally chilling your child will make them heat up faster afterwards as a response and can be really unpleasant. A cold bath is not a nice experience.

One of the most important things when managing a fever and illness is to manage hydration, especially if your child has had diarrhoea or vomiting. A poorly hydrated child will decline quickly and can become seriously ill. To monitor hydration you can perform a number of assessments very easily to measure how the fluids are going. The first is how your child is looking in themselves. A tired, listless child with rapid breathing, cold extremities, sunken eyes and a weak pulse is a warning sign that hydration is inadequate. A general lack of tears, mouth moisture and urine can indicate serious dehydration and you should get to a Doctor as soon as possible. With babies a sunken fontanelle is an indication of dehydration.

To test for hydration you can do the pinch test or the nail bed test. The pinch test assesses the skins turgor and is done by pinching the skin on the hand or arm and seeing how long the skin takes to return to its original position. It should spring back quickly but if it is slow to return taking up to 2 seconds then your child is moderately dehydrated. Longer than 2 seconds can mean a serious dehydration.


The nail bed test follows a similar principle but is simply pressing on the nail bed and measuring how long the capillary refill takes. This is when you press the fingernail until it is white and then watch as the pinkness returns, again, anything longer than 2 seconds is serious and may need immediate treatment.

You can keep your child hydrated by monitoring their intake, offering small sips of liquid and often and nursing on demand. Dr Momma has a great guide to nursing through an attack of the vomits here, as well as a recipe for oral hydration fluid.

Fever management is a really good skill to have with young kids, and while it has its place, reaching for the paracetamol or ibuprofen should not be your first port of call.