Fevers are the most common reason for emergency room visits by children. The majority of parents know that fevers in children can cause seizures, and those are all kinds of scary. Learning what to do if you can’t get to that pediatrician can therefore be important to preppers who’ll have kids around. (Fevers in adults are not handled much differently by the way; it’s only that they trigger less fear and fewer emergency visits.) .
I am not a physician, so this isn’t medical advice; it’s a summary of some things I learned from reading medical research and other sources (the most important of which are cited at the bottom of the piece). As always, make your own decisions.
What is a fever? What isn’t a fever?
On the practical level, a body temperature over 100 F (37.8 C) is classified as a fever. In a child, the preferred method to get that temperature is using an infrared ear canal thermometer. Since those require batteries and preppers can’t count on batteries, the backup plan is to use a manual thermometer, shake it down until it reads 96 F or lower, tuck it in the child’s armpit with the arm holding it in place, and leave it be for 2 min before reading it. Add about 1 F to an armpit temp to get real core body temp. Oral and rectal methods are less well thought of, but of the two rectal is preferred. (1)
There’s an unspoken “except” in this definition of fever, though. It’s only a fever if the temperature is high because the person’s brain has reset its internal thermostat to higher than the usual 98.6 F (37 C) and is intentionally keeping the body warmer. The most common reason the brain resets its thermostat is because the immune system told it to. If the person is trying to maintain normal body temperature but just can’t (usually because the environment is too hot), that’s hyperthermia but not fever. The reason for the high body temperature ends up being important.
Fever is when you’re hot because your immune system has told your brain to keep it hot in there. It’s not simple overheating and shouldn’t be treated the same.
Another thing fever is not: Fever is not a disease. It’s a sign that something is abnormal, absolutely; but it is only an outcome of whatever’s really going on; not the thing itself. That too is an important distinction.
Fever, of itself, is surprisingly unimportant
The reason the fever exists may well need treating. The other symptoms that often accompany fever often should be treated (mostly to improve the comfort of the patient). Here’s what surprised me, though: Getting the body temperature back down to normal is not of particular value in many cases, and most of the sources I read argued it shouldn’t even be attempted. (1, 2, 3, 4, 5) Why on earth not?
The fever doesn’t need to be eliminated, and often doesn’t even need treating of itself, because it’s not doing harm and might be doing good. The ‘doing good’ part is not certain, but evidence points that way: Immune cells work better at the higher temperatures, many disease-causing bacteria don’t reproduce as well at the same temperature. People treated to bring down fever took slightly longer to recover from their colds. (2) Not one of my sources, however, really thought the fever was harmful in average cases.
Hyperthermia without fever is a form of heat injury (there’s a post about it here). It’s a life risk and absolutely one should work to get that body temperature down, because it can get so high it causes brain damage and death. A real fever though is the brain’s idea, and the brain won’t set its thermostat high enough to cook itself. Fever is self limiting.
What about the seizures?
Approximately 4% of children under the age of five experience a febrile seizure (they’re rare in older children and adults). They normally occur between body temperatures of 104 F (40 C) and 107.6 F (42 C).(4) Two more important things about these seizures:
1) They normally do no harm, despite being very scary to observe. I read about a dozen research journal articles on this point today; of those, just one mentioned a possibility of brain injury from the seizures, while at least four denied such injury.
2) The determining factor of who will have a seizure is the child’s genetic makeup. The occurrence of seizures didn’t go up as temperature did; susceptible kids would have them during any high fevers while the vast majority of kids would not no matter how high the fever ran (they are self limiting after all). (2)
When should fevers be treated?
There are times when the researchers said the fever should be treated: (1,2)
- When there is excessive lethargy or delerium
- When there are other reasons why the person’s metabolic rate is really high or energy conversion is limited. Fevers use a lot of energy, and if the person can’t spare that energy it may be important to get the temperature down. Examples of such situations include people with serious impairments in their breathing or heart function, or already undernourished persons.
- When the person’s getting dehydrated. One loses a lot of water with a fever, through respiration and sweating. If they aren’t drinking a lot too, they’ll get dehydrated, which is a health risk.
- Some sources suggest fevers should be treated in the very young infants, since the data on which ‘the fever does no harm’ didn’t come from children that young, so we don’t really know.
Treating to keep the patient from feeling like poop is a much better idea than treating just to get body temperature down.
Often, one isn’t really treating the fever, but is treating the other symptoms that are caused by the same immune reactions that caused the fever. Common over-the-counter drugs that are marketed as antipyretics (fever reducers) probably make people feel better mostly because they’re reducing the headaches and body aches that the sick person has too. The way you treat is the same, but the goal is different: Any drop in body temperature is coincidental, you’re really aiming to make them feel better. It’s important not to overdose the person trying to get the temperature down to normal.
How to treat a fever
There are two main approaches to treating fever that are recommended (each recommended by a different sort of people, to be sure). There are some herbal remedies that have proven effective, particularly willow bark. I’m currently researching a post on those that I expect to have up soon, so for now I’ll just float that option and go on.
The other is the use of standard, over-the-counter medications. These are still good prepper options as they are easily available and store well (particularly in cool, dry, dark places like the back of a refrigerator). The two main classes of drugs used are acetaminophen and NSAIDS (non-steroidal anti-inflammatory drugs, including ibuprofen, aspirin, and naproxen). Of those two classes, acetaminophen was the every source’s first choice.
Acetaminophen can be great, but more is not better. Overdoses of acetaminophen cause about 450 deaths a year in the U.S. (about 100 of those being intentional suicides). (2) . Recommended dosing is 15 mg drug/kg of body weight of the child (6.8 g drug/lb), with no dose to exceed 1 g. This can be given every 4 hrs, but don’t exceed 90 mg/kg per day (41 mg/lb/day), or 4 g per day, whichever is lower. (1)
Ibupropfen isn’t a bad choice, it’s just got a little higher (but still small) risk of bad side effects; particularly letting skin infections pop up with chicken pox. If you use it, the recommended dose (1) is 10 mg/kg (4.5 mg/lb) doses every 6 hr to a max of 40 mg/kg/day (18 mg/lb/day).
How not to treat fevers
There are some things that are commonly tried that the researchers wanted to discourage. On the drug front, they advised against giving aspirin or aspirin-like compounds to children (over 2 yrs old) if better choices were available. Aspirin in children raises the risk of Reye’s syndrome, which causes swelling in the liver and brain. Reye’s is always rare, but it’s less rare after children are given aspirin, particularly for chicken pox or flu-like symptoms.
They also discouraged the common practice, among pediatricians as well as parents, of alternating doses of acetaminophen with doses of ibuprofen. The reasoning makes sense — using different drug pathways would seem to make metabolizing the drugs easier — but the studies the authors (1,2) looked at could find no evidence that it did any good, and they liked acetaminophen better as described above.
Overdosing, particularly just to lower body temperature, was very strongly discouraged because of toxicity.
On the non-drug front, sponging to cool the sick person is a very old practice. It’s not recommended, though (1,2,4,5). Remember that in fever, the brain is working to keep the body temperature at the higher level. Sponging does tend to cool the body, but then the body’s own systems kick in, keeping the temp almost as high as before but making the patient feel miserably cold. Sponging, unlike the drugs, does nothing to address the immune signals that are really causing the person to feel bad. If the problem is hyperthermia without fever, as in heat stroke, sponging can be a Great idea.
In summary
Well, that was a lot of research, so here’s the bullet points:
- The temperature itself is not the problem, so don’t bother struggling to lower it.
- Seizure isn’t an emergency, even though it looks like one.
- Treat there’s a need to manage related symptoms, such as body ache and malaise (that’s medico-speak for “I just feel cruddy”) or if the person doesn’t have the energy to run the fever.
- Push fluids; dehydration is likely otherwise.
- Acetaminophen is the best treatment choice. Other valued contenders include some herbal remedies and NSAID drugs like ibuprofen.
- Don’t overdose on the drugs or bother with sponge baths.
(1) Green, RJ and Penz, A. 2014. Fever in children: how to minimise risk and provide appropriate therapy. South African Family Medicine, 56(4):212-215.
(2) El-Radhi, A. S. M. (2012). Fever management: Evidence vs current practice. World Journal of Clinical Pediatrics, 1(4), 29–33. http://doi.org/10.5409/wjcp.v1.i4.29
(3) Adam, D. & Stankov, G. Eur J Pediatr (1994) 153: 394. https://doi.org/10.1007/BF01983400
(4) Torpy JM, Lynm C, Glass RM. Fever in Infants. JAMA. 2004;291(10):1284. doi:10.1001/jama.291.10.1284
(5) Purssell E. Physical treatment of fever. Archives of Disease in Childhood 2000;82:238-239.
