Fever Support

With the recent WHO stance against ibuprofen use due to the propellent effect seen in COVID-19 symptoms, there has been a lot of controversy surrounding how to go about treating fevers in the current population. Fevers are also a hot topic of concern as, in addition to the COVID-19 pandemic, this is also a time of colds and the end of flu season, both of which all could contribute to an elevated body temperature. Let’s break down what a fever is and what the red flags are, why fevers are important, and how to support fevers naturally to support their immune stimulating effects.

Fevers are one of the top reasons’ parents seek out medical attention in doctors’ offices, urgent care centers, and emergency departments. Most cases of fever are of sort duration and caused by a self-limiting viral illness, however, some could indication of a serious bacterial infection that requires immediate medical care. This is meant to be a guide to help parents discern between scary fevers needing medical assistance and the low fevers you can easily treat at home- and how to treat them at home utilizing naturopathic and holistic therapies.

Previously parents were advised to treat fever based on body temperature alone, but it is now recommended to take both temperature and the child’s overall state into account. Parents and caregivers should be well versed in taking their child’s basic vitals, such as heart rate and respiratory rate, and know common red flags to look for while monitoring their kiddos fever.

As fevers are often the first sign of an illness it is best not to treat the fever immediately with fever suppressant medications, rather wait and see what symptoms arise next to determine the next course of treatment. It commonly takes 1-3 days for that next symptom to appear following the first sign of fever. Tylenol and other antipyretic/antifever medications lower the body’s innate healing ability and should be reserved for when the child is unable to sleep due to discomfort or a fever over 102.2F, except for the special cases specified below.

What are fevers and why are they important?

Fevers are over 4 million years old. Humans aren’t the only animals that initiate fevers to help support the immune process. All mammals, reptiles, birds, fish, and even insects have the evolutionally ability to mount a febrile response to a pathogen. Fevers function in one of two ways: first our white blood cell production and function are optimal at an elevated body temperature, and second, fevers inhibit the growth of certain bacteria and viruses. Thus, fevers can be viewed as a representation of the sufferer having a strong and vital immune system. As long as the person suffering the fever is healthy, most illnesses accompanied by fever are easily overcome.

Fevers are an abnormal rise in body temperature in which the body’s thermostat, found in the hypothalamus in the brain, resets itself to a higher level. This occurs most frequently in response to a bacterial or viral infection however they can also occur due to inflammation. Our bodies are smart and with recognition of invading microbes it sends white blood cells, called phagocytes, to the area to eat the invaders. When the white blood cells encounter and eat certain invaders, it triggers the release of chemicals from our white blood cells called cytokines, whose function is to promote fever. At the first sign of fever most parents panic and try to suppress it, but fevers are extremely beneficial- to a certain point.

Although the body temperature is increasing, people suffering fevers will typically feel cold and suffer from the chills as a result of the body’s blood vessels constricting. As the core body temperature rises, it eventually matches the new temperature set by the hypothalamic thermostat, and the chills disappear. Once the fever has dissipated and the “thermostat” is lowered back to the normal body temperature, roughly 98.6F, sweating and other means of cooling the body begin to bring the temperature back down.

Fever basics

The first signs of fever in kiddos is often irritability or grumpiness, and a strong desire to be close to the parents/caregiver. The face and cheeks become warm to the touch and possibly flushed. Appetite reduction is very common with fever, which is addressed below, as is the feeling of being either too hot or too cold. In babies and toddler, the onset can be very sudden, occurring over a few hours. Children are also a unique fever presentation as the degree of fever doesn’t reflect the severity of the disease process itself. Extreme body temperature elevations often occur without relation to severity of the infection. An infant may have a normal body temperature, but a severe infection compared to a toddler with a fever above 100F who has a minor respiratory infection.

It is also extremely common for fevers to be lowest early in the morning, progressively increase throughout the day to be at their highest in the evenings. Also, parents, be prepared for a high rebound fever once medication wears off, if you choose to give Advil or Ibuprofen to help lower the fever.

How do you diagnose a fever?

Fever is defined as a core body temperature greater than 100.4F, in children over 3 years of age. Anything over 105F requires immediate hospital referral, with tissue and bran damage occurring around 107F.

With the array of thermometer types available today, finding the one best suited for your child’s age is the goal. For any age group, a rectal temperate is the most accurate but least ideal to perform. Oral, electronic pacifier or tympanic, via ear, are accurate if done properly, with axillary/armpit temperature being the least accurate. A tympanic/ear thermometer is not effective on babies under 6 months of age. Due to convenience, an infrared temporal thermometer is ideal for children under 5 years old. However, with any child over five years of age, ear or temporal thermometer provide the most equivalent reading to rectal.

To convert to rectal temperature (>100.4F is fever) - oral temperature + 1 degree = rectal - Axillary (armpit) + 1.4 degrees = rectal

Whether medical intervention should be sought is based on 2 main factors: the child’s exact temperature and whether the child has other symptoms. Generally, a child over 3 months who has good muscle tone, is making eye contact, and able to smile will recover without treatment. For children over 5 years of age, take activity level and behavior into account. The illness is unlikely to be serious if the child: maintain social contact and activity, maintains their appetite, is alert and responding to communication and if they are happy and smiling.

Whenever a new fever arises make sure you undress your child and examine their skin for any new rashes, any abscesses, bug or animal bites, or other local signs of infection such as redness, swelling and tenderness or heat.

Call the doctor if:

- child refuses fluids or seems too ill to drink, - has persistent diarrhea or repeated vomiting - child has a specific complaint (earache or sore throat) - fever still present after 24 hours in a child under 2 years or after 72 hours in a child aged 2 years or older, - if child has recurrent fevers over 7 days, even if they only last a few hours each night

Seek immediate medical attention if: - a child under 3 months whose rectal temperature is over 100.4F - Child 3 months to 3 years with rectal temperature over 100.4F for 3+ days - A child over 3 months whose fever over 103F isn’t not responding to fever reducing treatments listed below - if fever is accompanied with: difficulty to wake, inconsolable, whimpering, cries with movement or touching, unable to swallow anything or drooling, breathing difficulties with no improvements, headache and stiff neck, rash or purple spots that look like bruises on the skin, blue lips, tongue or nails, infants soft spot on top of head bulges outward

Diet to starve a fever, MCT oil, electrolytes, fresh veggie- not fruit- juice

During a fever, it is recommended to keep food to a minimum. Most peoples’ appetites decrease while experiencing a fever, with it to return as the fever resolves. This natural phenomenon is due to our bodies trying to conserve the energy digestion requires and spend it on fighting the infection. Regular food consumption has been shown to interrupt the body’s ability to produce a fever and leads to longer periods of infection.

Hydration is the main concern with fevers as sweating causes a huge overall hydration loss. Focus should be places on diluted fruit juice ( ½ juice & ½ water to limit sugar intake), fresh vegetable juices, warm broths, miso broth, lemon & honey water and herbal teas. Adding MCT oil (derived from coconut oil) in beverages also is recommended as it provides the body with a usable fat, which is necessary as the stress from the fever decreased one’s ability to break down fat for energy. Giving sips of water, especially cool to bring down a fever, is encouraged but should be matched with an electrolyte heavy liquid as well.

When fighting off infections your body increases many metabolic processes, thus burning through resources at a faster rate. Great electrolyte options are Nuun electrolyte tablets, supplemental forms of electrolyte powder, and DIY electrolyte drinks. Try avoiding premade sports drinks, such as Gatorade, due to the high sugar content, artificial colors and flavoring. I also recommend staying away from coconut water as it’s loaded with carbohydrates, which is a food form and thus takes the body’s energy away from the immune system and towards the digestive system to break it down. We are electrical beings with over 40% of our bodies energy expenditure at rest being used solely to transport electrolytes into our cells, to reiterate how important electrolyte replenishment is. Low electrolyte levels were also found in kids suffering febrile seizures, showing the important of their actions.

My favorite DIY electrolyte drink

¼ cup fresh lemon juice, ¼ cup fresh lime juice, 2 cups cold water, 2 TBSP honey and 1/8 Himalayan pink salt (avoid sea salt as its loaded with plastics).

When appetite returns

As always, eating a diet of nutrient-dense foods, including grass-fed and pasture raised proteins, healthy fats and organic vegetables and fruits, will help your immune system fend off invaders and keep you healthy all season long.

I recommend emphasizing foods rich in B vitamins, vitamin C, zinc, magnesium, and Omega 3 fatty acids in the daily diet. The nutrients in these foods support your immune system and when deficient in them, your immune system is hindered, leaving you are more prone to infection. With kids, it’s always a fun challenge to have them to eat a rainbow a day to encourage a wide source of nutrients and expand their palate. Picky eaters might pose a challenge but if you have got the time, try making fun shapes or animals out of the foods and get kids involved in the cooking process to get them interested.

Supporting your gut microbiome is also important. Your microbiome is made up of trillions of microorganisms – both good and bad – found mainly in your gut. Roughly 80% of your immune system is in your gut, so it is important to feed the good bacteria that contribute to healthy immune responses. To increase your levels of good microbes, “toss” foods that are inflammatory and suppress immunity, including: gluten, dairy, corn, soy, sugar, and processed foods. Opting for foods that contain liver active cultures to help maintain good flora diversity in your gut. These foods are yogurt, sauerkraut, kimchi, kombucha, apple cider vinegar (not all, must contain “mother”- Bragg’s is a good option), and fermented soy in the form of miso.

General immune support recipe

Blend ½ cup olive oil, 3 large garlic cloves, 2 TBSB raw honey and ½ tsp cinnamon in a blender. ½ tsp every 2 hours while awake and willing!

Naturopathic treatments

First and foremost, run through the list of possible environmental factors such as removing clothing, or wearing natural fabrics to encourage sweating, and making sure there is clean air circulating in the room. Also, keep the child away from school until the temperature has been normal for at least 24 hours and the child is otherwise asymptomatic.

Once a fever breaks, that is a strong indication that the body has done an effective job in mounting an immune response and suppressing the invading infection. However, lowering the fever before it breaks may prolong the fever and the illness itself. If the child looks red, appears hot or sweaty, and has thrown their blankets off, then the temperature is already on its way down.

Mild fever 99-103 degrees F

The goal is to support or encourage the fever to do its work. The child will likely look cold and be shivering, as their fever is likely still rising. Give plenty of fluids and electrolytes to prevent dehydration. Drinking warm liquids that encourage sweating are beneficial during this time and consist of spiced teas made of elder flower, ginger, cayenne, or cinnamon as well as broth or garlic/onion soup. Lots of kiddos refuse to drink when feeling sick, so you can entice them with some homemade ice pops (recipe below). You can also help raise the body temperature by taking a hot foot bath with 2-3 thick blankets wrapped around you to raise your core body temperature, and then finish by pouring cold water over the feet to stimulate blood flow and lymphatic circulation pumping.

Fevers 103 degrees F and up

If the fever is not subsiding and staying around 103-104, heat dissipating techniques should be implemented to start bringing blood to the surface of the body for cooling. This can be done by taking a tepid bath or a short hot bath/sponging while putting a cold compress on the head/forehead and an ice pack wrapped in towel, over the heart. Make sure to keep the air fresh and cool, around 65 degrees, and take frequent sips of cool, not cold, water to promote sweating.

Herbal Support

There are two main types of herbs used during fevers. As previously stated above, fevers are our bodies way of mounting an immune response and encouraging this response is extremely beneficial to shortening the duration of the fever overall. Diaphoretics are herbal medicines that promote sweating during a fever, allowing the body to control the fever. These should be used during the heating phase of the fever when the child is cold, shivering, and has the chills. Important diaphoretics are peppermint, catnip, ginger, and elderberry. These are commonly available in tea form, with elderberry being a popular syrup form among parents due to its delicious sweet berry taste.

Antipyretics are used to reduce fevers, sharing the place with common over the counter medications such as Tylenol, Advil and Ibuprofen. It is important to remember the purpose behind fevers: an elevated temperature is the body’s natural way of stimulating immune function, elimination toxins, and eradicating infection. There are instances which call for fever supporting and fever reducing, as mentioned above. Many of the herbs listed exhibit multiple actions, immune stimulating effect and help reduce the fever. Lemon balm glycerite is one of my favorites as it is palatable and easily added to tea, juice, or popsicles to get kiddos to take it. Chamomile is also a great option as it aids in overall fever reduction while stimulating an immune response, it also is helpful in promoting rest, relaxation, and sleep. Some other examples of herbal antipyretics are Andrographis, a potent anti-viral, and yarrow, which grows wildly here in the Midwest.

Essential oils and fever

Essential oils have become a common household staple in recent years, and for good reasons. The powerful energetic effects these oils carry prove beneficial when dealing with fevers in two ways. Oils such as lavender and tea tree work to promote sweating, thus encouraging resolution of a fever, or for it to “break”.

In comparison there are oils used to cool the body and lower the temperature such as bergamot, peppermint, or eucalyptus. Use 5 drops of oil in a tepid sponge or foot bath or add to a carrier/massage oil to rub on the feet, back, shoulders, and neck. Remember to use a carrier oil, and dilute it more with the carrier oil the younger the child is.

Over the counter medications

Acetaminophen/Tylenol is only indicated in children over 2 months and for a fever over 102 degrees F. Dosage is weight dependent and can be given every 4-6 hours, reducing fever 1-2 degrees within 2 hours.

Ibuprofen (Motrin/ Advil) may be given every 6-8 hours however should not be used in infants under 6 months of age. See packaging for weight dependent dose. It is not recommended to alternate with acetaminophen and Ibuprofen, rather stick to one type unless results aren’t achieved. Aspirin should never be taken for fever in children under 16 years old due to its association with Reye’s syndrome.

2 Recipes for Immune Boosting Popsicles

In a blender or food processor, put in 1 combined bag of frozen organic strawberries, blueberries and raspberries, 2 bananas, 1 cup of orange juice, 1 tbsp of infant/toddler probiotic powder (Klaire Labs is my favorite), and blend until creamy. After pouring into popsicle mold, add 1 tsp lemon balm, echinacea, or elderberry glycerite/syrup to each individual popsicle then freeze for at least 4 hours.

In a blender or food processor, add 2 oranges, 1 banana, ½ c. coconut water, ¼ c. frozen pineapple, ¼ c. frozen mango, 2 TBSB honey, ¼ c. ice. Blend for 1-2 minutes then pour into molds once again adding 1 tsp lemon balm, echinacea, or elderberry glycerite/syrup to each individual popsicle then freeze for at least 4 hours

References

1. Young, P.J., Prescott, H.C. When less is more in the active management of elevated body temperature of ICU patients. Intensive Care Med 45, 1275–1278 (2019). https://doi.org/10.1007/s00134-019-05668-0

2. Fischetti, Mark. Fact or Fiction? Feed a cold and Starve a fever. Scientific American. (2014)

3. Farhan, H.A., Hashim, A.H, Handhil, A.A. The impact of electrolytes in pathogenesis of simple febrile convulsions. Medical Journal of Babylon 15, 12-15 (2018).

4. An Encyclopedia of Natural Healing for Children and Infants. Mary Bove ND, 2001

5. Naturopathic Pediatric Essentials. Susan M Roberts ND, 2003

6. Berkowitz’s Pediatrics: A Primary Care Approach. Carol Berkowitz MD, 2012

7. Clinical Naturopathic Medicine. Leah Hechtman, 2016.