Treating Fever Without Medicine

As a pediatrician, I get paged on most nights by parents worried about their children’s fever. I patiently wait for the parents to complete their presentation and proceed to ask a battery of my standard questions:

  1. Is your child having difficulty breathing?
  2. Did your child appear listless today or was she active, playful, and out of bed?
  3. Does your child have diarrhea?
  4. Are you spending time hydrating your child (or rather spending time worrying)?
  5. How did you measure the temperature (oral, tympanic, axillary, or rectal approaches)?
  6. I usually remember if the child in question just received an immunization at my office, but if the caller is new, I inquire whether the child was recently immunized.

Except for the rare occasions such as a very young infant that is reported to be lethargic and febrile, I usually suggest that the parents should hydrate the child as best they can, and give Tylenol or Motrin for pain, rather than treat the fever. Most children could be checked in the morning if they are still showing signs of an illness.

Fever is Our Friend

Scientific studies show that children heal more quickly if their fever is not treated with medications. The fever is important in aiding our immune system in the fight against viral and bacterial illnesses. Fevers generally do not need treatment with fever-reducing medication, unless your child is uncomfortable or has a history of febrile convulsions.

Even higher temperatures are not in themselves dangerous or significant unless your child has a concomitant, overwhelming pneumonia, meningitis, or a history of seizures or chronic disease. Even if your child has a history of a fever-related convulsion and you treat the fever with medication, he may still have a febrile seizure. It is more important to watch how your child is behaving.

If your child is playful, with a good appetite and exhibits no signs of respiratory distress, he probably does not need any treatment. You should also talk with your pediatrician about when to treat your child’s fever and have clear guidelines.

If your child has a fever above 105, or if you’re febrile infant is younger than 8 weeks old, call your pediatrician immediately. These factors may signal a dangerous, invasive illness.

Useful Fever Treatment Tips Published by the American Academy of Pediatrics:

  1. Keep your child’s room and your home comfortably cool, and dress him lightly.
  2. Encourage him to drink extra fluid or other liquids (water, diluted fruit juices, commercially prepared oral electrolyte solutions, gelatin, Popsicles, etc.).
  3. If the room is warm or stuffy, place a fan nearby to keep cool air moving.
  4. Your child does not have to stay in his room or in bed when he has a fever. He can be up and about the house, but should not run around and overexert him/herself.
  5. If the fever is a symptom of a highly contagious disease (e.g., chickenpox or the flu), keep your child away from other children, elderly people, or people who may not be able to fight infection well, such as those with cancer.

Sponging

In most cases, using oral acetaminophen (Tylenol) or ibuprofen (Motrin) is the most convenient way to make your feverish child more comfortable.

However, sometimes you may want to combine this with tepid sponging, or just use sponging alone.

Sponging is preferred over acetaminophen or ibuprofen if:

*Your child is known to be allergic to, or is unable to tolerate, antipyretic (anti-fever) drugs (a rare case).

It is advisable to combine sponging with acetaminophen or ibuprofen if:

*Fever is making your child extremely uncomfortable.

*He is vomiting and may not be able to keep the medication in his stomach.

To sponge your child, place him/her in a regular bath (tub or baby bath), but put only 1 to 2 inches of tepid water (85–90 degrees Fahrenheit, or 29.4–32.2 degrees Celsius) in the basin. If you do not have a bath thermometer, test the water with the back of your hand or wrist. It should feel just slightly warm. Do not use cold water, since that will be uncomfortable and may cause shivering, which can raise his temperature and make the fever worse. If your child starts to shiver, then the water is too cold; take him out of the bath in this case.

Seat your child in the water—it is more comfortable than lying down. Then, using a clean washcloth or sponge, spread a film of water over his trunk, arms, and legs. The water will evaporate and cool the body. Keep the room at about 75 degrees Fahrenheit (23.9 degrees Celsius), and continue sponging him until his temperature has reached an acceptable level. Never put rubbing alcohol in the water; it can be absorbed into the skin or inhaled, which can cause serious problems, such as coma.

Usually, sponging will bring down the fever by one to two degrees in 30-45 minutes. However, if your child is resisting actively, stop and let him just sit and play in the water. If being in the tub makes him more upset and uncomfortable, it is best to take him out even if his fever is unchanged.

Dr. David Simai is a board certified pediatrician in his private practice in Cedarhust, NY. He is also an attending physician at LIJ-Cohen Children’s Hospital, North Shore Manhasset University Hospital and South Nassau Community Hospital. drsimaipediatrics@gmail.com


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