Fever is a Friend

Maureen MinchinChild Health, Infant Health

Paying attention to the baby requires constant (though not uninterrrupted) adult presence.

Two really important signals all caregivers need to notice in all children, especially young ones, are pain and fever. Both are indiscriminate responses to a wide range of problems that activate the immune system, among them allergy. And let it be said upfront, both pain and fever are part of the solution, and only rarely problems that require instant or total suppression.

Hot and bothered: the fever response in allergic children

Allergic children will suddenly develop high temperatures, sometimes with no other symptoms, sometimes accompanying an obvious reaction. To feel your baby hot and flushed, especially for no apparent reason – no rash, no cough, no sniffle – can be very distressing for parents. It is a cause for concern, but not alarm. Some allergic infants and toddlers wake up at night drenched in sweat, and parents think they have to adjust bedclothes, then find the baby waking because too cool, seeking warmth. (Night is the time of greatest histamine release, and thus of immune response.) Temperature fluctuations, bed-wetting, complaints of headaches and joint pains (once they can talk) are all more common in children with food allergies,1972 and Big Pharma is ready with remedies for symptoms, while obscuring causes.

Many parents are victims of what has been described as fever phobia.1973 In the Western world, parents have been bombarded with drug company advertisements telling them to use drugs to relieve ‘nasty pain and fever’, and many use those drugs quite inappropriately.

In my view, those symptoms are better described as lifesaving pain and fever, protective pain and fever. They are body signals that should not be suppressed arbitrarily or unnecessarily for up to eight hours. To do so is to cripple the immune response.

The fact that fever causes mother or child to feel awful, and so to rest, frees up bodily resources to deal with the immune challenge. That might be milk leaking into surrounding maternal breast tissue, or antigens causing mast cell breakdown and histamine release, or a virus, bacteria or parasites attempting to thrive in a new environment. We need to respect our body’s signals, not reach for drugs to suppress those signals. A body fighting off disease with a normal or lower temperature is handicapped. The problem may get worse without a temperature rise (fever). Suppressing fever may make physical exertion possible – at a time when the body really needs to rest. Rest allows the body to use its resources for the primary task of defence, using protein to make antibodies, for example.

Fever means something very important: that the immune system has been activated and is getting on with its job of restoring bodily order and balance. Inflammation is a good thing, an important defence mechanism. Fever allows immune cells faster passage to the area of the body where a battle is to be fought, as it does when a mother develops a fever with mastitis. It also makes life harder for any invading bugs, which can be quite sensitive to temperature changes. So we do not want to suppress all fever, though we want to keep it within reasonable bounds, as too high a temperature can sometimes trigger convulsions and may even cause brain damage. Nor do we want to wait twenty to thirty minutes for a pill to take effect and bring excessive temperatures down. What helps relieve unpleasant fever symptoms in infancy immediately?

Most fevers drop and lethargy disappears when we

  • unwrap and sponge the baby,
  • put the naked toddler to play in a tepid bath
  • provide cool drinks of water or very dilute natural juices

Monitor the fever, and write down the temperatures. There may be no need for any liver affecting, metabolism-altering medication if the temperature stabilises or drops. (If it continues to rise, or the child is sleepy or lethargic and does not respond, call for medical advice.) The fever may disappear as suddenly as it came, and the quiet or grizzling baby become active again, if a little clingy still, as their body recovers. Keep baby cool (but not shivering!), well-hydrated, and comforted, reducing all additional stress, and allow the clever body to rebalance itself.

When comforting includes body contact via a sling, don’t overdress the baby: indoors, a short-sleeved T-shirt or singlet and nappy/diaper is the most babies need if feverish and in contact with an adult body. A warm core allows good circulation. Bare arms, legs and head can shed heat, and can be sponged with tepid water as needed. This and sweat both allow evaporative cooling.

Synthetic fabrics lock in heat and sweat, and so hinder temperature regulation. Fabrics are important for temperature control in children. Notice how cotton breathes, but can get cold when damp, while fine wool or silk/cotton mixes breathe, and even when damp don’t feel cold or clammy, but stay skin temperature. This is why grandmas knitted soft woollen singlets and used red flannel pilchers for babies, for those readers young enough not to remember such things! Babies that sweat in cotton will wake as they cool down; wool keeping the body’s core warm helps with uninterrupted sleep. Babies do like to be with a source of warmth at night, even if only a foot or hand is in touch, to help regulate their temperature.

Of course there can be times when conservative and local treatments don’t reduce fever enough, and so systemic medication can be justified. The World Health Organization (WHO) recommends that fever in children be treated with paracetamol (acetaminophen) only if their temperature is higher than 38.5C (101.3F). But medication doesn’t start to take effect until after about ten to fifteen minutes, which may be too long to prevent seizures/fits in the baby. Questions are being raised about paracetamol, now known to result in gastrointestinal blood loss. So even with a high temperature, the simple measures like giving liquids and sponging with, or immersion in, tepid water should always be tried immediately, while waiting for medication to decrease the inflammatory response.

Fever can diminish rapidly when antibiotics are given. This is not because antibiotics have instantly killed all microbes. Antibiotics, like all drugs, can have a wide variety of effects on the body. As well as kill sensitive micro-organisms, some of them useful ones, they can help the body fight infection in other ways. Some antibiotics can initially enhance the normal process of white blood cells mopping up anything that oughtn’t to be where it is (that’s called phagocytic clearance in medical parlance.). But this stimulus to the natural immune system is temporary, and once the antibiotic is removed, phagocytic clearance is then less effective than it originally was. So symptoms may reoccur if the original problem that caused the fever has not been addressed by the time the antibiotic course ends.

Antibiotics may kill the pathogens responsible for the problem. But even if they don’t, antibiotics can sometimes buy time to identify and fix the underlying problem. That problem might not even be bacterial infection, but might still improve, because of the effect of certain antibiotics on white blood cell clearance.

On the other hand, if you can control the problem, not with systemic antibiotics, but with less drastic local means, do. You are decreasing the risk of developing antibiotic resistance, as well as decreasing the risk of fungal overgrowth and infection, and not messing with the micro biome your breastmilk has created. Antibiotics are wonderful, and life-saving, and sometimes, but not always, needed to reduce fever. As the problem of multiple antibiotic resistance grows, it is likely that we will come to see greater value in the body’s fever response, which makes life very difficult for temperature sensitive pathogens. Readers of Victorian literature will recall accounts of seriously ill heroes and careful nursing by devoted females, tepid sponging and feeding sips of fluids through long nights at the bedside, until with the dawn the fever breaks and the patient stirs back to life, weak but on the way back to health. Many died, the old and very young especially, from infectious diseases. But attentive nursing saved many very sick people too. And there were fever treatments in the early twentieth century that may have cured some cancers: the idea has been explored again recently. Totally suppressing the mechanism by which the body retards pathogenic growth and mobilises its defences to the invasion sites makes no sense at all to me. It may even be that suppression advantages cancer cells.

When fever strikes, most people think of infection with pathogens. In the allergic child there may be absolutely no infectious invasion, simply a rapid or more extreme response to an antigen, by an effective immune response, which needs to rebalance. Such temperature rises usually stabilise at tolerable levels then disappear as swiftly as they came, leaving the child a little grumpy and in need of nothing more than TLC and water. And the parents worried about what it all means, and assuming the cause was ‘a virus’, that catch-all diagnosis which usually means only that no obvious pathogen has been detected.

I started teaching this many years ago now, swimming vainly against the tide of marketing that engulfs parents. So it was with considerable interest that I read a very recent article indicating that needless chemical suppression of fever may be causing many thousands of deaths and illnesses worldwide. It causes deaths both by prolonging the illness in infected persons, and by providing symptomatic relief, which encourages infected persons to return to social settings such as the workplace, rather than staying at home to rest. ‘Soldiering on’ can mean both suffering the disease longer, and spreading it wider: just what any incipient pandemic needs humans to do, so that it can spread and become a global threat. So don’t go out, leave the pills in the cupboard, and let that ‘healing heat’ do its work, while monitoring to ensure that dehydration and convulsions are not a threat, and that food intake is helpful.

Don’t spread the bug: catch any sneezes in tissues or soft toilet paper, and wash your hands often with soap and water. (And use your common sense!)