One-third of all pediatric outpatient visits in the United States is for compliant of #fever. Providers throughout primary care, as well as those in convenience care or urgent care clinics, are often encouraging the rotation of #acetaminophen or NSAIDs for fever, but fever is not in itself an illness. In fact, it is a normal and healthy central nervous system response to threats and an attempt to restore our health and wellness. Fear of fever though, contributes to the perceived need for antibiotics and frequent visits to the convenience care or urgent care center. Many believe that fever equals an infection and an infection equals antibiotics.
Fever is a defense mechanism and plays a vital role in our body's effort to protect us. Can you imagine your immune system, donning its superhero cape, calling into command center to alarm headquarters of a serious threat to your physical body; orders are received to initiate the cascade of troops skilled to fight the invasion, including elevating the body's temperature in effort to smoke out or bake the invader, but just as your immune system turns up the heat, you decide, "Nah, let me sabotage myself by turning down this life-saving heat so my invaders can thrive in an environment much more friendly for them." Your immune system though, wakes from its stupor a few hours later and again, is back in action turning up the heat in effort to neutralize enemy threat; yet once again, you are wiping those efforts out with additional acetaminophen.
The temperature of the human body is so misunderstood that most believe there is a specific degree deemed the "normal body temperature," when in fact, the core body temperature follows a circadian rhythm and can be affected by many factors such as age, exercise, hormones and our menstrual cycle. Each of us have our own natural baseline as well, with many reporting they settle much lower than the standard 98.6 degrees Fahrenheit.
Fever can be anxiety-provoking, not just for parents but also healthcare professionals, and like most all aspects of health and wellness, there is a happy balance with extremes on either side. However, that "goldilocks spot" in the middle is more of a range or spectrum than an actual degree so specific it is read to the exact decimal point. The fear of the fever is largely unjustified. Medical professionals can contribute to this phobia as well, especially when we are offering what can be mixed messages in our efforts to address elevated temperatures.
Most Fevers are Self-Limiting & Non-Concerning
In otherwise healthy children, most fevers will resolve without any intentional effort of your own. They are also, most often, benign. Fevers typically resolve without our ever knowing why they presented in the first place, largely because the overwhelming majority result because of a viral infection. These simply run their course and when our bodies are supported in their effort to defend us, they really do a miraculous job.
There are times though, this fever is communicating a much more significant issue. We see this in little ones younger than eight weeks, in those who are immune compromised, and when the temperature reaches 105 and higher. These scenarios call for increased action and consultation with your child's provider. We do want to be observant and mindful, responding to our body's effort to communicate its needs, but we also want to respect our body's innate effort to heal so we aren't working against our own efforts.
Interestingly, my own son, who has #autism, has a unique response to his own body temperature. He is my son who doesn't get dizzy, no matter the challenge, has very little pain perception, and he is largely unaware of his own body temperature. He will wear a hooded sweatshirt through the entire summer, playing outside in the sun without complaint. He will stand in the sun, in line at the pool, awaiting his turn on the surf-board, unaware of his increasing temperature so that he passes out with heat stroke. He will also walk to the bus stop, in the coldest part of the winter, in a thin t-shirt without discomfort because he prefers that to having to walk to his locker to hang his coat.
When my son is ill, it isn't abnormal at all for his temperatures to reach 105, but he has normal skin color, he responds normally, and is alert when awake. He has normal respirations and is well hydrated. In spite of my own medical training, there are times this occurs and I still take him in for evaluation, because I don't want to risk missing anything more serious. They have thus far corroborated my assessment, sending him right back home and assuring me that his virus will self-resolve in a few days. He is atypical, far to one side of the spectrum, but I share to highlight the point that the fever is less like a cliff one falls off after a specific degree on the thermometer is reached, and more a spectrum we swing from side to side, with that normal and necessary range unique to the individual and the circumstance. Seizures are less related to high fevers and more so to elevated fevers brought down too quickly.
Kiss My Forehead
When my oldest littles were young, it seems the thermometer was always lost with the scissors. I learned to kiss their foreheads to identify presence of fever. Studies have demonstrated this subjective fever assessment to be a pretty reliable indicator of fever (Graneto, 2011) and I think doing so can often help us from extending too much attention to this single variable, and instead, learn to discern the child.
A thriving child is typically doing quite well. Hydration is key. When we are especially warm, we dry out just like the oven. Our bodies need hydration to assist in moving out any toxins and pathogens. Generally speaking, several discomforts is more representative of a virus and when there is essentially a single prominent symptom, then this is more indicative of a bacterial infection. Viruses self-resolve. We simply need to support and continue to observe, but bacterial infections have a greater tendency to move into more concerning pathology.
Consider the #flu for example. We often have a headache, sinus congestion, runny nose and probably a postnasal drip. We might have an intermittent fever, night sweats, achy muscles and joints, and sometimes stomach upset. Cough tends to show up day four or five, as the runny nose starts to resolve, but it can then stick around for a few more weeks. We may feel like we've been hit by a truck and want to stay in bed and sleep it off, but there isn't typically one symptom that is so much worse than all of them together. This resolves itself without any treatment but many, many folk head to the urgent care or convenience care center for diagnosis and treatment, often adamant they require antibiotics. Unfortunately, 60 to 90% of practitioners concede and offer antibiotics, which often validates the client's perception they were necessary because as the antibiotics are initiated, the virus was already resolving.
Keep in mind though, we do have to encourage and nurture ourselves. We want our sinuses to drain and we want to cough up the phlegm from our throats and lungs. Not doing so means this mucous becomes stagnant which is great breeding ground for bacteria. This takes several days though, nearly two weeks in fact, so reason why practitioners are encouraged not to prescribe antibiotics before that time even when such drainage is all sorts of pretty green, yellow, even a bit bloody. Giving antibiotics too early wipes out the natural, healthy ecosystem, leaving the more dangerous superbugs behind with opportunity to more quickly multiply and ultimately become a much more nasty infection that now requires a more potent treatment.
Observe your little one for signs that offer reassurance. Are they social? Do they want to play when they are awake? When they are younger, is the quality of their cry vibrant and typical, or are have they become more high-pitched, weak, more like a bark, or even causing them to vomit when they cough? Do they wheeze and have trouble catching their breath? The latter are all reasons to have a clinician evaluate the underlying cause, but a fever with normal behavior, or behavior consistent with not feeling so fabulous, with reassurance of vigor is a healthy child fighting invaders like a superhero.
Breastfeeding is especially challenging as most mommas know all-too-well. There is quite a bit for your little one to coordinate, most especially their breathing and suction efforts, so if they maintain a vigorous suck, emptying your breast as normal, on their typical routine, then this is quite reassuring. When not feeling well, they may want to be at the breast more often and for longer periods because it is here they feel safe and secure, but when feeding, they should be effective and have a well coordinated suck and breathe pattern that empties your breast. If they are just nuzzling, not engaging in active nursings, and have become a quiet, calm little one then this isn't as reassuring. Connect with your trusted provider.
We want our little ones to be somewhat fussy when they feel bad and have the resilience to communicate their discomfort. An ear infection for example, almost always viral and self-resolving, will cause them discomfort when they create that negative pressure required for nursing. They may fuss and squirm but most always there is little additional indication they are sick at all. Sometimes mothers interpret this as a desire to no longer nurse, because they are vibrant in every other way and will eat foods and drink without complaint otherwise. A week or two later, the virus resolves and baby wants to nurse again but mom's milk has plummeted. That trusting relationship with your provider can help you discern the difference, but know that "nursing strikes" in an otherwise thriving child may be a viral ear infection that will self-resolve.
Rashes are common in little ones with infection as well, whether viral or bacterial. Discerning the cause isn't often necessary. Practitioners, as well as parents, are typically so eager to identify a diagnosis that they seek a plethora of rapid tests to confirm a number of viruses but conventional wisdom tells us that whether flu, #COVID, rhinovirus, the common cold, or any of the additional hundreds of viruses, each are contagious and each are essentially treated the same. No matter the virus, each require nurturing and mindful observation. Our focus is to support symptoms and allow the body to do its job in protecting and healing itself. When a child presents much more toxic though, the clinician may utilize testing to help zero-in on whether a much more concerning pathology is cause for the fever, one that may require more urgent or emergent evaluation and management.
Be discerning for those more concerning findings, and certainly seek medical support as appropriate, but when all else is reassuring, let the body do its work. We offer an Earth Medicine course for those who might desire a deeper dive into botanicals for treating common illnesses, including horehound which has historically been used to offer relief for those with a sore throat or chronic cough. A warm infusion of horehound, a diaphoretic, can induce sweating so for some, this helps break a fever. Elderberries are a popular remedy among healers, with studies demonstrating effects consistent with antivirals. Feverfew has also been recommended by herbalists for reducing childhood fevers, but again, this is not just because it is elevated, but because maybe they are especially uncomfortable with the elevated temperature or maybe the heat is dehydrating them more than they can compensate. No need to wake your little one to dose them with an antipyretic or fever relieving agent, and children should not be given combination cough and cold preparations as this can be overly sedating. My role as a primary care practitioner is to help educate my clients so they can discern when it is best to support their fever, and the fevers in their little ones, and when we need to intervene. Of course, being available as a trusting resource is critical as well, so we avoid over reacting, and certainly not under reacting.