Fever per se is self-limiting and rarely serious provided that the cause is known and fluid loss is replaced. With fever, unlike hyperthermia, body temperature is well regulated by a hypothalamic set-point that balances heat production and heat loss so effectively that the temperature does not climb up relentlessly and does not exceed an upper limit of 42 °C.
Within this upper range, 40 °C to 42 °C, there is no evidence that the fever is injurious to tissue. About 20 percent of children seen in the emergency room have temperatures over 40 °C but they usually have a full recovery. If there is morbidity or mortality, it is due to the underlying disease.
The associated fever may well be protective. Fever exerts an overall adverse effect on the growth of bacteria and on replication of viruses. It also enhances immunological processes.
The mobility, phagocytosis and killing of bacteria by leukocytes are significantly greater at temperatures above 40 °C. Elevated temperatures of 38 °C and 39 °C have a direct positive effect on lymphocyte transformation. (2)
Why we should not interfere with the beneficial symptoms
Unfortunately the allopathic approach underestimates the wisdom of our immune system, instead of embracing the healing process drugs are used to suppress our immune response. The SYMPTOMS of illness are the body's normal physiological response to illness; they are the CURE. Embrace this brilliance as these defences facilitate the healing process and accelerate recovery. To maintain a healthy functioning system we need to ensure that we support it both nutritionally and emotionally. By providing the building blocks that are required for optimal balance we encourage a healthy terrain which allows for optimal clearance of invading pathogens. We have a responsibility to ourselves and our loved ones to nurture this gift and not suppress the innate defences with pharmaceutical drugs and unnecessary medical intervention. By disabling the immune response we disarm our body's army, allowing the invaders to go deeper, potentially resulting in more invasive infections.
Our immune system responds to invading pathogens in various ways:
The prevailing fever-phobia finds parents scared and unsure when a fever presents, yet fever plays a vital biological role in the immune response. The increase in body temperature enhances our fighter cells (leukocytes) and helps eliminate the invading bugs. Parents' quickly run for the antipyretics (drugs that lower the temperature) but ironically their well meaning intervention actually does further damage - as soon as we lower this fever we allow the invaders to thrive.
Healthcare providers advise parents to alternate antipyretics four to six hourly yet there is no evidence to support this recommendation.
This study (1) concluded that the use of antipyretics and external cooling of ICU patients with sepsis had an adverse impact on mortality. We should fear medicating more than we fear the fever as relentless medication to lower the temperature may exacerbate the symptoms and shift that illness deeper, leading to invasive disease like a pneumonia or meningitis. A few of our academic government hospitals are using this evidence based approach and avoid lowering their patients temperature (with certain exceptions like head injuries, as a rise in temperature increases intracranial pressure.) Unfortunately, many of our private institutions hold onto the archaic misconceptions and their first line approach is antipyretic therapy. Healthcare facilities should not be implementing this protocol without the supporting evidence. This careless antipyretic use is the epitome of iatrogenesis.
"The practice of alternating antipyretics has become widespread at home and on paediatric wards without supporting scientific evidence. There is still a significant contrast between the current concept and practice, and the scientific evidence. Fever phobia, an exaggerated fear of fever in their children, is common among parents. Parents have a poor understanding of fever and little or no information about its beneficial role in diseases. As antipyretics do not normalize body temperature or prevent recurrences of fever, parents’ concerns increase, leading to increased use of antipyretics and health services. " (2)
What about a febrile seizure?
This is a sensitive topic as a parents' fear this the most. The assumption is one will have a seizure if the temperature gets to high, but a febrile seizure is not directly associated with a high fever. Ninety five percent of children tolerate high fevers without experiencing a febrile seizure, in many circumstances the seizure is triggered at lower temperatures. Patients with a history of febrile seizures follow a prophylactic approach by administering antipyretics as soon as a fever presents, yet there is no evidence to suggest that this protocol will prevent subsequent episodes:
"Several randomized, placebo-controlled trials on children at risk of Febrile seizure (FS) found no evidence that the antipyretic paracetamol or ibuprofen, with or without diazepam, was effective in preventing FS during subsequent febrile episodes. Furthermore, numerous studies show that a temperature > 40 °C is associated with decreased incidence of recurrence while children who develop seizures with lower degrees of fever have lower seizure threshold and therefore high recurrence rate of FS. Thus, a high temperature at the onset of FS is a useful predictor of non-recurrence. Furthermore, a Cochrane review concluded that the evidence that paracetamol has a superior effect than placebo is insufficient."(2)
Although terrifying febrile seizures do not cause long term damage, however, just to be safe, a full medical evaluation is required if your child experiences one.
When we have a child with a temperature the best approach is to remain calm, acknowledge the beneficial role and avoid interfering. Attempts to cool the child (cool baths, fans or air conditioning) drops the temperature quickly but the body retaliates - in an attempt correct itself the temperature spikes - and this is a risk factor for a febrile seizure (a rapid rise in temperature). The best way to manage a fever is to keep the child's temperature even and avoid under-dressing or over-dressing. Make sure you offer plenty of fluids, or breast milk, and always remember that small babies are at greater risk of dehydration, so if you are concerned contact your healthcare provider. If a child under 3 months of age presents with a fever you should follow up with a medical assessment to rule out severe infections. As a last note, one should not confuse fever with hyperthermia - hyperthermia is a very dangerous situation that can occur with drug reactions or heatstroke and immediate medical intervention is required.
Inflammation is an important part of the immune response, if you cut yourself and debris gets into the cut your body initiates healing through inflammation by increasing blood circulation and mobilizing our fighter cells, transporting them to the site of infection. The white blood cells and the chemicals that they produce play a pivotal immunological role and the inflammatory molecules create pathways that trigger a cascade of events that are integral to the healing process. The area appears tender and painful to touch as the inflammation exerts pressure on the surrounding nerves, triggering a pain response in the brain. By administering anti-inflammatory drugs it may relieve the pain, but it reduces the inflammation and prevents the body from effectively clearing the infection. In severe situations anti-inflammatory drugs are necessary as they offer much needed temporary relief, but we need to be aware of the drugs ability to impede healing and use them sparingly.
Swollen Lymph Nodes
Lymphadenitis, inflammation of our lymph nodes during infection, plays an integral role in healing. The process mobilizes our immune fighting cells and as the lymphatic fluid flows through the nodes they filter out the invading pathogens. The lymph nodes often distress parents', but be assured these small lumps under the skin are a sign that your little ones body is doing an excellent job at fighting the infection. In fact, the absence of palpable lymph nodes during infection is problematic and a sign that the immune system is not functioning optimally. If you are unsure or the lumps persist get them checked out by your healthcare provider.
Loss of Appetite
When we are ill the body tries to conserve energy to fighting the invader. Digestion uses up a lot of our energy, we lose our appetite so we can focus on the invader. In 2016 an article was published in the journal of Autophagy (3). Researchers found that temporary fasting during illness leads to an increased cellular autophagy. Autophagy is the natural regenerative process where the body recycles its own tissue as a metabolic process. Through this process the body cleans up and recycles old cellular components and regenerates newer ones. When cells are starved of nutrients through fasting they are forced to upregulate this autophagy, and at the same time invading pathogens are also broken down. This means our regular cells also help play a role in the fight against the invaders.
Some may be alarmed if their children are tired and just want to rest during illness, but think about how you feel as an adult when you are sick - all we want to do is lie down and rest. There is a physiological reason for this - it is called cytokine-induced sickness behaviour (4). The brain recognizes cytokines (chemical messengers that are released during illness) as an indication of illness and changes occur which lead to these behavioural patterns. The subsequent malaise, fatigue or exhaustion is an inherent biological organized strategy for the body to fight infection. We are forced to rest so the body conserves its energy, saving its reserves for the fight ahead.
Vomiting / Diarrhoea
Bacterial, viral or parasitic pathogens may lead to gastrointestinal conditions. Other causes range from food sensitivity or food poisoning to drug reactions or underlying diseases. In most cases the body's attempt to purge the gastrointestinal contents is a deliberate strategy for survival as it promotes the clearance of pathogens or irritants. A study published in cell host and microbe (5) found that our innate immune activation of diarrhoea promotes pathogen clearance. Immune cells are capable of migrating to the intestinal wall and trigger a chain of events that lead to increased intestinal permeability whereby water (and other molecules) flush through the openings pushing out the invaders via the gastrointestinal tract . The study suggests that by suppressing the diarrhoea with pharmaceutical medication one interferes with the natural response, delaying pathogen clearance and prolonging disease.
Please note that severe dehydration is life threatening and babies are at far greater risk. It is therefore essential that you have your child checked out by a healthcare professional as intravenous fluid replacement may be required. You can decline unnecessary medication, but a simple intravenous line can save a life.
This is the most under-appreciated symptom that does not get the credit it deserves. This is our front line of defence that contains our fighter cells - the white blood cells. The thick mucosal consistency helps trap unwanted microorganisms in our environment, preventing them from entering the body and adhering to the internal surfaces. It also helps expel the invaders through the flow of mucus, which is driven by the movement of those small hairs that line the mucosal surface called cilia. When we are fighting an invader the white blood cells in these secretions produce an enzyme that contains iron, this is what gives it the greenish colour and as it becomes more concentrated the colour may darken. The colour of nasal discharge does not determine the cause of infection (bacterial or viral) and this change in colour should never justify the use of antibiotics. It should be clear that if one tries to dry up these secretions with drugs we disarm our front line and open the door for the microorganisms to walk right in.
The skin is our largest elimination organ and it plays a vital role within our excretory system, flushing out toxins from the body. It removes large amounts of waste daily and rashes of the skin provide us with clues about the health of the internal organs. Skin is actively involved in the detox pathways and the blood and lymphatic system remove waste via the skin in the form of a rash during illness. This rash is toxin elimination and these skin conditions should be regarded as a productive step in disease elimination, skin diseases should be viewed as outer reflections of internal conditions and suppressing this process with pharmaceutical drugs block the body's detoxification process.
We all love our children and we do the best we can with the information available at the time. We hope this article empowers parents so they are better equipped to manage illness and help their loved ones thrive. By interfering and suppressing the symptoms we allow the disease to go deeper, delaying the healing process and potentially leading to more invasive disease and complications. The fear that many hold for the innocuous fever should be the fear held for unnecessary medication, because it is the pharmaceutical intervention that may cause harm. The result of such interference could be negligible (such as prolonging illness) or severe (leading to an invasive condition like). Unfortunately many clinics and hospitals follow outdated treatment protocols that are not evidence based and it is up to the parent to take responsibility for ones health. Do not be afraid to speak up, advocate for your child's health and question healthcare professionals when they impulsively administer unnecessary drugs, they should have a better understanding of the serious implications posed by careless medicating.