Linda B. White and Sunny Mavor
Originally printed in Mothering
Excerpted from Kids, Herbs, and Health: A Parents'
Guide to Natural Remedies by Linda B. White, MD, and Sunny Mavor,
AHG, $21.95, with permission from Interweave Press, 1999. CLICK
HERE to view on Amazon.com.
Fever is not a disease but
rather a symptom of an illness.
Childhood fevers frighten grownups.
Fever is maligned and misunderstood.
Controversy surrounding the management of fever causes anxiety
for parents, because they are not completely sure what to do
when their child has one.
It may help parents to remember that fever is only one part of
the picture of an illness. In fact, for children under eight years
of age, and especially for infants, the severity of a fever is
an unreliable indicator of the severity of the child's illness.
For example, infants and toddlers can be very sick with a low or
even subnormal temperature. Conversely, children three to eight
years old can be running about quite cheerfully with a fairly impressive
fever. The important thing is how your child is acting, not the
First, let's define normal body temperature. Most people say 98.6ºF
(37ºC) is normal, but this doesn't account for individual variations
or the fact that kids tend to run slightly hotter than adults. You
can think of anything between 97º and 99.4ºF (36º
and 37.4ºC) as normal.
Consumption of hot food, recent exercise, overbundling, hot weather,
or an overheated room can drive body temperature up a degree or
two. Body temperature also varies during the course of the day,
and, with teenaged girls, the menstrual cycle.
Fevers usually hit their highest point in the late afternoon.
Conversely, kids often have their lowest temperature of the day
early in the morning. So don't panic at 4 p.m. when your child's
fever rises slightly; this does not necessarily forebode a raging
fever. On the other hand, if your child has a low-grade fever upon
awakening, you may want to keep him home.
How Fever Happens
Infections most commonly launch fever, especially in children.
Other triggers include transfusion reactions, juvenile rheumatoid
arthritis, tumors, inflammatory reactions caused by trauma, medications
(including some antihistamines, antibiotics, or an overdose of aspirin),
immunizations, and dehydration.
Most physicians do not believe that teething directly causes significant
fever, but we have seen it happen.
When infectious "bugs" stimulate white blood cells in
a specific way, they release a substance called endogenous pyrogen,
which signals the brain's hypothalamus to raise the body's thermostat
setting. In turn, the body heats up by increasing its metabolic
rate, shivering, or seeking warm environments.
It also minimizes heat loss by restricting blood flow to the skin,
giving it a pale appearance. Once body temperature rises, the skin
flushes and sweats. A fever sufferer may lose appetite and feel
lethargic, achy, and sleepy. When these phenomena happen to our
children, we just tuck them into bed and let them sleep.
A basic fever, one
due to minor bacterial or viral illness, can be an expression of
the immune system working at its best. Given that
most animals (vertebrates anyway) mount a fever in response to illness,
it's likely that humans have preserved this evolutionary response
because it improves survival. Some research supports this theory;
animal studies show when fever is blocked, survival rates from infection
Fever increases the amount of interferon
(a natural antiviral and anticancer substance) in the
blood. A mild fever also increases the white blood cells that
kill cells infected with viruses, fungi, and cancer, and improves
the ability of certain white blood cells to destroy bacteria and
infected cells. Fever also impairs the replication of many bacteria
Bottom line: A moderate fever
is a friend, but not one you want to spend a lot of time with. So
it makes sense to avoid suppressing moderate fevers with drugs,
while continuing to monitor your child for dramatic increases in
temperature and worsening of any other of his symptoms.
Can Fever Do Harm?
Any time body temperature increases, salt and water are lost via
sweating, and stores of energy and vitamins, especially the water-soluble
ones, are burned up. During moderate fevers, we can compensate for
these losses by drinking appropriate fluids, ingesting nutritious
foods, or taking vitamin supplements.
Replacing water-soluble vitamins (chiefly C and Bs) makes sense.
However, during fevers, the body makes some minerals unavailable
for a good reason - bacteria need them to thrive. In terms of energy
stores, our bodies switch from burning glucose (the favorite meal
of bacteria) to burning protein and fat.
This means a few
days of poor appetite is probably adaptive. In other words, don't
cajole or coerce your children into eating during fevers if they
don't feel hungry; they will likely regain any
lost weight quickly after the illness ends. You do, however, need
to encourage fluids, because dehydration alone can drive up fever.
Very high fevers - those above 106°F
(41°C) - can harm the heart and brain. Some authorities,
however, say that fever is unlikely to cause brain damage in a previously
healthy child. During most infections, the brain keeps body temperature
at or below 104°F (40°C). So in most - not all - cases,
you don't need to be afraid that your child's temperature is going
to continue to rise above that point.
What About Febrile Seizures?
First, let's define them. These abnormal jerking movements occur
in children between the ages of three months and five years in association
with a fever, but without evidence of infection of the nervous system.
The seizure lasts no longer than 15 minutes (usually five minutes
or less) and causes twitching all over. About 3 percent of kids
get febrile seizures.
The reason some children have this susceptibility isn't well understood.
Of those kids who have a first-time febrile seizure, about one-third
have a recurrence. Risks for recurrence go up with younger age at
the first seizure (16 months old or less) and a family history of
Frightening as these
seizures are for parents, they're benign; once
they pass, the child continues to develop normally. Often pediatricians
can help parents learn to block high temperatures by giving ibuprofen
or acetaminophen when fevers start. For the few children who have
recurrent febrile seizures, anticonvulsants or sedatives may be
What to Do If Your Child Has a Febrile
Try to stay calm. That's a tall order, but your child needs you
to be collected. Take a deep breath. Let it out. Tell yourself that
the seizure will not last long (although it may seem like forever)
and that your child will likely be fine afterward.
Look at your watch to time the length of the seizure. This sounds
like a big demand, given the anxiety a parent naturally feels. However,
you will otherwise overestimate the time, and the duration of the
seizure is important information for the doctor. If it exceeds five
minutes, call 911.
After the seizure is over, comfort and reassure your child, then
call your doctor for an immediate appointment. He or she will want
to evaluate your child for any abnormalities (other than fever)
that may have triggered the seizure. If the seizure lasted longer
than five minutes and/or your child seems to be very sick, your
physician may tell you to go to the emergency room right away.
Over-the-Counter Medications for Fevers
It makes sense to us that if fever helps
defend against infection, giving fever-reducing medications may
make things worse. In addition, some fever medications
can have undesirable side effects. On the other hand, no one likes
to watch a child suffer. And fever can deplete a child's energy.
Here's a profile of over-the-counter medicines for reducing fever
Acetaminophen reduces fever and pain but not inflammation. Follow
the package instructions. Because of the risk of liver damage, do
not dose more frequently than every four to six hours or for more
than five consecutive days. There is no need to awaken your child
to give her a dose; sleep will do far more good.
Ibuprofen (Children's Motrin, Pediaprofen, Advil) reduces fever,
pain, and inflammation. Follow the package instructions. Do not
give more often than every six hours unless your physician advises
otherwise. This medicine can cause stomach upset.
Aspirin reduces fever, pain, and inflammation, but pediatricians
rarely recommend it.
Use of aspirin in children during viral
illness has been linked to Reye's syndrome, a disease
characterized by severe liver dysfunction and brain swelling. Symptoms
include effortless and repeated vomiting, then a change in the level
of consciousness (lethargy, stupor, combative behavior, delirium,
No one knows what the cause of Reye's is, but it seems to be linked
with aspirin use during viral illnesses. For this reason, authorities
have recommended that children under 21 years with symptoms of viral
respiratory illness or chickenpox do not take aspirin. Sometimes
herpes outbreaks and viral gastroenteritis (marked by vomiting and/or
diarrhea) are included in the list of illnesses during which aspirin
must be avoided.
Unfortunately, it is often difficult to be certain of the cause
of an illness when it starts. Aspirin is a component of many cold
and flu over-the-counter medications, so avoiding it requires careful
label reading on your part.
Medications for fever can act as a screen. Here are some pros and
cons to giving your child over-the-counter medication to ease a
Medication such as acetaminophen can help sort out whether your
child feels miserable because of a fever or because of an infection.
Some physicians use a trial of acetaminophen as a screen. If, after
the drug kicks in, the child looks and acts better, it is less likely
that he has a fever or that his infection is a serious one.
Fever medications can make your child feel better. He may be more
likely to drink fluids, nibble food, and sleep. All can help him
can mask symptoms. In other words, your child acts as though his
health has improved, but it really hasn't.
Fever medications may actually prolong the illness. This opinion
of some practitioners is backed by a few studies. Assuming the response
of the body to illness (fever, inflammation, sleepiness) is adaptive,
it seems reasonable to assume that interfering with the process
may do more harm than good. The following are some examples that
support this theory.
In test-tube studies, therapeutic levels of aspirin suppressed
the ability of human white blood cells to destroy bacteria.
Acetaminophen did not have this effect. Another study found
that a host of pain relievers, including aspirin and ibuprofen,
inhibited white-cell production of antibodies by up to 50 percent.
The bottom line.
Use these medicines sparingly when your child
is in pain or suffers discomfort from a fever over 102°F (38.8°C).
Ask yourself whether you are administering the fever-reducing medicine
to make your child more comfortable or to decrease your own anxiety.
Nondrug approaches can go a long way toward helping your child
feel better. If the situation does not seem urgent, you might want
to consider a trial of herbal treatment before you pull out the
Home Management of Fevers
Do give your child lots to drink.
Fever increases fluid loss, and dehydration can drive up your child's
temperature. Kids with fever often do not feel thirsty, or by the
time they do, they're already dehydrated. So keep offering fluids.
Small, frequent sips are often best,
especially if the child feels nauseated. If necessary, use a plastic
medicine dropper to gently insert water into your child's mouth.
The type that holds several ounces is best to use.
Dress lightly or bundle? The
answer depends on your children's perception of temperature - follow
her cues. If your child looks pale, shivers, or complains of feeling
chilled (things that tend to happen in the early stages of fever),
bundle her in breathable fabrics so that sweat will evaporate, but
make sure she can easily remove the layers. If she is comfortable
and her fever is low, dress her snuggly and give warm liquids to
assist the body's fever production. If she sweats and complains
of heat, dress her lightly and let her throw off the covers. Older
kids will take care of these needs themselves.
Don't push food. People with
fevers generally don't have much appetite. Let your child determine
when and what she eats. Just bear in mind that consumption of sugary
foods could delay the natural immune response.
Herbal Remedies for Fevers
A rule of thumb that herbalists like to use during minor illness
with fever is: "First, do nothing,"
meaning that a short period of observation ought to precede
any action against the illness. Follow our guidelines above for
seeking medical assistance for feverish children under the age of
two, and encourage fluids. For older children, give liquids, make
them comfortable, and observe closely.
Is your child drinking fluids well? Urinating at least once
every eight hours (ideally, every three to four hours, or wetting
eight to ten diapers per day)? Does your touch console her? Is she
playing normally? If the answer to these questions is yes, she is
probably not seriously ill.
This observation time can also help you figure out which of the
following herbs are most indicated and effective.
Boneset. We cannot find much current research on this herb, but
folklore, historical medical texts, and personal experience tell
us it works. Consider the opinion of Drs. John Uri Lloyd and Harvey
Felter from 1898, two of the most respected herb doctors in American
history: "In influenza, it relieves the pain in the limbs and
back. Its popular name, 'boneset,' is derived from its well-known
property of relieving the deep-seated pains in the limbs which accompany
For more information about herbal remedies for children, see the
following articles in past issues of Mothering: "The
Scent That Soothes," no. 80; "Natural Remedies for Childhood
Diseases," no. 77; "Natural Immune Boosters," no.
73; "Natural Remedies for Winter Illnesses," no. 69, and
"Childhood Fevers," no. 51.
Linda B. White, MD, is the mother of two and the author of The
Grandparent Book. She is a national natural health writer.
Sunny Mavor, AHG, is a professional member of the American Herbalists
Guild and lectures nationally on botanical medicine. She is the
mother of two and the founder of Herbs for Kids.