Methods for fever reduction

Instead of the less differentiated word "antipyretics", we use two more differentiated terms:

  1. Support of natural (optimal) fever
  2. Inhibition of natural (optimal) fever

What do they mean?

  1. Supporting an optimal fever means accompanying the phases of the natural course of the fever. This means alleviating symptoms that are difficult to bear (such as feeling unwell, headaches and muscle aches) without suppressing the beneficial side of the feverish condition. That’s what hte FeverFriend and scientific research recommends.
  2. Inhibition of the fever process is any "antipyretic method" that interrupts the natural, optimum course of the fever and returns (forces) the body back to baseline sooner than necessary. This is neither professional nor justified and is therefore not recommended.

In order to be able to behave appropriately in all situations, it is important to know the typical stages of optimal natural fever. We have also written about this in detail.

1) The ascent phase usually begins in the afternoon and elevates to the target temperature. The capillaries of the in the skin close, the child's limbs become cold, and his/her face becomes pale. At this time, the children shudder, shaking with cold, shiver, become languid and despondent, develop headaches and feel unwell. If febrile seizures occur, they do so at this time. Therefore, in this case, we do notcool but warm the child: we give heat so that the body can reach the desired target temperature by itself with less effort. Assisting with this endeavour significantly improves well-being, eliminates shuddering, reduces headaches, and reduces the incidence of febrile seizures (132).

We can warm the child by

  • warmly rubbing the child's limbs (wrists, lower legs), put a hot water bottle under his/her feet,
  • covering him/her,
  • giving him/her warm liquid by sips.

2) At the peak: this usually happens late at night, or during the night. Capillaries of the skin open, and heat production and release are balanced. The face flushes, the limbs heat up, well-being improves, and children become more vivid.

No form of cooling should be cold, unpleasant.

Heat dissipation can be helped by:

  • Slightly uncovering the child. This improves the efficiency of heat radiation.
  • Thin lukewarm compress (not with cold-pack), lukewarm wash. Each ml of evaporated water consumes about 2400 joules of energy. This is what the body does when a fever patient sweats.
  • Wash with lukewarm, wet washclothsas follows:
    • moisten a washcloth with lukewarm-warm (37-39 °C) water, which may have some fresh lemon juice in it,
    • press it out well,
    • wipe off warm limbs (arms, calves), forehead,
    • either allow the liquid to evaporate or wipe dry after a few minutes.
  • Lukewarm wet leg compresscan be done as follows:
    • moisten two cloths with lukewarm-warm (37-39 °C) water - which may have some fresh lemon juice in it,
    • press it out well,
    • put the two cloths on the calves,
    • invert or refresh if heated.
  • Cooling bath (not unpleasant cold), 
    • which we start slightly warmer than body temperature.
    • The bath does not need to reach higher than the waist. Water the upper body (123).
    • If a person is in bed, thin slices of lemon (78-81) can be placed on his/her soles. This reduces the headache.

None of the methods should be unpleasant!

3) At the onset of temperature decline: the individual's well-being continues to improve they and begin to sweat.

We help them lose heat by sweating; Mahatma Gandhi did the same with his children (69): he let them sweat.

 

4) Normalization: end of decrease.

No intervention is required below 38 degrees. Leave the child and adult undisturbed.

 

Some important aspects of the Hungarian recommendation for fever (123):

1) Routine administration of antipyretics in healthy children is not indicated only for the sake of reducing body temperature. … Fever eclampsia (fits) cannot be prevented by using anti-fever drugs. Concomitant use of various antipyretics with different active agents is not recommended. Routine switching between drugs with different active agents is not recommended. The use of salicylate-containing antipyretics is not recommended in children under 10 years of age.

2) Physical methods for treating fever (cooling bath and trunk or whole-body compress) may be used in the treatment of fever (especially when medication is not indicated). For a child, a gentle cooling bath can be the least subjective discomfort.

It may help to cool the bath water at the current body temperature (i.e. not cold!) slowly and carefully while it is still not unpleasant, but do not cool it below 31°C! Swirl frequently and pour water on the body of the child using gentle lukewarm water.

Cooling is more effective if the water reaches just below the breast and pouring water over the remaining body surface continuously with the mixed water, rather than placing the child in neck-high water.

Do not continue cooling if the body temperature has dropped to 38°C.

It is important to avoid shivering as it prevents heat loss. Never use ice cold water. Never leave a feverish child alone in the bathtub. In the event of the child turning blue (cyanosis), worsening of symptoms of circulatory disturbance, shuddering and shivering, the child should be removed from the tub, as in such cases the opposite effect may be expected. In this case, the patient's body should be wiped dry and left uncovered for a while.

 

We also write in detail about the four main aspects of further care for a febrile child:

1) Monitoring body heat (fever)

2) Fluid and energy intake

3) Keeping calm and bonding (providing comfort)

4) Monitoring symptoms (risk assessment)

 

Refer to the literature by numbers in this document here: References

Version update: 08th March 2020