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. In support of the optimal fever course, we accompany the phases of the natural fever flow 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 is, we improve the patient's well-being without lowering their temperature. We can rely on the patient's wishes in this. That’s what the FeverFriend and latest scientific research recommends.
  2. Inhibition of the fever process is any "antipyretic method" that interrupts the natural, optimal 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 a chapter about this in detail.

 

1) The ascent phase usually begins in the afternoon and rises to the target temperature. The capillaries in the skin close, the child's limbs become cold, and his/her face becomes pale. At this time, children shudder, shake with cold, shiver, become languid and despondent, develop headaches and feel unwell.

If febrile seizures occur, they usually do so in this period.

Therefore, in this case, we do not cool but warm the child: we give heat so that the body can reach the desired target temperature by itself with less effort. Assisting 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 warm 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.

We can already help to dissipate the heat, but do not reduce body temperature with any procedure. Follow the body's own targeted (set-point) temperature!

The primary goal is to improve well-being. In case of dyscomfort, external physical and nursing interventions can be performed.

None of these forms should be cold, unpleasant! Do not cause shivering.

Do not reduce body temperature with the procedures, as the body will try to get itself up to the target temperature again.

Wait patiently until the temperature starts to decrease on its own.

 

Heat dissipation can at this point be helped by:

  • Slightly uncovering the child. This improves the efficiency of heat radiation.

The three procedures listed here are no longer recommended in some countries to reduce temperature, but can be used to improve comfort.​

  • Wash with lukewarm, wet washcloths as follows:
    • moisten a washcloth or sponge 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 compress can 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 when warmed up.
  • Cooling bath (NOT unpleasantly cold), 
    • we start the bath with slightly warmer water than body temperature, and measuring by water thermometer we let it cool until 34°C, or until it feels pleasantly cool to our hands
    • The bath does not need to reach higher than the waist.
    • Wet the upper body with your hands or a sponge (123)

To reduce headache for a person lying in bed, thin slices of lemon (78-81) can be placed on his/her soles. Such and similar procedures are not based on scientific evidence but on tradition. If they are pleasing to the patient and do not harm them, we can safely apply them as tender, loving, attentive care.

Compresses, washes, baths: every ml of evaporating water consumes a lot of energy. The body does the same when the feverish patient starts to sweat. By this significant amounts of energy are withdrawn, which introduces the next phase of the fever process: the decline.

 

3) At the onset of temperature decline: the individual's comfort continues to improve, the patient begins 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 (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 accompy fever (cooling bath and trunk or whole-body compress) 

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 an extra chapter you find details about the four main aspects of further care for a febrile child:

1) Monitoring body temperature (fever)

2) Fluid and energy intake

3) Keeping calm and tender loving care, providing comfort

4) Monitoring symptoms (risk assessment)

 

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

Version update: 30 October 2020