Methods for fever reduction

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

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

What do they mean?

  1. When we support the „optimal” fever course, we accompany the phases of rise and fall of a fever, but also alleviate symptoms that are difficult to bear (such as feeling uncomfortable, headaches and muscle aches) without suppressing the beneficial side of the feverish condition. That is, we work to improve the patient's general sense of well-being without lowering their temperature. We can rely on the patient's wishes to help guide this process. That’s what the FeverFriend and latest scientific research recommends.
  2. Inhibition, or blockage, 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 a natural fever curve. We have also written a chapter that gives more detail.

 

1) The ascending (rising) phase of a fever usually begins in the afternoon and increases the body’s warmth to until it gets to a target temperature. During this phase, the capillaries in the skin clamp down, a child's limbs become cold, and his/her face becomes pale. During this time, children often shudder, shake with cold, shiver, feel fatigued and despondent, develop headaches and generally feel unwell.

If febrile seizures occur, they usually do so during this period

Therefore, to help prevent this, 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 warming process significantly improves well-being, eliminates shivering, 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 up with blankets,
  • giving him warm liquid, taken a sip at a time.

 

2) Fever peak: this usually happens late at in the evening, or during the night. The capillaries of the skin open up to balance heat production and heat is released. The face flushes, the limbs heat up, well-being improves, and children become more animated.

At this stage we can help to dissipate the heat, but we do not want to reduce body temperature with any procedure. Respect the body's own carefully targeted (set-point) temperature!

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

None of these treatments should be cold, of feel unpleasant! Do not cause your child to shiver.

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

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

 

Heat dissipation can aided at this point be helped by:

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

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,
    • wring it out well,
    • gently wipe the warm limbs (arms, calves), forehead,
    • either allow the liquid to evaporate or wipe the skin 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,
    • turn them over (invert) or refresh the clothes with the lukewarm water when they have become hot.
  • 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. These kinds of procedures are not based on scientific evidence but on homecare traditions. 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 expends a lot of energy when the feverish patient starts to sweat. By sweating, significant amounts of energy are released, which introduces the next phase of the fever process: the descent.

 

3) At the onset of temperature descent: the individual's comfort continues to improve, as 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 of temperature: end of descent.

No intervention is required below 38 degrees. Leave the child (or adult) undisturbed.

 

Some important aspects of the professional recommendation:

1) Routine administration of antipyretics in healthy children is not indicated solely for the sake of reducing body temperature. … Febrile seizures (fits) cannot be prevented by using fever-reduding drugs. Concomitant use of various antipyretics with different active agents is not recommended. Routinely 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 and disrupts the natural cycle. Never use ice cold water. Never leave a feverish child alone in the bathtub. In the event that a child turns blue (cyanosis, getting pale) shows a worsening of symptoms of circulatory disturbance, begings shuddering or shivering, then the child should be promptly removed from the bathtub, as in such cases the opposite effect may be expected, The body is going to heat up again.

 

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, providing comfort and loving care

4) Monitoring symptoms (risk assessment)

 

You can find the corresponding numbered references here: References

Version update: 30 November 2020