Parents Still Don’t Understand Fevers: A Blessing In Disguise

Fever is one of the most common reasons that parents seek medical attention for their children. Parental concerns arise in part because of the belief that fever itself is a disease rather than a symptom or sign of the body adapting to a cause. (1) Additionally, many parents over react in the treatment of fevers and actually add to the duration of the very condition the body is trying to eliminate. Fear and misinformation about febrile seizures add to parents' concerns and their often unwarranted mode of treatment. Understanding fever and its function in health is imperative in caring for our children more effectively.

Children's temperatures generally run higher than adults. It is often perfectly "normal" for a child's temp to range between 97º and 99.4ºF (36º and 37.4º C) External factors like overdressing, physical exertion, hot foods can drive body temperature up a degree or two. Body temperature also varies during the course of the day, and during the menstral cycle.

Generally, fever is caused by an infection in the child's system. The body is raising the temperature to kill off the invading organism. A basic fever, one due to minor bacterial or viral illness, is a normal function of the immune system working at its best. Studies show that the survival rate in animals increases when a fever "purges" the animal of unwelcomed organisms.

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 and viruses.

In a study looking at how 161 pediatricians treat children's fevers, researchers found that half tell their parents to give both ibuprofen and ascetaminophen in alternating doses. According to Dr. Clara E Mayoral and her colleagues at Winthrop University Hospital in Mineola, N.Y., this strategy could put children at greater risk from the drugs side effects, which include liver damage.

"Parents need to understand that fever is not necessarily a bad thing," she states, It's the body's response to an infection. Treating the fever does not treat the underlying cause." anti-fever drugs make people feel better when they have infections. The bad news is that they may cause the illness to linger longer," says Dr. Mackowiak, adding that people "should be aware that anti-fever drugs have a modest cost associated with relief and that cost is that they may be sick longer."

According to a brochure published by the makers of Tylenol, fever is a very important thing for your body to be able to produce. It helps the body prevent or clear infections, whether they are viral or bacterial.

This same publication states that fevers are generally not dangerous until they reach a temperature of 106.3 degrees Fahrenheit. In fact, it says that there is not really even much danger of a seizure from the fever until it has been at 106 degrees for 3 days or more! Furthermore, it states that, "even if a seizure does occur, there rarely is any residual effect at all." Febrile seizures last about 5 minutes (which may seem like years to the parent) and are considered benign without residual damage. Another study sites that parents and some nurses still worry that fever is a risk factor for serious complications even though these associations have long since been disproven.

When looking at fevers, we need to consider and respect that the body has a specific purpose for producing a fever, and trying to reduce it may not be in the best interest of our child's overall well-being. Sometimes our own fears and misinformation may override good judgement leading to unnecessary treatment and prolonged symptoms in our children.

Most fevers in children are the body's own mechanism to establish a state of homeostasis (balance) by reducing infection. Frequently, fevers in children will elevate in temperature by the afternoon, causing additional, unnecessary worry in parents.

Since fever in children over two months of age is often a sign of normal body function, follow the guidelines your child sets: keep them warm if they are chilly, uncover them if they are hot. (Tepid baths may lead to seizures and alcohol baths are toxic). Give them plenty of sips of water to stay hydrated. Broths and drinks with minerals and electrolytes are helpful as well. If your child is breastfeeding; nurse, nurse, nurse! Avoid sugary drinks which hinder overall immunity and do not force them to eat solid foods.

In addition to the home care and possible outside management you choose for your children with fever, have their spines checked by your Doctor of Chiropractic. The nervous system affects the immune system both directly and indirectly and plays an important role in the immune response. Alleviating nerve system stress with the chiropractic adjustment allows for better function. Optimal health and well-being comes about when the body is working at its maximum potential.

· According to the American Academy of Pediatrics (AAP), a fever helps your child’s body fight off infection.

· Fevers usually have to be above 102 or 103 degrees to make a child uncomfortable.

· Treating a fever usually doesn’t bring the temperature back down to normal – just down 2 or 3 degrees.

· Only 4% of children ever have febrile seizures – and when they do occur, they usually cause no permanent harm.

Fever medications 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.

· A study of adults with colds found that aspirin and acetaminophen suppressed production of antibodies and increased cold symptoms, with a trend toward longer infectiousness.

· In a study of children with chickenpox, acetaminophen prolonged itching and the time to scabbing compared to placebo treatment.

· 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. Ask yourself whether you are administering the fever-reducing drugs to make your child more comfortable or to decrease your own anxiety.

Non-drug 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 acetaminophen.

An acute, usually afebrile, viral infection of the respiratory tract, with inflammation in any or all airways, including the nose, paranasal sinuses, throat, larynx, and sometimes the trachea and bronchi.

Translation: a viral infection causing a stuffy nose and/or throat, WITHOUT a fever.

Clinical symptoms and signs are nonspecific, but often starts with a burning sensation in the nose or throat, followed by sneezing and rhinorrhea (watery mucus discharge from the nose). Characteristically, fever is not present. Nasal secretions are watery and profuse during the first days, but become more mucoid (mucus-like) and purulent (thick). Mucopurulent secretions (coughing up phlegm – mucus and pus) do not indicate a bacterial super-infection. Cough is usually mild but often lasts into the 2nd week. In the absence of complicating infection, symptoms resolve in 4 to 10 days.

A warm, humid environment increases comfort. Rest is indicated for those with fever or more severe symptoms. Antipyretics (drugs to fight fever) help reduce fever, but repetitive doses of aspirin can increase viral shedding while only slightly improving symptoms. If influenza is suspected, particularly in children, aspirin should be avoided to reduce the risk of Reye's syndrome.

Nasal decongestants may provide temporary relief, but the effect is insufficient to warrant repeated or prolonged use, since rebound congestion may occur. Hydration is important to maintain secretion fluidity. Treatment of cough, unless harsh and painful, is often better left untreated to preserve defense mechanism.

An acute viral respiratory infection with influenza, a virus causing fever, coryza, cough, headache, malaise, and inflamed respiratory mucous membranes.

Translation: a viral infection that causes a fever, runny nose and/or eyes, cough, headache, achy all over, stuffy nose and/or throat.

In mild cases (in resistant or partially immune hosts), the symptoms are like those of a common cold. Chills and fever up to 102 to 103° F begin suddenly. Generalized aches and pains (most pronounced in the back and legs) appear early. Headache is prominent, often with photophobia (light sensitivity) and retrobulbar aching (headache-like feeling behind the eyes). Respiratory tract symptoms may be mild at first, with scratchy sore throat, substernal (chest) burning, nonproductive cough, and sometimes coryza (runny nose or eyes). Later, the lower respiratory illness becomes dominant; cough can be persistent and productive.

Treatment for most patients is symptomatic (meaning, they do nothing to enhance the immune system or actively get rid of the infection, but only treat discomfort). The patient should rest and maintain hydration. If symptoms of acute uncomplicated influenza are severe, anti-influenzal chemotherapy, antipyretics, and analgesics are helpful. Steam inhalation may relieve respiratory symptoms and prevent some of the discomfort of dry membranes.

Side Note: According to a report in the Journal of Pharmacotherapy, the investigators found that flu symptoms lasted 5.3 days in participants who did not take aspirin or acetaminophen, compared with 8.8 days in people who took the anti-fever drugs.

Based upon the results of studies conducted over the past 30 years on antibiotics and otitis media, antibiotics were linked to short-term decreases in the duration of pain or fever in patients in a few (but not all) of the studies, no long-term (more than six weeks) benefits are reported.

The authors point out that children whose previous ear infections were treated with antibiotics have a rate of Ampicillin (amoxicillin)-resistant bacteria that is three times higher during subsequent otitis media episodes. In extreme cases, deaths from drug-resistant meningitis have been linked to built-up antibiotic resistance traced to previous treatment for ear infection. -JAMA November 26,1997;278(20):1643-1645

Pacifiers May Increase Ear Infection Risk

It's estimated that 75-85% of children in Western countries habitually use a pacifier during infancy and early childhood. Although pacifier use has long been considered a relatively harmless habit, recent evidence points to increased risks of oral/dental problems and recurrent ear infections (acute otitis media, or AOM).

A study in Pediatrics examined pacifier use as a potential contributor to AOM by pairing 14 well-baby clinics in Finland, with one clinic in each pair designated for intervention and the other clinic serving as the control. At intervention clinics, parents were instructed to limit their children's pacifier use during visits to the clinic; at control clinics, no such recommendation was offered.

Results showed that in 272 children at the intervention clinics, pacifier use decreased by 21% and the incidence of AOM decreased by 29% compared with children (212) at control clinics. Overall, children who did not use a pacifier continuously suffered 33% fewer episodes of AOM than children who did use a pacifier, leading the authors to suggest limiting pacifier use to "moments when the child is falling asleep."

Niemela M, Pihkari O, Pokka T, et al. Pacifier as a risk factor for acute otitis media: a randomized, controlled trial of parental counseling. Pediatrics, Sept. 2000: Vol. 106, No. 3, pp483-88.

Antibiotic treatment of otitis media is no more effective than placebo, and increases the risks of reoccurrence

Nine studies of antibiotic prophylaxis of recurrent otitis media with 958 subjects had an RD of 0.11 (95% confidence interval [Cl], 0.03 to 0.19) favoring antibiotic treatment. Twelve studies of short-term patient outcomes of OME with 1697 subjects had an RD favoring antibiotics of 0.16 (95% Cl, 0.03 to 0.29), while eight studies using the ear as the outcome measure with 2052 ears studied had an RD of 0.25 (95% Cl, 0.10 to 0.40). No significant difference was shown between placebo and antibiotics (RD, 0.06; 95% Cl, -0.03 to 0.14) in the eight studies of longer-term outcome of OME.

There have been numerous studies in the medical literature reporting the ineffectiveness of antibiotics as treatment for ear infections

Recent evidence has thrown into question the use of antibiotics and the length of treatment, if prescribed. The growing worldwide development of multidrug-resistant bacteria, the uncertainty of diagnosis, and that up to one third of cases of AOM are viral in origin ¹² have made popular a wait-and-see approach to the initial prescription of antibiotics, especially in many European countries. In several randomized clinical trials, antibiotics provided only a small benefit. ^13-15 In a meta-analysis of more than 2000 children with AOM, ear pain resolved spontaneously without antibiotics in two thirds by 24 hours and in 80% by day 7.

William F. Miser, MD To Treat or Not to Treat Otitis Media-That's Just One of the Questions J Am Board Fam Pract 2001 (Nov); 14 (6): 474-476

There are several reasons why fluid might build up in the middle ear. Here’s why and what you can do naturally….

Many studies have suggested a link between food intolerance and middle ear problems. One study tested 104 children with recurring middle ear problems for food allergy and discovered 81 to be allergic. After eliminating the offending foods, 86 percent got better, and 94 percent got worse when the offending foods were reintroduced. The most common allergens are dairy products, wheat, egg white, peanuts, and soy. If your child suffers from recurring ear infections, you might first try eliminating dairy products and sugar from his or her diet, then the other common allergens. Remember, dairy and sugar are fantastic mediums for yeast to grow and cause inflammation in the ears and sinuses.

Researchers have found that children with high susceptibility to ear infections are often deficient in zinc, iron, or vitamin A. One study found substances related to the improper intake of dietary fats in the middle ear fluid of children with otitis media. Eating trans-fatty acids--found in margarine as well as french fries, donuts, cake frostings, and other junk foods--can set the stage for inflammation. Often children with recurrent earaches improve simply by switching to a more wholesome diet.

Some people, including all kinds of doctors, are fearful of vitamin A. There is little to be afraid of. Vitamin A is the number one nutrient needed in keeping epithelial tissue healthy. Different types of epithelial tissue is basically what almost every tissue in our body is made of. Vitamin A toxicity occurs in extremely high doses, like 200,000 iu each day for an extended period of time and is 100% reversible.

A blockage of the eustachian tube can occur as a result of swollen tonsils or adenoids, or from structural problems in the bones surrounding the ear. The biomechanics of these delicate bones can be disrupted by any physical trauma, including a fall or a difficult birth. Chiropractic adjustments are often effective at resolving these problems and preventing recurring ear infections.

Many children with recurring ear infections undergo tympanostomy tube placement--surgical insertion of drainage tubes in the eardrum. Tube placement is the most common general anesthesia-based procedure performed on children under two. However, many doctors themselves believe that the surgery is prescribed more than is necessary. A study of more than 6,600 children who had undergone tube placement found that almost 60 percent of the surgeries performed were unnecessary or had risks equal to benefits.3 A five-year study reported in the Townsend Letter for Doctors (April 1991) indicated that the procedure provides only temporary relief from ear infections and may, in fact, cause deafness. In 98 children with tubes placed in one ear, there was a 21 percent higher incidence of deafness in the ears with the tubes.

If you got it, use it. Breastmilk has antibiotic and anti-viral properties and works two-fold. One, breastfeeding causes the opening of the eustachian tube due to the jaw moving and allows the babies’ immune system to be stimulated by these properties. The other way breastmilk works well is to actually put some in the ear, as it is warm and will help with the pain, but also help as a topical for the infection itself.

Some products that work well to get the yeast under control, are probiotics, caprylic acid, but so far, the best we have found is by Standard Process, called Lactic Acid Yeast. They are chewable and easily crushed to administer in foods.

Therapies that boost helpful bacteria may not only keep otitis media at bay, but also prevent harmful bacteria from becoming resistant to antibiotics by reducing the need for the drugs. This is a new way of looking at the normal flora as a defense against infections.

The study involved 130 children aged 6 months to 6 years who had a history of recurrent otitis media. All of the children received a 10-day course of antibiotics to treat the infection.

After completing the antibiotic treatment, half of the children received a nasal spray containing beneficial bacteria (alpha-streptococci) for 10 days. About 2 months later, these children received another 10-day course of the spray. The remaining children received two cycles of a placebo spray that did not contain any bacteria.

Otitis media was significantly less likely to recur in children treated with the bacterial spray, the report indicates. Forty-two percent of these children did not develop another ear infection during the 3-month study, compared with just 22% of children who received the placebo spray.

Ear drops can help relieve the pain of an earache. A blend of mullein and garlic oil is a good choice because of its antiviral and antibacterial properties; St. John's wort and calendula can also be added. You can buy herbal ear drops or make your own. Garlic can be irritating to the ear canal in high concentrations, so be sure to dilute the garlic oil with other oils such as mullein. Garlic may be best used ingested in food.

To administer ear drops: Run hot water over a spoon until it is warm, pour a few drops of oil onto the spoon to warm the oil, then put two to three drops in each ear while your child is lying down; plug the ear loosely with a cotton ball. Repeat two or three times a day for no more than four days.

Make an aromatherapy ear rub with several drops of lavender, tea tree oil, and chamomile in 1 ounce of olive oil. Rub the oil mixture around the outside of the ear and over the lymph nodes on the side of the neck, or dab a cotton ball in the oil, gently place it in the ear, and leave it in until the infection is gone, replacing it with a fresh cotton ball several times a day.

A chiropractic treatment plan featuring gentle adjustments appropriate for very young children, offers hope for comforting relief – without recourse to heavy use of antibiotics or surgery. Chiropractic upper-spine adjustments and massage of the tissue surrounding the ear can help clear the eustachian tube blockage that causes otitis media. Dietary/nutritional guidance (such as testing for food sensitivities and vitamin deficiencies) may also be offered. The chiropractic approach is an alternative to traditional medical treatments that may be less effective and involve serious side effects.

· 46 children aged 5 years and underwere adjusted by a single Chiropractor. Typical care was three adjustments per week for one week, then two adjustments per week for one week, then one adjustment per week. Interestingly, children with a history of past antibiotic use was associated with a less favorable outcome. From the abstract: "93% of all episodes improved, 75% in 10 days or fewer and 43% with only one or two treatments. Young age, no history of antibiotic use, initial episode (vs. recurrent) and designation of an episode as discomfort rather than ear infection were factors associated with improvement with the fewest treatments. Improvement was based on parental decision (they stated that the child had no fever, no signs of ear pain, and was totally asymptomatic), and/or the child seemed to be asymptomatic to the treating DC and/or the parent stated that the child's MD judged the child to be improved.

Homeopathic remedies can be administered at home to relieve the pain of occasional earaches. If your child is angry, fearful, and sensitive to light and noise, consider Belladonna, which is effective for earaches that come on suddenly, with severe, throbbing pains. Chamomilla is good for earaches associated with teething. Children who need Pulsatilla tend to be weepy, sensitive, and clingy. Their cheeks will be pale, and there may be a thick, yellow-green discharge from the nose or the ear. Symptoms often come on gradually, frequently following a cold. Aconite is for the sudden onset of earache after a chill. The child may awaken in the night screaming with pain and appearing anxious and scared. Recurring earaches also respond well to homeopathic treatment; consult a trained homeopath for help in choosing the right remedy.

The pain of otitis media results from pressure on the eardrum and typically lasts about 24 hours without treatment—an eternity if you are the one caring for the two year old! There are other ways to alleviate pain. The American Academy of Pediatrics suggests applying a warm compress to an older child's ear. Use a hot-water bottle, or warm a sock filled with grain or flaxseed heated to a comfortably warm temperature in the microwave or oven

Vitamin C: If you get a supplement with 500mg of ascorbic acid, try to make sure there is 500mg of bioflavinoids in the same supplement. This will make the vitamin C more bio-available.

The medical literature has clear documentation that high enough doses of injectable vitamin C are almost always effective in curing any of a number of viral infections still considered today to be incurable. Klenner (1949) completely cured 60 out of 60 cases of infantile polio in North Carolina in the middle of a polio epidemic. Several infants already had neurological involvement, but nevertheless recovered completely. –Thomas Levy, MD

Vitamin A: Try to get the oil form mixed with vitamin D. The higher the dosage, the less capsules the child will need to take. Also, small kids *love* to chew them, so don’t make a face when they eat it…say, “mmmmmm, that’s good, huh?” You’ll be surprised how easily it is to administer them when they like them. Most kids actually ask for them later.

Zinc: Make sure this is taken with food, as zinc can cause nausea when taken on an empty stomach. Start in small doses, very little of this is necessary. Zinc lozenges might be a good choice. Also, make certain there is little sugar, if any, in the supplement. Do not give them any supplements with Aspartame or Splenda. There is not enough research on these sugar substitutes, especially with kids, to allow them to ingest these.

Echinacea: It has been extensively researched and found to be effective in both the prevention and treatment of acute colds and upper respiratory tract infections. It is primarily used as an immune stimulant and for immune support. It may be used to promote wound healing, to treat wounds, bruises scratches, burns and leg ulcers; and as a prophylaxis for colds, influenza, and other viral and bacterial infections. Echinacea has also been shown to inhibit Strep growth. It should not be taken for more than 8 weeks, without a 3 week rest period. Children usually need it for a few days to a week.

There is a great brand of Echinacea that works well and tastes well for kids. It’s in a tincture (liquid form) and you can buy it at Farm to Market in San Juan Capistrano. The brand name is Herbs for Kids – Echinacea/Golden Root. Follow the directions on the label.

Vitamin E: In the past few days there has been bad press about vitamin E. I have not read the recent study on E, so I have no idea how the study was performed or who paid for it, so I can’t tell you whether it was a worthwhile study. In the past, vitamin E has been touted as a fabulous anti-oxidant. When looking for vitamin E, this is what you need to know….buy the natural. It will be more expensive, but your body will actually be able to utilize it.

*Remember to keep your kids away from sugar – it will decrease the function of the immune system almost immediately. If they are use to eating sugar, then teach them that while they are sick, they may not eat sugar. They will carry this one lesson through life and will be better prepared to care for themselves and their own families, one day.