What fevers are, How fevers work, When fevers are good, and What to do about fevers at home.
by: Alicia Hart, ND
I was all set to write something about the behavioral conditioning class I was supposed to teach before Snowmageddon 2016 set in? and then my twins came down with twin cases of erythema infectiosum aka fifths disease aka parvo. They?re both miserable, feverish, and not sleeping, which is pretty much par for the course with fifths and a 102.9 F fever. That?s when I thought that it might be more practical to talk about home care for fevers this week.
Step 1: Fevers are NORMAL
They are an adaptive response by your body to fight off an infection. Fevers are an important part of a normally function immune system. If you tank a fever with antipyretics every single time you or your kid tries to get a fever, you?re not helping your immune system out. Your immune system wants to be hotter because 1) bacteria and viruses do not like changes in temperature and 2) white blood cells are more active in a hotter temperature. Some people even use saunas to induce a higher body temperature for this effect. (it only works for athletes though, so you might want to start running before you plan on getting sick if you?re going to use the sauna method for increasing your white blood cell count.) The cells that work better at a warmer temperature are a type of white blood cell called a CD8+ cytotoxic T-Cell, otherwise known as the killer T cell, so called because they are excellent at killing cells that shouldn?t be in our body.
Essentially, a fever is your body noticing that you?ve got some bad microbes hanging around and deciding that it would be lovely to bump up the cells that help destroy microbes. This is important for a few different reasons:
- Your body knows what it?s doing. I feel like we are all socially and culturally inundated with messages that we are powerless and need some sort of something to get our wayward bodies back on track. Sometimes we just need to sit down and roll with the beautiful and intricate way that we function.
- Your body is trying to do this for a reason. This is why if you?re using acetaminophen or ibuprofen to reduce a fever, when the medication wears off you might experience a higher fever due to the rebound effect. Essentially your body has been trying so hard to get this fever, and you?ve been putting the brakes on, so your body was trying even harder to get a fever and then the medication brakes wore out but all that momentum from trying to overcome the medication is still there and you overshoot that optimal mild fever.
Step 2: Fevers come with Side Effects
Pyrogens (little molecules that just want to watch the world burn) have other effects on biochemistry as well. These little messengers that go cell to cell and tell the body what to do fall into a few different categories, and they all do slightly different things.
IL-1: Interleukin 1alpha and beta are the main fever producers. These are the messengers that make you have chills and increase fever, and they also go to a gland in your brain called the hypothalamus to help you crank out the hormone that releases stress hormones. It bumps up two types of white blood cells, macrophages and monocytes. Macrophages are the white blood cells that eat up the bad microbes. Monocytes can turn into macrophages, and they can also turn into dendritic cells which are like messenger boards telling killer cells what to go after. Interleukin 1 is pro-inflammatory, which also means IL-1 makes you feel like crap. This is the tiny molecule that makes you want to wrap up in a blanket, watch movies, and feel achy muscles. It also gives you a transient insulin resistance, probably because of how it interacts with the stress hormone cascade.
TNF is a happy group of cell messengers that cause cell death. They?re pretty metal about it, and if someone is going to have a real bad hospital-needing kind of day due to a fever, it?s usually because of these molecules. This by itself can make a fever, or it can tell IL-1 to make a fever. One of the molecules called TNF-alpha can also help cool you down. This cytokine also makes you tired, takes away your appetite, and if you have too much of it, will send you into shock. It does a lot of cool things that aren?t relevant to fevers, too.
IL-6 is an interesting molecule that both makes inflammation and prevents inflammation. During a fever, interleukin-6 waltzes right into the brain and adjusts the thermostat to make your set point higher. The protein also actively floats around and helps white blood cells spot viruses. This pyrogenic cytokine also is the thing that makes you depressed and anxious when you?re sick, and is implicated in schizophrenia because it makes your DNA hard to read in the brain. Essentially this is the part of making a fever that might also make you delusional, worried that you?re going to die, and sure that there?s no hope for you.
Interferon, or IFN, is a group of signaling proteins that tell the white blood cells ?Hey over here, look over here!? They also screw up virus reproduction and activate other white blood cells that help take out microbes. As a bonus, they give you ?flu like symptoms? including muscle pain, dizziness, headache and fatigue.
Like all biochemical processes in the body, you only want just the right amount of the pyrogens causing fever. In that goldilocks combination, fevers come with being tired, not wanting to be around other people, muscle aches, not wanting to eat, and all of the other things we just talked about. It?s a smart system- fighting microbes is hard work, and humans in general tend to keep doing their day to day lives unless they have a reason to stop. Your body gives you the reason, and then rest helps your body fight off the microbes.
Step 3: Recognize a Healthy Fever, and know when a fever is dangerous
A fever in an infant 3 months or less is always an emergency. Go straight to the hospital. Newborns can?t regulate their temperature, so getting up to 100 F means something is not right in a major way.
After that age, it?s not a fever until 100.4 F (38 C). 99 F is not a fever. You can run 99 F and be totally normal. It?s only 0.4 degrees away from average body temperature. A healthy fever is between 100.4 F and 102 F. Look at yourself or your kid and see how they?re acting. My kiddos with their 102.9 fever were playing, eating, drinking and moving around. Playing, eating, drinking, and moving around are normal kid behaviors, so I wasn?t super worried about their fever even though that number was up there. We did give them medicine, and they did respond well. Today they?ve been running at about 101.9, and I haven?t been medicating them. It?s interesting to note that generally children handle fevers better than adults, and that may be because average body temperature tends to go down as we age.
Fevers that get over 102 and leave you or your child unusually irritable, lethargic, and uncomfortable are problems. Fevers that last longer than 3 days are problems. Fevers that won?t respond to anti-pyretics are problems.
Fevers that come along with severe headache, seizures, stiff neck, confusion, repeated vomiting or diarrhea, worrisome, different, or unusual symptoms should get emergency care. For kids, I am generally most worried if they are lethargic. If they stop playing, there?s a problem. If something normally bothers them (like a physical exam, or getting their temperature taken) and they?re not reacting to it, that?s a problem.
Fevers that are between 100.4 (not 99) F and 102 F that last for less than 3 days, respond to treatment, and don?t cause unusual irritability, lethargy, or intense discomfort, are how your body helps white blood cells fight off bacteria and viruses.
Step 4: What to do for a normal fever at home
Consider doing nothing. Bodies need fevers to fight off microbes, and it?s a totally viable option. It?s also free. Get some rest, follow those cytokine cues, stay hydrated, drink some bone broth or tea, put on a Disney movie (or my personal sick day favorite, The 10th Kingdom) and ride it out.
However, if a fever is preventing your family from sleeping or starting to head in a too-much-fever direction, there are some other things you can try too:
- Tepid Bath is one of my favorites because water is usually pretty accessible and easy to use. Pop that feverish body into a bath that?s set at 95-100 F and not very full. Let kiddo splash around and use a washcloth to put a thin layer of water over the whole body. You?re essentially using water evaporation to cool down. Don?t use cold water- it?ll be uncomfortable and if you begin shivering, your body is trying to heat back up and may heat up more. 30-45 minutes later, temperature should have dropped by 1-2 degrees.
- Cold washcloth to the head or neck feels good anyway, and can help you regulate your temperature. Note, if you are using a temporal thermometer and a cold washcloth on kiddos temples, the thermometer will be inaccurate.
- Elderflower and Ginger Tea helps you sweat, which helps your body cool down via evaporation without having to sit in a bath for half an hour. These are both kid safe herbs, though kiddo might not be fond of ginger, so it?s okay to leave that out if desired. 2 teaspoons of elderflower and ? teaspoon of minced ginger in 8 ounces of hot water, steeped for 15 minutes. Adults can drink it hot, but you should make sure it?s cool enough for kiddo before handing it over to them to drink 3 times a day. For people over 1 year old you can add honey to sweeten the deal, and honey has a number of soothing effects for sore throats and coughs too.
- Cold socks are a treatment you?ve heard about from me before, but they truly are a magical treatment for helping you feel better and get some good rest. To warm feet (put them in a warm bath if you need to), apply thin cotton socks that you?ve soaked in cold water and wrung out until they were cold and not damp. Cover (completely) these cotton socks with dry wool socks (though I?ve found that fleece feetie pajamas or a really thick sock work just as well), get those feet into bed, cover up, and go to sleep. It sounds crazy but what the process does is trick your body first into thinking that it?s freezing, and then when your brain figures out it?s not freezing, sends all your blood to your feet to warm them up. Since blood operates in a closed system, that vasodilation at the feet pulls blood from other places in your body to diffuse the cold. I use this method especially when the kids have a runny nose or a lot of mucousy congestion. The twins were only 2 months the first time they got cold socks for runny noses (though their socks were more like, slightly less than room temperature socks) and my 4 year old will actually ask for cold socks when he?s not feeling well. Anything that helps the kiddo sleep while also lowering a fever is a great trick in my book.
- Antipyretic medications have their place here too. Don?t use aspirin in kids or teenagers because aspirin (or willow bark, or any other salicylate containing herb) in the presence of a viral infection can trigger a serious disease called Reyes Syndrome.
Tylenol aka acetaminophen should not be used in infants less than 6 weeks (and I?m not a fan of using Tylenol for basically any reason at any age because of the ease in overdosing and harming the liver as well as implications that Tylenol has a number of other effects in the brain that aren?t positive).
Ibuprofen aka Advil should not be used in infants less than 6 months. Both acetaminophen and ibuprofen are dosed in children according to weight, so check out this helpful chart.?I only use dye free medications as there are a number of side effects and problems with the most common coloring agents used in the United States.
Fevers have a way of disrupting the whole house. I?ve been up with my sick post bedtime kids 3 times just while I was writing this, and I?m definitely looking forward to everyone being healthy again. While I understand and appreciate fevers, they sure are a pain in the butt! I hope you and yours find this useful, and that you all sail through this season of illness with no problems. If you have questions or need more help, please come in and talk to us to get an individualized care plan, as this is not intended to be a substitute for an office visit.
If you want to go literature hunting, here is a haphazard citing of what I used while I was writing this:
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3916915/ – athletes and sauna for WBC
- A. Mace, L. Zhong, C. Kilpatrick, E. Zynda, C.-T. Lee, M. Capitano, H. Minderman, E. A. Repasky.Differentiation of CD8+ T cells into effector cells is enhanced by physiological range hyperthermia.Journal of Leukocyte Biology, 2011; 90 (5): 951 DOI:?10.1189/jlb.0511229
- Watanabe N, Kobayashi Y (Nov 1994). “Selective release of a processed form of interleukin 1 alpha”.?Cytokine.?6?(6): 597?601.?doi:10.1016/1043-4666(94)90046-9.?PMID?7893968.
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1909906/pdf/brjpharm00087-0052.pdf TNF
- http://www.ijdvl.com/article.asp?issn=0378-6323;year=2013;volume=79;issue=7;spage=35;epage=46;aulast=Dogra TNF alpha suppression
- ?Greicius MD, Flores BH, Menon V, Glover GH, Solvason HB, Kenna H, Reiss AL, Schatzberg AF (Sep 2007).?“Resting-state functional connectivity in major depression: abnormally increased contributions from subgenual cingulate cortex and thalamus”.?Biological Psychiatry.?62?(5): 429?37.?doi:10.1016/j.biopsych.2006.09.020.?PMC?2001244.?PMID?17210143.
- Bhatti Z, Berenson CS (2007).?“Adult systemic cat scratch disease associated with therapy for hepatitis C”.?BMC Infect Dis.?7: 8.?doi:10.1186/1471-2334-7-8.?PMC?1810538.?PMID?17319959.