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Did you know that just five days of Ibuprofen use has been associated with gastritis, a potentially dangerous inflammation in the lining of the stomach that is caused by this medication? That ibuprofen now has a warning for increasing the risk of heart attacks in adults who use it? And that Tylenol eats up glutathione, one of the body's main natural detoxification chemicals.
Yet these are the medications we turn to over and over for our kids when they have a fever. In this article and podcast, Who's Afraid of Fever?, we're going to talk about fever and get to the bottom of what you need to know – the safety and risks of these medications and some gentle alternatives you might consider using.
One recent afternoon, a lovely natural mama in my neighborhood wrote me a semi-frantic email. Her little nine-month old daughter was ‘running a high fever,' she said, ‘of 100.4.' Since her daughter also had a cough, this mama was worried about pneumonia. “I've been giving her ibuprofen around the clock to try to bring the fever down,” she added, “and I'm really scared.”
A few emails later, she was reassured that this was a low temperature and that her daughter did not have symptoms of pneumonia, and she was more able to relax. I totally get it though: When my son was around 18 months old – now he's almost 38 now – he had his first fever. I took him to the doctor because I didn't know what else to do. It's still what most mamas do.
She told me it was probably a viral infection, and still she recommended that I give him an antibiotic – and she told me to rub him down with rubbing alcohol. I got the prescription filled, but something inside me was saying, “Wait a minute. Viral infection? I thought antibiotics were for bacterial infections.” And when I opened that bottle of rubbing alcohol that I brought home with me and had my son in the bathtub – she had said, put him in a tepid bath and rub him down with the alcohol – something just struck a nerve in me and I didn't do it.
I ended up not doing any of these things. Instead I called the doctor and told her he was nursing, resting, and otherwise seemed himself, so could I just watch and wait – and that's what I did.
What's really interesting and slightly disturbing is that we now know that rubbing kids down with rubbing alcohol when they have a fever is a major cause of nerve damage in kids! So it's not recommended medically anymore; that treatment has gone the way of the dinosaur – as in it's a completely extinct recommendation.
We also know that 70% of all antibiotics that are recommended to kids are completely unnecessary and inappropriately recommended – and that they can cause long-term health problems in our children. It's also a leading cause of the global antibiotic resistance crisis.
I'm glad I trusted my intuition, but I was pretty scared. I think we've all been pretty well programmed to assume that we have to treat a fever and that fevers are kind of scary or maybe dangerous. So I set out to understand more about fever and get comfortable with it, to know when to get medical care and when not to, and what I could do to to make my children more comfortable when a fever did happen.
That was 37 years ago and in the interim years, I've now guided tens of thousands of families safely through fevers without unnecessary medical treatments. And now as a Yale- trained medical doctor, I'm even more convinced of the need for us to avoid unnecessary meds for our kids.
Unfortunately, I've seen kids chronically overmedicated for fever, encouraged by doctors and also moms who are scared. We don't know what else to do. I really want us to feel empowered to know when to treat, but also to know when not to treat and what we can do instead. If you're a mama, which is probably why you're listening to or reading this, or maybe you're a grandparent, you are inevitably going to have to deal with a fever because pretty much every otherwise healthy kid is going to have one at some point. In fact, over 5 million parents take their kids to the emergency department every year for fever, 5 million parents. That's a lot of emergency department visits.
I wanted to learn more so that I felt more confident next time. So I set out to to understand more about fever, get comfortable with it, know when to get medical care – and when not to – and what to do to make my child more comfortable. That was 30 years ago, and I’ve now guided 10's of 1000's of families safely through fevers without unnecessary medical treatments. And I want to help you get more comfortable with fever so you can make the best decision when your child inevitably does have one. And also you can understand the risks and benefits of both fever and the treatments for fever. So you can decide what to do. You might be wondering, should you give Tylenol? Should you call the doctor's office hoping that you reach someone?
So what if your little one wakes up in the middle of the night, fretful and hot to the touch. You check her temperature and it is 102 degrees. She’s had a cold for a few days but hasn’t had a fever until now. Or she's screaming from the pain of an ear infection. You feel worried and don’t know what to do. Should you give Tylenol? Should you call your doctor’s office hoping to reach someone in the middle of the night? Go to the emergency department? Can you wait until morning? You’ve heard about using herbs for fever and thought it sounded good at the time, but now that your child has one, you’re not so sure.
Believe me, I've been there as a mama, and also as a family doctor who practices pediatrics and spent several years on night call triage and hospital admissions!
What should you do?
The immediate answer to the above question for starters if you're child has a fever right now is:
- If your child is under 1 month old and has a temperature of over 100.4 degrees, or under 3 months old with a fever over 101.5 and nobody else in the family has a cold, call your doctor or go to the emergency room.
- If your child is listless, not responding to you normally, or seems ‘very sick,' call your doctor or go to the emergency room.
- For everyone else, take a deep breath, relax, and read on…
If this is your child's first time having a fever, it can make you feel really anxious and it can cloud your judgment. Even if it's not your first time at the rodeo, our child being sick generally makes us feel vulnerable, anxious, and emotional. So try to take a few deep breaths. Literally take take a step back, take some deep breaths, and try to objectively notice how sick your child seems to be. Kids with fevers, especially if it's on the higher end, are gonna be sleepy, they're gonna be cranky. They may sleep a lot with a higher fever at the lower end of the range. They may be really fussy, irritable, cranky, uncomfortable. A breastfeeding baby may never want to get off your boob cause they just want to nurse all day long. It's how they're staying hydrated but also comforted. And very commonly kids when kids are coming down with something, the fever is the first thing you notice – or sometimes you'll notice your kid was kind of acting not herself for a day or two, then fever and then cold symptoms come on. Sometimes the cold symptoms come first. You notice a little runny nose, their eyes look a little glazed or red or irritated and then Shazam – it all comes on at once.
Fear of Fever
Fever is at the top of the list of the three conditions that parents are most afraid of their kids getting (cough and meningitis are the other two). We’ve all been pretty well programmed to assume we have to treat fever, and even that it’s scary or dangerous.
And what we're mostly afraid of is usually the implications or the consequences of a fever. Is it some really scary disease that's causing the fever? And even more so most, most parents wonder or worry that the fever can cause brain damage, a coma or death. That's pretty scary stuff to wonder about. Actually some healthcare providers are also afraid of this, even though the facts show that these are completely unrealistic fears in almost every case of fever in a But the facts are that those fears are very unrealistic in almost every case of fever in a child.
Nonetheless, it can feel really darn scary when our kids are sick. We've been raised to think that fevers are dangerous, and this is reinforced by the fact that we're encouraged by our children's doctors to give medication to bring the fever down. But is this really necessary? And are fevers dangerous?
How to a Check Temperature
Most of us mamas are pretty cued into our children's fevers – we know when they feel hot. And that's what usually leads us to check a temperature – which I recommend doing to confirm that there is (or isn't) a fever – which will also help you decide what the next best steps are. It also gives you a baseline to compare to so you can see if the temperature is going up, or resolving.
Digital (electronic) thermometers are easily found in stores and are relatively inexpensive.They can be used for rectal, armpit and oral temps. Most of them give an accurate temp in 10 seconds or less. The AAP suggests you replace any glass thermometer in the house with one of these products – definitely do not use mercury thermometers with children of any age – and if you do dispose of them, they should be disposed of properly as they are considered toxic waste (i.e., don't toss them in your trashcan!).
A temperature is typically considered a fever if over 100.4 degrees F. Most fevers are in the range of 101-103.5 degrees. A high fever is over 103.5. However, readings are also going to be higher or lower depending on whether you take the temperature: under the armpit, forehead, rectally, or in the ear, and not all methods are appropriate at any age:.
Here's a helpful list: of when doctors consider a child to have a fever:
- Rectal, Forehead or Ear temperature: 100.4° F (38.0° C) or higher
- Oral (mouth) temperature: 100° F (37.8° C) or higher
- Under the arm (armpit) temperature: 99° F (37.2° C) or higher
What's the most accurate?
- Rectal temperatures are the most accurate.
- Forehead temperatures are the next most accurate and are the most convenient.
- Oral and ear temps are also accurate if done properly. and ear temperatures are generally easy to check, but ear temperatures are not accurate before 6 months of age
- Temperatures done in the armpit are the least accurate. but can be done at any age.
And methods also differ by age:
- Under 3 months old: Checking an armpit temperature is the safest method, while a forehead temperature may be accurate and is easy, too. However, if the temperature is elevated in either of these methods, check it with a rectal thermometer and if elevated, bring your baby to the doctor immediately.
- Age 3 months to 4 years old. Rectal or forehead temperatures are accurate, and an ear thermometer can be used after 6 months old. The armpit method is also okay if done correctly.
- Age 4 years and older. At this age, it's safe to take the temp by mouth (orally). Ear and forehead thermometers are also good methods.
It's important to check in the same place each time during any illness, and to compare to the expected ranges for that method.
Temperatures are going to be slightly higher if your child has been swaddled, bundled, or in a warm bath (I don't recommend checking temperatures within 15 minutes of a bath), and oral temperatures will be higher after warm drinks, so wait 15 minutes after those if checking orally.
What is a Fever? Is it Dangerous?
Why do we get fevers? Simple: The body creates fever for a reason. It raises the temperature to create an inhospitable environment for most of the “bugs” that can make our kids sick, and which prefer to thrive at normal body temperature – 98.6 F.
When the temperature goes up, the body mounts an inflammatory response that fights bacteria, viruses and other infections. In fact, the aches and discomforts that you are probably familiar with from having had a fever yourself and our kids get is due to these inflammatory chemicals, some of them called cytokines that are fighting off the infection.
Fever also activates white blood cells and antibodies and many other mechanisms for fighting off the infection. So the body raises the temperature a few degrees to give the body a winning edge because those microorganisms don't thrive or survive as well at higher temperatures.
So fever is actually beneficial and not harmful in almost all cases. The fever itself is not an illness – it's a symptom, and also part of a natural and healthy inflammatory response that mobilizes white blood cells, antibodies, and cytokines to fight infection.
Fevers in kids are generally caused by common viral infections, and most of these are not dangerous. Kids will often have symptoms such as a cough, runny nose, earache, or rash – but often the fever comes before the symptoms. When there are cold symptoms accompanying a fever, all you pretty much need to do is wait it out, keep your child comfortable, and keep him hydrated. Interestingly, even more kids with ear infections and sore throats (85% of sore throats are viral, not strep) do not need medical treatment other than also comfort, support, and hydration.
Bacterial infections such as strep throat, urinary tract, and some bacterial ear infections can also cause fever and these are times when your child may need antibiotics, but that's to treat the infection – even in these cases , the fever is a symptom telling you something is going on – not the problem itself.
Of note, the height of a fever has very little relationship to the severity of the illness, except for in babies under 3 months; in that case, the risk of a serious illness is 10 times higher with a high fever. Kids can have more serious illnesses with lower temperatures, and have common upper respiratory viral infections with a high fever.
But what about brain damage from fever? The idea that there is a “glass ceiling” on fever has been recognized since the 1940s. Unlike in a condition like hyperthermia, which can occur with certain medications or nervous system problems where the body’s thermostat has been hijacked, in fever the brain has a natural turn-off mechanism. Fevers in kids rarely EVER exceed the body's natural fever cut-off point above which it's not going to go higher than is safe. So fevers and kids rarely ever get above 105 – high enough to cause brain damage or a coma. In fact, brain damage from a fever is so extremely rare that it's just really not something to worry about in normal, healthy kids with otherwise intact brain function. In fact, there is nothing inherently dangerous about fever. The risk really has to do with what the underlying infection is, and whether your child is staying hydrated.
Are Fever Medications Okay to Give?
Tylenol and Ibuprofen can both moderately reduce fever and with it, aches and pains that accompany fever and cold and flu, as well as earaches and other conditions that might cause fever. Ibuprofen is the more effective of the two, and they are commonly used in conjunction, alternating them over the day. These medications do help with comfort but they're not helping the illness to go away any faster nor do they decrease the risk of febrile seizures.
While Tylenol, ibuprofen can reduce fever by about a degree, they don't get to the underlying cause, don't shorten the duration of the illness, and while they can help your child to be more comfortable, which is important, they do carry risks.
Tylenol has been associated with liver toxicity and increases the risk of developing asthma. Tylenol uses up, it burns up something called glutathione, which is naturally produced by your body. Your body uses glutathione to take care of what we call free radicals. It helps as an antioxidant. When we burn that up, we open up ourselves to lots of oxidative stress. Tylenol partly as a result of this, is associated with liver toxicity. In fact, in some countries Tylenol can only be sold over the counter in pharmacies by the pharmacist at a maximum dose.
Ibuprofen, and other NSAIDs (non-steroidal inflammatory drugs, like Ibuprofen), can cause gastritis and stomach bleeding just from using them every day for a week for fever, are associated with secondary infections, and may delay healing.
In fact, I treated a 4 year old girl who had developed severe gastritis as a baby from the simple, usual recommendation of giving alternating Tylenol and Ibuprofen “around the clock” which led to her requiring Prilosec for 6 months, and in her case this all led to a domino effect of medical problems, including an autoimmune disease. Of course, this is rare, and fortunately, we were able to put her condition into remission – but the more we learn about these medications, the more we learn about their potential unintended side-effects, short and long-term. So yes, use them if needed, but remember, they're not ‘candy' and they're not benign.
In my practice, if a child is mildly uncomfortable with a common febrile illness (cold, flu, sore throat, ear infection), I suggest starting with natural remedies if possible. If a child is quite uncomfortable, for example with the flu, and natural remedies aren't touching the symptoms, I recommend a day or so of using the common fever medications, but I do always recommend natural remedies first because they are often a safer choice.
Febrile Seizures
I just want to mention a word about seizures, because if your child experiences them, it can be downright terrifying to see, and it's a good idea to know about them.
About 4% of all children will sometimes have a seizure with their fever. A febrile seizure is caused by rapid increase in the temperature, not by the height of the temperature. They typically occur between 6 months old and 5 years old and they rarely ever have any lasting consequences, and they rarely ever predict that that child has a seizure disorder like epilepsy. Once a child has already had a high fever and a febrile seizure, a seizure is unlikely to recur again in that illness, but that child is likely to have seizures with subsequent fevers.
If your child does have a seizure, it's very scary. A lot of parents will call 911. It's not technically necessary to do so, but no harm if you do, of course, and you might feel you need that support – totally understandable. Importantly, make sure your child is in a safe space, for example, there's nothing to bang his or her head on or fall off of. Call your pediatrician or family doctor and let them know what's happened and find out what they want you to do, and discuss your plan of action for next time so you're prepared should it happen again. Of note, the use of fever-reducing medications has not been shown to prevent febrile seizures.
When to See the Doctor
Most fevers are due to minor and self-limiting viral infections. The exception to that is if a child has a fever and doesn’t really have any cold symptoms. One thing to consider in that case is a urinary tract infection, so you want to be aware of that.
Any babies under 3 months old with a fever should be seen by a physician because they’re more susceptible to serious bacterial infections just due to the natural immaturity of their immune system, and also higher risk of infections that they could have picked up if they were born in the hospital or if mom had any kind of communicable vaginal infection.
Any babies under 6 months old with a high fever (~103.5 F) should be seen, unless the fever comes down quickly, with fever treatments like Tylenol or ibuprofen, and the child is otherwise comfortable.
Any kids who are not taking fluids or not urinating a normal amount or just not acting right should be seen. If there’s a stiff neck, persistent vomiting or severe headache – which can be meningitis, although again, that’s rare – severe ear pain or belly pain, they should be seen. If they don’t seem fully able to wake up, they seem weak or limp or they can’t make eye contact.
And children of any age who have had recurrent fevers for more than 7 days, even if the fever lasts only a few hours. And, of course, if you just feel like your child needs to be seen, then go get seen.
Now, for me, as a mom, I usually started to get a little anxious when the fever got over 104. And that’s my experience with a lot of parents. Once it starts climbing over 104, 104.2, parents get pretty nervous. That’s a good time to call your pediatrician or family doctor, if you haven’t already, and that’s the point where I usually say, “You know what? If you want to give something to bring the fever down a little bit, that’s reasonable.” Because it just puts you back in your own comfort zone.
And here's the thing – if you're just not sure, if your emotions are running away with you, or if your mom intuition alarm bells are ringing – call your child's doctor, go to urgent care, or the emergency department. That's what we're here for and we don't mind providing reassurance. Just keep in mind that you can get the assessment but if it is a common viral infection and an antibiotic is prescribed, you can ask more questions about whether it's truly needed to avoid the antibiotic overprescribing that's so rampant and can have unintended personal health consequences and contributes to the global problem of antibiotic resistance that we all have to play a part in preventing.
In summary, see the doctor for:
- All babies under 1 month old with fever should be seen by a doctor immediately. This can be a medical emergency!
- Babies under 3 months old with a high fever (see above) should be seen by a doctor.
- Any kids who are not taking fluids, not urinating a normal amount compared to usual, or are just not “acting right” should be seen by the doctor.
- Any kids with fever along with stiff neck, persistent vomiting, or severe headache should be seen by the doctor.
- If your child has severe ear pain or severe belly pain.
- If your child is lethargic – that is, he just isn’t really waking up fully, seems weak, or just seems sort of limp, is just lying there, and doesn’t really make eye contact.
- Fevers that stay high for more than 3-5 days.
- If you feel worried that your child has a serious illness, take your child to the doctor. Remember, trust your momma intuition! (and better safe than sorry).
Remember, though, most times a fever is just a helpful way your body has to fight a viral infection. Supportive care with fluids, rest, and light foods, and the comfort of herbal teas and extracts, is generally all that's needed to help your children recover safely and naturally.
What Can You Do? Common Sense and Natural Fever Remedies
Keep in mind that you do not have to treat the fever itself – the body is trying to mount this fever to fight the infection.
When your child has a fever the most important thing is to encourage rest and give plenty of fluids. Fevers may continue for a number of days or go away and come back – especially in the afternoon and evening – for several days. This is usually not a problem if the child is taking plenty of fluids and seems otherwise well.
Hydration is key: Give your child loads of fluids during the fever. Nursing babies should nurse freely. Older babies can be nursed often and given a little bit of water by teaspoon, sippy cup, or even an eye-dropper every 30 minutes. If your child is sleeping a lot, wake him up periodically for sips of water, a healthy electrolyte drink, or herbal tea (no caffeine!). If your child is refusing to drink much, then give sips of their favorite unsweetened flavored water, broths, herbal teas or natural fruit juice ice pops. While I'm not a fan of giving sugary fruit drinks, getting fluids in is essential – and an average ice-pop has about 4 oz. of fluids and kids love them.! Herbal ice pops are also a terrific, tasty and sneaky way to get natural remedies into your kiddo! See the opt-in option at the end of this article for a wonderful herbal ice-pop recipe download! Signs of dehydration occur when dehydration becomes significant and include: not producing much body fluid so they're not peeing very much, tongue appears dry, skin has less tone, eyes may look a bit sunken, and the mouth might appear pasty. If your child had gotten to the point of showing dehydration, that's when you do wanna call your doctor and when IV fluids may be needed.
Rest and Stay Home: Let your child rest and sleep as much as she needs to. Create a quiet, comfortable, restful environment and keep your child home from day care or school during a fever. If your child has a fever, please keep him or her home from school optimally for 24 hours after the fever is resolved. This allows your child to rest and convalesce, while keeps infections from spreading. I know this can be really inconvenient if you have a job outside the home, and more so if you're a solo parent – but it's so important personally and for public health. One of my all-time favorite memories from childhood is having the flu and my single, working mom staying home and reading books and watching movies with me on TV.
Nourish with light foods: t's normal for kids to have very little appetite when feverish. Keep foods light – soups, broths, toast, small amounts of fruit, steamed vegetables – and don't force them to eat. But do push fluids!
Avoid swaddling and overheating: Remember that swaddling increases body temperature so make sure you're not over-bundling your baby or child. Light loose layers of natural breathable fibers and light layered blankets are best. If your child is old enough to say he has a child or feels cold or hot, you can adjust layers as needed.
Herbal Support
Herbs can be used to help ease the symptoms associated with a fever – aches, headache, tummy discomforts, and chills. High fevers can be lowered a bit with these herbs. Here are some classic herbs for feverish kids that I used with my own children and that I use in my medical practice. These are also safe for babies.
You can also use these herbs in teas, glycerites or tinctures, which I discuss below.
- Chamomile, Catnip, and Lemon balm tea: These herbs are all relaxing, traditionally used for fever, ease aches and pains, and reduce tummy upset: They're all very pleasant tasting and very gentle even for little babies.
- Fresh ginger root tea: Ginger is antiviral. It's antibacterial, it's great for tummy troubles. It helps break up mucus and congestion. So it's great when there's coughing or a lot of runny nose. It also helps with chills, aches, and general discomfort with fever.
- Spearmint leaf and Elder blossom tea: This is traditionally used to bring the fever down a little bit by causing a sweat, which you can do if you're feeling nervous, but remember, causing a child to sweat actually leads to more loss of fluids and risk of dehydration, so bump up the liquids.
- Lavender oil: A few drops of Lavender essential oil can be added to a warm bath, 3-5 drops per bath, to soothe fever symptoms, but avoid a chill when they come out.
Purchasing and Dosing Herbal Remedies
Teas are a wonderful way to use these herbs (other than the lavender, which is for aromatherapy only). Many of these herbs are also available in the form of glycerites – a form of tincture that tastes sweet and is slightly syrupy that kids love. Herb Pharm and Gaia Herbs are good sources for these. Both companies offer a wide variety, and offer a plus in that they put baby and child dosing on their packaging making it easier for you dispense the correct amount by age or weight.
If you can't find the bulk herbs locally, they can be ordered from the online company Mountain Rose Herbs. Nursing moms with feverish nursing babies can drink adult doses of these herbal remedies. Some of the benefits of the herbs will pass through the milk to the baby, but not a ton – baby can be given unsweetened herbal tea via eye dropper next to the nipple, but honestly, breastfeeding itself does the job, so that's what I encourage – and never substitute tea or other beverages for breastmilk – your milk is actually able to adjust to your baby's needs while sick, including providing extra doses of antibodies and immune-supporting factors!
Tea is usually given in a dose of 1-2 eye dropperful to 1/4 cup to children under 1, 1/4-1 cup every few hours to toddlers and older children.
For children over 1, teas can be sweetened with honey or maple syrup. Honey is excellent for treating coughs, too! (Do NOT give honey to babies under 1 year old – it can cause infant botulism.)
Full instructions on preparing and using herbal remedies for children can be found in my book, Naturally Healthy Babies and Children, and even more comprehensively in my online course for parents who want to be natural home-health mavens, Healthy All Year.
Other Supplements
You can also supplement with age appropriate doses of immune supporting vitamin D, zinc and vitamin C as well as a probiotic – all of which have been shown to prevent colds, and which may shorten their duration. I usually recommend staying on the supplements if you've started them, the vitamin D, the zinc, the vitamin C and the probiotic as I mentioned, again for five to 10 days after the fever has broken and the symptoms have gone away just to continue to support the immune system.
If you want to learn about all things herbal and natural medicine, and also become an expert at mom-home-health – you might also love my course, Healthy All Year, which you can learn about under courses on my website home page.
How To Know That Things Are Improving
Kids can run a fever for as short as 24 hours, but typically, fevers last for 5-7 days. Things are improving when your child is starting to perk up and feel better. Sometimes, you’ll notice they’ve broken a sweat. Your child starts to want to get up, play more and interact, and their appetite is returning.
In summary, remember, most fevers are viral infections; in babies under 3 months a visit to the doctor is critical; it may also be necessary in babies under 6 months old. Keeping your child comfy, offering a light diet guided by your child’s appetite, lots of hydration, using simple herbal remedies, and creating a supportive, nourishing environtment is all that's needed for most common children's illnesses with fever. If medications are needed, keep it to the minimum amount of doses for the shortest number of days. And allow some time for convalescence to prevent rebound and secondary infections – and remember, you're not bothering your doctor if you call or go in – but there's a lot you can learn to do to also build your confidence as “doctor-mom.!
Wishing you trust in your momma wisdom!
