"Childhood Fevers" by Rahima Baldwin Dancy deals with how fevers can strengthen the immune system and how childhood illnesses can help a child's development; febrile seizures and home care are also covered. The article first appeared in Mothering, Spring 1989.
Most childhood illnesses are characterized by fever. It is widely known that fever activates the immune system in a natural way. It is less widely known that fever can strengthen the immune system, help prevent susceptibility to other illnesses in later life, and confer developmental benefits as well.1 Pediatrician Uwe Stave reports: "Fever attacks can affect children in quite a positive way. Even though his physical strength is reduced, the child may disclose a wealth of new interests and skills. He may find new and advanced ways to communicate, think, and handle situations, or display a refinement of his motor skills. In short, after a fever, the child reveals a spurt of development and maturation."2
Dr. Stave explains this observation by referring to the effect of warmth on the physical organism: "Fever acts by shaking and loosening up the physical body. Activation by heat can help the Ego form and reshape the physical organization of the young child. In addition, the physiological and biochemical functions of organs and systems are assisted in the maturation process through febrile illness, and inner forces gain strength and become more differentiated. Although the pediatrician often shares parental concern that repeated feverous infections overstress the young child's fragile organism, fever most often supports development and individualization, although it is sometimes a warning signal, indicating weakness in the child's defense against his environment. As children grow older and learn how to control the will, gradually an "inner fire" replaces the "developmental fever" of a young child. 3
The Vaccine Factor
Many of the childhood illnesses that involve fever, such as measles, chickenpox, and mumps, have nearly become anachronisms due to the routine vaccination of infants. Parents who choose not to have their children vaccinated for some or all of these illnesses need to appreciate the seriousness of the diseases and the child's special need for strict home care and medical help in mustering the forces to overcome the illness. Measles cannot be treated like a common cold or flu. Whooping cough requires weeks of convalescence and may require medicine to help fight the illness successfully.4
On the other hand, if you do vaccinate your child, you need to recognize that introducing the illness through the vaccine is a powerful shock to the body. Dr. Wilhelm zur Linden states that the reason vaccinations are given to babies and infants is because older children can react with cramps, fever, vomiting, and confusion. He states, "It is now known that small children react so mildly because they do not yet possess sufficient strength with which to counteract the vaccination."5 Dr. Zur Linden suggests giving the homeopathic remedy Thuja 30x morning and evening, starting on the day of vaccination, to help protect the child from the effects of the vaccine-induced illness. Whether or not to vaccinate a child, for which illnesses, and at what age are individual decisions that parents must make for their children, weighing the pros and cons as best they can.
Fevers Are for Monitoring, Not Suppressing
Hippocrates taught that fever is the helpful response of the body to the disease process-the body's way of overcoming disease. About 150 years ago, this theory was replaced by the still prevalent opinion that fever itself is a disease and needs to be treated as such. The tendency today is to give antibiotics, or at least aspirin or acetaminophen, at the first sign of fever. However, recent studies show a strong connection between taking aspirin for viral illnesses, such as chickenpox or influenza, and the subsequent development of Reye's syndrome. As a result, the Centers for Disease Control and the Committee on Infectious Diseases of the American Academy of Pediatrics now warn against giving aspirin to children. The approved choice, acetaminophen, as well as antibiotics work to suppress fever "safely." But when a fever is artificially suppressed in this way, the body's defense system remains inactive.
Fever needs to be monitored, not suppressed. This allows the fever to mobilize the body's immune system, which helps fight the disease at hand and is of possible long-range value in a world with immune-deficiency diseases. Monitoring the course of a fever is also a valuable diagnostic tool. Because certain illnesses have characteristic fever patterns, observing your child's fever will help in a diagnosis. If your doctor advises bringing down the fever or you decide to do so, consider using some of the nonsuppressant therapies discussed later in this article.
Treating Febrile Seizures
What if the fever gets "too high"? When fever runs high, it can sometimes lead to a febrile seizure, or convulsion. Dr. Alvin N. Eden, whose point of view is representative of sound mainstream medical thinking, explains that a "simple febrile seizure" is a convulsion caused by a high fever from an infection anywhere in the body that does not primarily involve the brain. He notes, "Therefore, by definition, a child who has a fever during a seizure does not have epilepsy. Furthermore, simple febrile seizures do not lead to mental retardation' '6 He suggests that if a child has a febrile seizure, the parents consult with the physician to make sure the child does not have a "complex febrile seizure;' which stems from infection in the brain.
What usually happens is that a healthy one or two year old becomes ill, often with a sore throat or ear infection, and starts to run a high fever. If the temperature reaches the child's particular threshold for convulsions, it produces a seizure. The child may start to twitch and then shake violently all over. He or she loses consciousness, the eyes roll back, and often the child foams from the mouth. "These generalized convulsions, called simple febrile convulsions, rarely last longer than five minutes and stop by themselves without specific treatment. After it is over, the child frequently goes to sleep, and when he wakes up, he is fine. The first seizure is always a harrowing experience for parents, but no permanent damage results, and the baby will be fine."7 In almost all cases, the convulsion occurs during the first day of the child's ill
ness and does not recur during the same illness.
It is important to know what the child's temperature is at the time of a convulsion, for this is the "threshold convulsion temperature"-the temperature that you want to avoid in future illnesses! One child might have a convulsion at 103°F, while another might be fine until 106°F The great majority o f infants and children never have a febrile seizure.
If your child does have a febrile convulsion, Dr. Eden advises keeping calm, putting the child on his or her stomach, turning the head to one side, and making sure the mouth is empty. Once the seizure is over, you will want to start bringing down the temperature by giving the child a "sponge bath" with lukewarm water or by putting the child into a cool bath. The evaporation of the water causes the body to cool; however, if the water is too cold, shivering may occur, which increases muscular activity and raises the temperature.
Dr. Eden then suggests having the illness diagnosed. He warns that "some doctors recommend that a child who has had a simple febrile seizure should be kept on daily doses of Phenobarbital for a period of two seizure-free years to help prevent any further trouble. If the child is under three years of age at the onset, these doctors recommend that Phenobarbital should be given until he is five years old. Most physicians do not agree with this approach, however" (italics mine) s
If your physician advises Phenobarbital for fever convulsions, seek a second opinion and research the matter yourself, rather than accepting a course of action on which even conventional physicians do not agree. My own experience with young children on Phenobarbital suggests that the drug's effect is almost like a veil, keeping children from really being "present" in their bodies. As always, the decision and responsibility for your child rest with you. So, become informed of your options and the potential results of various courses of action.
Drawing Out the Fever
Several techniques are available that do not suppress fever but rather draw heat from the body. To help keep a fever from becoming too high, doctors recommend giving the child plenty of fluids (such as water, tea, or juice), keeping the child's room relatively cool, and giving a sponge bath a mentioned above. Alcohol should not be used in a sponge bath for babies, because it is absorbed through the skin and can cause neurological damage.9
A lemon wrap. This technique, described in the useful book Caring for the Sick at Home10, is designed to draw heat away from the head and out the feet. It should be used only if the feet are very hot. Gather long strips of cotton cloth for wrapping the legs. Then, cut a lemon in half and place it in a bowl of warm water. Reach into the water to make slits in the lemon, and then squeeze it by pressing it against the bottom of the bowl. Roll up the cotton strips and soak them in the lemon water.
Now, place a towel under each of your child's legs. Remove one of the strips from the water, squeeze hard, and begin wrapping the first leg starting at the foot and wrapping from the inside of the arch to the outside of the foot. Continue with additional wraps working all the way up to just above the knee. Be sure to cover the entire foot and leg, without leaving any gaps. Immediately wrap the towel up around the foot and leg to prevent too-rapid chilling. (If you do not have a towel handy, wrap a wool shawl or strips of wool fabric over the wet cotton strips.)
Repeat the entire process on the second leg, working carefully but quickly. Immediately replace the covers. Leave the wraps on until the cotton strips dry. This may take about 20 to 25 minutes. If the fever is still high after half an hour, repeat the procedure.
In the absence of the materials described above, others will do. If cotton strips are unavailable when your child produces a high fever, you can substitute a pair of adult cotton tube socks or a pair of your own knee socks that can reach well up your child's legs. In lieu of towels, simply cover your child's wrapped legs and feet with a blanket to prevent too-rapid cooling. If you do not have a fresh lemon, try adding vinegar to the water instead.
Caring for a Sick Child
More important than how you care for a sick child is that you care for a sick child. Children need time and rest to fight off illness and to consolidate the physical and developmental changes that may be occurring. If given insufficient time to recuperate, their immune systems can weaken and become more prone to complications or future infections.
Many busy mothers are so harried that they do not think to call everything to a halt so they can keep their sick child at home and attend to his or her needs; they do not think to get help withthe shopping or driving of other children or managing the many errands that arise each day. Mothers who work away from home are often tempted to give antibiotics immediately (suppressing symptoms) so that their children can be back in school or daycare within 24 hours. Those who cannot use their own sick days to stay home with a sick child are expected to take their children to unfamiliar daycare "infirmaries." Clearly, our culture is not set up to meet the needs of children and working parents.
When a child is sick, one important principle must be kept in mind: the child needs reduced stimulation. A familiar setting and lots of quiet time can optimize the ability to regroup the inner forces needed to heal. This means quiet play, staying in bed if necessary, and eating lighter foods (usually less meat or egg, which most sick children desire less of instinctively). Television, because of the quality of stimulation it produces, is best avoided during an illness.
The importance of home care for a sick child cannot be overestimated. But what can you do at home? For one thing, you can observe your child, both physically and intuitively. With infants, note how they hold their body when they cry, observe the breathing and the nature of the cough, and note the eyes and facial expression. Try to feel what is happening and whether your child is getting better or worse.
All good pediatricians ask parents for their observations and intuitions about a sick child and take this information seriously. So be alert, and develop a relationship of trust with your child's doctor, a feeling that you are both working toward healing of the whole person. Paracelsus, the renowned 16th-century healer, said, "Nature heals, the doctor nurses.... Like each plant and metallic remedy, the doctor, too, must have a special virtue. He must be intimate with Nature. He must have the intuition which is necessary to understand the patient, his body, his disease. He must have the 'feel' and 'touch' which make it possible for him to be in sympathetic communication with the patient's spirits."" As parents, we too must develop the intuition and powers of observation that will help us see our children as more than machines that require a quick fix.
You can do much to help your child's comfort and recovery at home. First, recognize the value of your care and love. All children, particularly when ill, need to be surrounded by warmth and love; but love and connectedness often tip the scales in the cases of seriously ill infants or premature babies. There is real healing power in love.
Next, look at your child's surroundings. Putting the room in order, fluffing the pillows, and placing fresh flowers in a vase will enhance the impressions your child is taking in. Consider the air in the room and the amount of light coming through the curtains, and make adjustments that feel "right." A bowl of water with a few aromatic drops of rosemary or other oil can add freshness to the air. Apply compresses and poultices, prepare special herbal teas, and offer therapeutic touch.
If your child is well enough to sit up, try setting a straight-backed chair upside down at the head of the bed to make a backrest. And maybe make a small lap table out of a cardboard box. Once your child is nearly recovered and eager to do things, you can provide quiet activities. Coloring or playing with small figures in the covers is engaging yet not over stimulating.
If at all possible, do not send your child back to school or the usual routine until he or she has regained full strength. The old adage recommending one day of rest afterward for each day of fever is sound advice-even when your child is symptom-free. Children sometimes become ill because they need time to be quiet at home, time to "reorganize" before making the next developmental move forward. One boy in my kindergarten, for example, tested positive for strep throat but had no symptoms. By law, he was not allowed back in school until he had a negative throat culture. I had a sense that this particular child had gone through some "stretching" to be at kindergarten and to adapt to all the children and activity, and that he was telling us he had had enough for a while and needed 10 days at home with no discomfort!
The health and vitality of our children are our responsibility. Our children will benefit as we learn to view childhood illnesses as a developmental necessity and to regard fever as a serious but essential strengthening process. We can assist in this process by reaching out to healthcare providers and integrating their expertise with our own. Healing is a joint effort, combining the child's inherent immune response, sensitive diagnosis, careful monitoring, and therapeutic home care.
10. Tineke van Bentheim et al., Caring for the Sick at Home (Edinburgh, UK: Floris Books, 1987), pp. 76-77.
11. Gudrun Davy and Bons Voors, eds., Lifeways (Gloucestershire, UK: Hawthorn Press, 1983), p. 269.