Fevers: treat at home, urgent care, or ER?

I have teamed up with Natalie Wescott, an ER RN, to discuss the top 3 reasons she sees kids in the Emergency Room. We’ll also discuss how to support and treat these issues at home, and when to seek a higher level of care. Natalie brings a very unique perspective, as she is holistic minded but works in the field of modern medicine. This is great, because there is a time and a place for both!

The top 3 reasons Natalie has seen kids in the ER:

• Respiratory Distress

• Fevers

• Lacerations

Fevers can be tricky because they can be a symptom of so many different illnesses and diseases - some very serious. For the purpose of this post, we are focusing on viral illnesses. If your child has a fever of unknown origin, or has odd symptoms (not typical viral symptoms), you may need to seek a higher level of care. 

What is a Fever?

A fever is a natural response to an infection or illness. It is a good sign, because it means that your body is fighting off the infection. The increased body temperature from a fever boosts the performance of immune cells and induces stress on pathogens and infected cells, providing a strong immune defense (3).

Why Let a Fever Do Its Job

Since fevers are the body’s natural way of fighting off illnesses, reducing a fever can actually prolong the illness or infection. Fevers also trigger immune cells to recruit and activate T-cells, which coordinate long-term “adaptive” immune responses such as antibody production (2). By letting a fever run its course, you are also providing better protection for future illnesses.

How High is Too High?

Parents are told that fevers over 104F need to go to the ER, but that is not always the case. If the child is relatively comfortable with a temperature of 104F, you can continue to support their healing at home. If you decide to come to the ER, make sure that you give a fever reducer first. At the ER, your child will receive fever reducers if they are still febrile, then the cause of illness will be investigated. Viral illnesses will typically respond to medicine. A temperature of 102F vs 104F does not change the course of action in the ER. 

Febrile Seizures

Febrile seizures are caused by sudden temperature changes (example: temp going from 99.4 to 101.9 in minutes), NOT by the high temperature itself. This is why it is not recommended to put a fevering child in a cold bath. Instead, put them in a warm bath and let them sit in the water until it cools off

Before Heading to the ER

If you determine that the ER is necessary despite trying natural remedies - medicate first. Do not wait to medicate your child because you want the doctor “to see how high it is.” If the temperature goes down before arriving to the ER, you may save yourself a trip and money.

When & How to Medicate

Medicating a fevering child is up to parents’ discretion as a last resort after supportive care. You can try to reduce the fever if your child is unable to eat, drink, or sleep due to discomfort from the fever.

Ibuprofen (Motrin) or Acetaminophen (Tylenol)

Acetaminophen (Tylenol) lowers glutathione stores - an antioxidant very important in immune function. By lowering this antioxidant, we are prolonging the illness. 

Ibuprofen (Motrin) does lower glutathione, but not to the extent that Tylenol does. If choosing to medicate, try Ibuprofen first (in children over 6 months old). If the fever is still not going down, and you think you may need to head to the ER, then you can try Acetaminophen as a last resort.

Peppermint Oil

Peppermint oil can be used as a fever suppressant. Dilute 1-2 drops with 1/2-1 tsp coconut oil and apply to soles of feet and spine. It can also be used for headaches. Apply directly to temples, forehead, behind ears, back of neck whenever you have a headache (if using on child dilute; or if adult has sensitive skin).

Always use your discretion, and consult with your trusted provider before using oils. John Hopkins Medical does not recommend the use of peppermint oil under 30 months, and CHOP does not recommend any essential oils under the age of 3.

Wet Sock Trick

Sleeping in wet socks signals your body to dilate the blood vessels in your feet resulting in blood being moved to and warming, the feet. This increases circulation throughout the entire body. This cycle should continue throughout the night and helps boost the immune system and reduce body temperature - making it great for fevers. You can do this by placing damp cotton socks on your feet followed by thick wool socks.

Hydration

Hydration is so important when sick, especially if experiencing fever, vomiting, or diarrhea. Add in electrolytes as needed! If having extended vomiting or diarrhea without adequate re-hydration, call your pediatrician. You want to avoid severe dehydration.

Rest

Your body heals when it sleeps, so if you follow a strict sleep schedule don’t hesitate to throw it out. Let your kiddo nap longer than usual, go to bed earlier if needed, sleep in, etc. Resting allows the body to focus all it's energy on healing, cleansing toxins, and immune support. If a fever or cough is keeping your child up at night, that would be a time where you could consider medication if you feel that their body needs to rest and reset.

Click below to view next:

• Respiratory Distress

• Lacerations

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How can we support optimal immune function?

1. Eat whole, real foods 

2. Prioritize vitamin C, vitamin D, zinc, and magnesium 

3. Get plenty of restorative sleep

4. Drink lots of water 

5. Daily sunshine exposure

6. Manage stress

7. Limit toxins 

   
   

There are many minerals and vitamins necessary for immunity support. Some of the top are:

• Vitamin C

• Vitamin D

• Zinc

• Magnesium

  
  

This is not medical advice. The following doses are based on the general NIH and CDC daily recommendations. Many children will meet these recommendations through diet. It is always best to consult with your trusted provider on what may or may not be a beneficial supplement for your child.

Vitamin C

Vitamin C helps the body produce immune cells, specifically T cells. It also encourages healthy cells to stay alive and active. Vitamin C is also essential for the growth and repair of tissue throughout the body. It helps heal wounds and fight free radicals in the body to prevent cancers and heart disease. There is evidence showing that Vitamin C may help decrease the length and severity of cold symptoms, making it a great supplement for the winter months.

NIH recommendations:

• 0-6mo: 40mg daily

• 7-12mo: 50mg daily

• 1-3yr: 15mg daily

• 4-8yr: 25mg daily

• 9-13yr: 45mg daily

• 14-18yr male: 75mg

• 14-18yr female: 65 mg

*infants typically need higher vitamin C because their bodies are still developing and they have a higher need for growth support, immune function, and collagen production

Vitamin D

Vitamin D is vital for the immune system because it helps regulate both the innate and adaptive immune systems. It helps build immunity and fight infection by regulating immune cells, which are what prompt antiviral responses. Vitamin D deficiencies have been linked to increased autoimmune diseases along with susceptibility to infection. It is estimated that up to 90% of the US population has insufficient vitamin D levels. 

Dosing recommendations vary from doctor to doctor and institution to institution. Some believe the lower end doses are fine, while others believe in higher doses. This is why I always recommend finding a provider you know and trust, to help navigate what is best for your unique situation.

• CDC minimum vitamin D dosage:  Newborn-12 mo: 400 IU daily, 1yr-adult: 600 IU daily

• CHOP maximum vitamin D dosage:  Newborn-12 mo: 1500 IU daily, 1-8yr: 3,000 IU daily, 9yr and older: 4,000 IU daily

  
  

Zinc

Zinc is an essential mineral that plays an important role in the immune system, cell growth, wound healing, managing blood sugar levels, metabolism, and the sense of taste and smell. If taking via supplement, it is recommended to take with food as it can upset the stomach.

CDC Dosage Recommendations

0-6mo - 2mg

7-12mo - 3mg

1-3yr - 3mg

4-8yr - 5mg

14-18yr - 11mg male, 9mg female

19+yr - 11mg male, 8mg female

Magnesium

Magnesium is an essential mineral that plays a key role in hundreds of bodily functions, yet it’s estimated that up to 60% of the population is deficient. A few of its most important functions include:

• Muscle relaxation

• Stress management

• Nerve function, 

• Blood sugar regulation 

• Energy production

• Activates Vitamin D and supports bone health

If going to take as a single form, choose magnesium glycinate. Many magnesium supplements include a blend in order to receive the benefits of each. Read more about the different forms of magnesium, and specific recommendations here.

Other Immunity Support Options

Probiotics

Probiotics are live microorganisms (live bacteria) that support your gut and immune system. Our bodies are FULL of bacteria both good and bad. Probiotics help to balance the microbiome with “good” bacteria. By increasing good bacteria, our body can more effectively fight against harmful bacteria, restore gut balance, and reduce inflammation.

The best way to increase probiotic intake is through foods. Fermented foods that are high in probiotics include yogurt, kefir, sauerkraut, kimchi, kombucha, miso, and fermented vegetables. 

If choosing to supplement, probiotic dosing is a little different than normal vitamins. If an age range isn’t specified, a good rule of thumb is to use 1/4 the recommended adult dosage for children up to 6 years; half for children 6-12 years, and the full dose for 13 years and up. 

Thieves

Thieves is an oil blend typically consisting of clove, lemon, cinnamon, eucalyptus, and rosemary. It’s an oil inspired by the legend of four 15th century French thieves who would steal from the dead. They formulated the blend to protect against sickness when they stole from plague victims.

Rub on bottoms of feet during cold/flu season or if feeling sick (dilute with coconut oil if using on children) I like YL thieves, and Plant Therapy germ fighter

John Hopkins Medical does not recommend the use of essential oils under 3 months.

Their dilution guidelines are:

• 3mo-24mo: 0.25% to 0.5%

• 2-6yr: 1% to 2%

• 6-15yr: 1.5% to 3%

• Over 15yr: 2.5% to 5%

  
  

Elderberry

Elderberries are believed to boost the immune system due to their high levels of antioxidants and anti-inflammatory properties. They contain polyphenols which can help prevent cell damage. They also contain Vitamin C which can help prevent illness and support the immune system. Many people are comfortable giving their babies elderly syrup as long as it doesn’t contain honey. But there isn’t enough research to deem it officially safe for children under 5. Many integrative pediatricians recommend waiting until at least 10 months. 

Garlic Honey or Mullein

Garlic contains antibacterial properties and contains allicin which helps stimulate the immune system. Honey is filled with antioxidants like flavonoids and polyphenols, which help fight against inflammation. Honey is also antibacterial, antiviral, and antifungal. *Honey is not recommended for children under 12 months.