Tim Niehues: A novel approach to the treatment of fever
Prof. Tim Niehues, Chief Physician of the Center for Pediatric and Adolescent Medicine at Helios Hospital Krefeld, guideline officer and board member of the German Society for Pediatric and Adolescent Medicine, debunks common myths about fever and explains how parents should respond properly.
The new recommendation takes into account that fever is an important bodily response in fighting illness. In the past, fever was mainly seen as a symptom that needed to be treated quickly. Today, we know that fever has developed over the course of evolution and helps the immune system function more effectively. This understanding is based, among other things, on studies showing that higher body temperatures improve the performance of immune cells and reduce the replication of viruses.
Fever is a symptom, not a disease. In infections, it is usually self-limiting. In previously healthy children and adolescents with fever, there is no indication to lower the temperature solely because of how high it is. However, since parents tend to become anxious once a certain threshold is reached—and understandably want to do something for their child—it is important to provide proper education. This is exactly where our newly published guideline comes in. Until now, there were no action-oriented recommendations in Germany for managing febrile illnesses in children and adolescents. Our aim is to educate about safe fever management and the rational use of antipyretic medications.
This actually depends on the child’s age. In newborns and infants, temperature should always be measured rectally using a digital thermometer. It is best to lubricate the tip of the thermometer beforehand. In older children and adolescents, measurement in the ear is possible. Alternatively, temperature can also be taken under the tongue using a digital thermometer, although this is somewhat less accurate—just like forehead thermometers. Measuring temperature under the armpit should be avoided at all ages due to its inaccuracy.
Above all, your child needs attention, rest, and a sense of security. Make sure your child drinks enough fluids. When the fever is rising, children may feel cold—cover them if they need it. During the fever plateau, hands and feet usually feel warm. If your child feels uncomfortable, you can apply lukewarm calf wraps. Uninterrupted sleep is also important. As the fever begins to fall, heat is redistributed throughout the body and the child may feel very warm all over. During this phase, the child often relaxes and falls asleep. If your child feels too warm or starts sweating, they will need less covering, possibly just a light blanket. The focus should always be on your child’s comfort and well-being.
The key question is what goal you are pursuing. Our recommendation is clear: do not give fever-reducing medication simply to lower the temperature at all costs. However, if your child is in pain or significantly distressed, medication may be given to improve overall well-being. The level of fever itself does not matter. The only exception is infants in the first three months of life, who should receive an antipyretic suppository if their body temperature exceeds 38 °C.
As mentioned, give medication only if your child is in pain and only for as long as necessary until they feel better. It is especially important to administer the correct dose. Be sure to ask your doctor or pharmacist to explain how to measure the right amount for your child. The dosage usually depends on your child’s weight. Ibuprofen is approved only from the age of three months.
Children under three months of age must always be seen by a pediatrician if their temperature reaches 38 °C. The same applies if your child appears drowsy, disoriented, unresponsive, or extremely sleepy; if they are in severe pain or very sensitive to touch. Medical attention is also recommended in cases of dehydration—for example, if no urine has been passed for more than 12 hours—or if the fever lasts longer than three days. And as always: if you are very worried or unsure, your pediatrician can help.
Allowing sufficient time for recovery provides long-term benefits for your child’s health. Make sure your child gets proper rest. Children should be well and fever-free for at least one full day before returning to daycare, kindergarten, or school.
Febrile seizures are a common emergency in infancy and early childhood. They are usually witnessed by parents at home and are often very frightening. However, they are generally harmless from a medical standpoint and usually have no lasting health consequences for the child. Febrile seizures typically stop on their own after a few minutes and cannot be prevented. Fever-reducing medications do not prevent them. Any first febrile seizure requires medical or emergency medical evaluation.
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