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TABLE OF CONTENTS

INTRODUCTION

FEVER PHOBIA

 FEVER PHOBIA REVISITED: HAVE PARENTAL MISCONCEPTIONS ABOUT FEVER CHANGED IN

20 YEARS?
 CAREGIVER ANXIETY ABOUT FEVER MAY BE HEIGHTENED BY THE PEDIATRICIAN’S LACK OF
KNOWLEDGE REGARDING THE IMPORTANCE OF FEVER.

HOW BEST TO TREAT A FEVER: HOME MANAGEMENT

 ENCOURAGE DRINKING PLENTY OF WATER:

 DRESS LIGHTLY OR BUNDLE UP?
 STARVE A FEVER?
 DEFINITELY AVOID WHITE REFINED SUGAR

TO MEDICATE OR NOT TO MEDICATE

WHEN A FEVER SHOULD BECOME A CONCERN

WHEN TO CONTACT YOUR DOCTOR

BOTTOM LINE

Dr. Sherri J. Tenpenny

Introduction
Childhood fevers can be frightening, mostly because they are misunderstood. A fever is an
increase in body temperature above the “normal range.” But the definition of normal can vary
from person to person. Body temperature also varies with different levels of activity and at
different times of the day. Medical texts differ in their definition of the highest normal body
temperature, which can range from 98.2 to 100.4°F (37 to 38°C). The generally accepted
definition of fever is an “early morning temperature greater than 99°F (37.2°C) or a temperature
greater than 100°F (38°C) at any given time of the day.”

There are many causes of fever, but a fever is most commonly associated with the dozens of
different viruses, bacteria and parasites that cause upper respiratory and urinary tract infections,
pneumonia, and diarrhea.

When a microorganism invades the body, it is fever that gets our attention. Yet, despite its
universal recognition, little is known about how the body actually generates a fever. The current
understanding is when a pathogen enters the blood stream, the body activates the innate immune
response, leading to the release of complex mediators called cytokines with equally complex
names: tumor necrosis factor alpha (TNFα), interleukin beta (IL-1β), and interleukin 6 (IL-6).
These substances signal the hypothalamus, the part of the brain that raises the body’s thermostat,
to generate chills and shivering. Restricting blood flow to the skin minimizes heat loss and gives
the pale, pasty appearance that goes along with not feeling well. Fever sufferers lose their appetite
and feel tired, achy and lethargic.

However, contrary to the ingrained reflex to give an aspirin, acetaminophen (Tylenol) or other
anti-pyretic medicine such at Advil or Ibuprofen, an elevated temperature is an indication that
the immune system is on full alert and is taking prompt action. White blood cells are released and
cascades of cytokines are called to action in pursuit of the intruders. Fever creates an inhospitable
environment for the offending organisms. By turning up the heat, the microbes cannot replicate
and by definition, they die off.

While fever is sometimes a response to severe bacterial infection that requires an antibiotic, fever
in children is usually an indicator of an underlying harmless and self-limiting viral infection.

Always remember: When it comes to infection, if you are otherwise healthy, fever is your
friend. It eliminates the microbe, exercises the immune system cascade, purges the lymphatics
and allows the body to return to health.

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FEVER PHOBIA

Fever is the most common reason parents seek medical attention for their children. In 1980, a
paper published by Barton Schmitt, M.D. reported on a survey of 81 parents who were asked about
their understanding of fever. What he discovered was telling. All parents were inappropriately
worried about low-grade fever, with temperatures of 102°F (39°C) or less. Most parents (52
percent) believed that fever of 104°F (40°C) could lead to serious neurological consequences, even
death. As a result, almost all parents treated fever aggressively: 85 percent gave anti-fever
medications and 68 percent used cool water sponge baths temperatures far below 102°F (39°C).
Schmitt coined the term “fever phobia” to label the inappropriate response to fever.

Fever Phobia Revisited: Have Parental Misconceptions About Fever

Changed in 20 Years?

In 2001, a follow-up study published in PEDIATICS (Crocetti) again investigated fever phobia, to
see if trends had changed. The study sought to explore current parental attitudes toward fever and
to compare these attitudes with those described by Schmitt in 1980. The results of the study were
disturbingly worse:

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 Of the 340 caregivers parents who were interviewed, 56 percent reported that they were
“very worried” about the potential harm fever could cause their children. Compared to
20 years earlier, more caregivers:

 Listed seizure as a feared outcome from fever.

 Woke their children often to check temperatures.
 Gave anti-fever medications or initiated sponging for near-normal temperatures.
Forty-four percent considered 102°F (39°C) to be a high fever, and 7 percent thought that
a temperature could spiral out of control if untreated and reach temperatures greater
than 110°F (43°C). Almost all caregivers (91 percent) believed that even a low-grade fever
could cause harm. The worst concerns listed were brain damage (21 percent) and death
(14 percent).
Strikingly, 25 percent of parents admitted giving medication for fevers less than 100°F
(37.8°C) and a full 85 percent admitted waking their child to give fever medication. When
it came to cool baths, 73 percent stated they sponged their child to treat a fever. However,
24 percent sponged at temperatures less than 100°F (38°C) and nearly 20 percent used
alcohol instead of cool water.

In 2000 PEDIATRICS reported that 50 percent of pediatricians surveyed stated they advised
parents to alternate acetaminophen and ibuprofen, using various regimens despite no evidence
to support this protocol. A 2013 Cochrane Review further confirmed this recommendation:

There is some evidence that both alternating and combined antipyretic therapy may be
more effective at reducing temperatures than mono-therapy alone. However, the
evidence for improvement in measures such as child discomfort remains inconclusive.
There is insufficient evidence to know which of combined or alternating therapy might
be more beneficial.

Many parents incorrectly believe that antipyretic use is always a safe intervention. They have not
been warned that antipyretics can cause side effects ranging from liver and renal failure, to serious
skin disorders (e.g., Stevens-Johnson syndrome) and gastrointestinal ulceration. It has been
reported that 89 percent of caregivers administer antipyretics to febrile children who appear
otherwise comfortable, as many as 50 percent of parents routinely give incorrect antipyretic doses
to young children and 86 percent would schedule a clinic visit for a fever less than 38°C (100°F).

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Caregiver Anxiety about Fever May Be Heightened by the Pediatrician’s
Lack of Knowledge Regarding the Importance of Fever.

Most parents still rely on their

physicians as their primary
resource for information about
fever. Unfortunately, fever
phobia is often fostered by the
medical community itself.
When doctors tell parents to
give a medication when a
temperature rises above 101°F
(38°C), many parents
automatically assume that
fever is dangerous.

A study in PEDIATRICS
revealed that instructions given to parents about the management of fever are often dismally
incomplete and lack consistency. Pediatricians were asked,

1. How dangerous do you believe fever to be?

2. How do you treat fever in your practice?
3. What types of educational information do you give families regarding fever?

Of the 234 pediatricians surveyed, 172 responded. Amazingly, 65 percent believed that
fever itself could be dangerous to a child, citing that a temperature of 104°F (40°C) or
greater could lead to complications such as seizures, brain damage, or death. In practice,
72 percent “always” or “often” recommended treatment to reduce fever and a disturbing
number (89 percent) even recommended lowering the temperature when it was only
between 101°F and 102°F (38-39°C).
Researchers also found that during sick-child visits, 10 percent of providers almost never
discussed the definition of a “high fever”; 25 percent almost never discussed when fever
was at a dangerous level, and sadly, a full 15 percent almost never discussed the reasons
for fever, assuming that parents understood the importance of fever.

A review of the current medical literature finds that over prescribing of antipyretics and
unnecessary antibiotics is a common theme around the world, from the Netherlands, to Korea
and China. Even as recently as 2013, professional and caregiver literacy had not improved much.
A 2016 nursing meta-analysis concluded that fever phobia remains common and has not
significantly declined over time.

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How Best to Treat a Fever: Home Management
Unnecessary parental fear and anxiety regarding fever is costly. In 2013, children presenting to
outpatient clinics and emergency departments accounted for a combined 68 million visits, costing
the healthcare system nearly $10 billion.

Having a fever might be uncomfortable, but research has shown that a fever is part of an effective
immune response. Understanding that a fever will not spiral out of control and how important
fever is to overcoming an infection, parents should be able to breathe a little easier. Here are a few
tips for managing your child’s fever – or your own – in the comfort of your own home:

Encourage drinking plenty of water:

Fever increases fluid loss, and

dehydration cause fevers to remain
high. Often, children with fevers do not
feel thirsty, or by the time they ask for
something to drink, they are already at
least mildly dehydrated. Every drop and
every teaspoon counts. Small, frequent
sips are best, especially if your child
complains of an upset tummy. For
babies, use a glass medicine dropper to
gently hydrate. These can be readily
purchased at the drug store. Keep
encouraging them to drink purified
water or offer a tasty electrolyte-based
drink such as coconut water.

Here’s a healthy recipe you can make at home:

 3 cups of coconut water

 1 cup 100% organic apple, orange, pomegranate, cranberry juice, low in sugar
 1 cup ice
 1/8 teaspoon sea salt
 1 tablespoon raw, organic honey

Put all ingredients in a high-powered blender, and blend for 1 minute. Drink immediately
or store for up to 1 week in refrigerator. If you have access to liquid minerals, add 1T to the
mixture prior drinking.

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Dress lightly or bundle up?

The answer depends on your child's perception of temperature - follow their lead. If s/he
looks pale, shivers, or complains of feeling cold, bundle the child in layers of breathable
fabrics but be sure that the layers are easily removed. If the fever is low-grade, dress
him/her snuggly and give warm liquids to assist the body's fever production. If s/he
complains of being too hot, choose light clothes and cool sheets for comfort.

Starve a fever?

Children with fevers generally don't have

much appetite. And it is much more
important to remain hydrated than to
consume foods.

Let your child determine when and what

to eat. Use light foods such as
homemade chicken broth or cooked
gluten-free or rice cereal for calories and
easy digestion. Remember, when you don’t feel well, you don’t feel like eating much
either! A return of appetite is generally a clue that your child is on the mend.

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Definitely avoid white refined sugar

It has long been documented that refined white sugar suppresses the immune system. As
far back as 1977, a study in the American Journal of Clinical Nutrition reported the adverse
effects that refined sugar has on the immune system.

Blood was drawn from subjects and the activity of the white blood cells that
neutralize viruses and bacteria was observed and calculated. The white blood
cell activity was calculated before and after subjects were given various doses
of refined white sugar: 6, 12, 18 and 24 teaspoons, respectively.
Each subsequently higher dose of sugar created a corresponding decrease in
the activities of the subject’s white blood cells. The group that had consumed
the largest amount of sugar had essentially no functioning white blood cells
within an hour after consuming the sugar. The immunosuppression occurred
for up to two hours after consuming the sugar, but the adverse effects of no
white blood cell activity persisted in some instances for up to five hours.

White blood cells eliminate viruses and bacteria that cause illness. Without the efforts of
these cells, recovering from infection is stalled. Therefore, do not offer children with a
fever Gatorade or Coca-Cola for hydration, ginger ale for an upset tummy or ice cream to
soothe a sore throat. The hefty doses of refined white sugar can drag down the immune
system during the time it needs to be strongest.

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To Medicate or Not to Medicate

A rule of thumb when treating a fever is "First, do nothing," meaning that observation is a better
choice or option than running for the medicine cabinet.

Is your child drinking fluids well? Is he urinating at least once every few hours or wetting at least
8 diapers per 24-hr day? Does your touch console him/her? Is h/she attempting to play? If the
answer to these questions is yes, this is not a serious illness, despite the number on the
thermometer. In reality, even gentle anti-fever methods, such as cool baths and ice chips, should
only be used for comfort. Let the body fight off the infection. Here are a few recommendations for
comfort:

If your child seems miserable, one dose of over-the-counter medication can be

1 given as a “screening test.” If your child looks and acts much better within a short
period of time, it is likely that the infection is not serious.
Elderflower tea is a good remedy for fever. Steep 2 teaspoons of dried
2 elderflowers in a cup of water for 20 minutes. A few sips at a time can greatly
increase comfort.
Work with a practitioner trained in homeopathy. It is safe and amazingly
3 effective. Belladonna and pulsatilla are frequently used to support the body’s
fever-fighting abilities.
Several studies have shown that by suppressing the fever, the body needs a longer
4 time to recover. In a study of children with chickenpox, acetaminophen
prolonged itching and the time to scabbing compared to placebo treatment.
A study of adults found that aspirin and acetaminophen suppressed production
5 of the patient’s antibodies and increased cold symptoms, with a trend toward
longer viral shedding and prolonged symptoms.

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When a Fever Should Become a Concern

What most parents don’t recognize – and apparently many pediatricians don’t understand either
– is the body has a way to protect itself from excessively high temperatures. In the absence of
overwhelming factors, such as extreme dehydration or unsafe circumstances, such as being locked
in a closed automobile, it is exceedingly rare for a temperature to exceed 106°F (41°C).

Parents are most fearful that a sustained high fever will lead to seizures. A febrile seizure manifests
as abnormal jerking movements all over the body, without evidence of central nervous system
infection, such as meningitis.

Febrile seizures are divided into two types. The most common is a simple febrile seizure
which lasts less than 15 minutes and does not recur within 24 hours. They are often
seen in children between the ages of three months and five years. About 3 percent of
all children experience a simple febrile seizure sometime during childhood. Simple
febrile seizures occur most commonly due to a sudden rise in temperature and rarely,
if ever, associated with prolonged high fever, unless the child is severely dehydrated.

A second type, referred to as a complex febrile seizure, is a prolonged episode, lasting more than
15 minutes, reoccurring one or more times within 24 hours. Complex febrile seizures may indicate
a more serious infection, such as meningitis or a brain infection. If a seizure persists for at least
30 minutes, it is defined as febrile status epilepticus, which can be caused by a long list of serious
conditions. Medical help is essential for both of these circumstances.

Why some children are susceptible to febrile seizures and others are not is not well understood.
Although frightening, simple febrile seizures are almost always benign, self-limiting episodes with
low risk of injury, death, and long-term neurologic consequences. Nonetheless, if your child
experiences a febrile seizure, be sure to have an evaluation by a healthcare professional.

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When to Contact Your Doctor

The following situations warrant a call to your doctor. If none of these situations occur, then you
probably don’t need to call your doctor.

 If your infant is under 6 weeks of age and has a fever of 101°F (38°C) or higher, this is
considered a medical emergency and your doctor should be contacted immediately. Go
directly to his/her office, or to the nearest emergency department. Do not give any fever-
reducing medications. It is best to confirm the fever with a rectal thermometer.
 Infant’s age 7 weeks to three months with a fever 101°F (38°C) but appearing
comfortable, should have an appointment with the doctor within the next several hours.
If it is evening, page the doctor on call since you will not be able to go to the office until the
following day. Confirm the temperature with a rectal thermometer.
 If your child has a fever and one or more of the following symptoms at any age, seek
medical care immediately:
o Prolonged fevers of 104°F (40°C) or higher that don’t go down to 102°F or less
(30°C) with measures previously discussed.
o Lethargy: If your child is limp and lifeless, won’t nurse or won’t make eye contact.
o Marked irritability: If your child is nearly impossible to console, for even brief
periods of time.

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 o Signs of meningitis: If your child has a sustained high fever, complains of neck
pain or appears to be in pain when you touch the back of the neck, this could be a
sign of meningitis. If the neck pain is accompanied by vomiting, an unusual rash,
pain in the eyes due to lights, or worsening pain with leg movement, go
immediately to the nearest hospital.
o Children with asthma: If your child is breathing so hard that his/her rib cage is
“sucking in,” i.e., retractions, seek medical care immediately.
o Children with cancer: Fevers are always of concern in adults or children who
are immune compromised. Contact your physician even with low-grade fevers of
100°F (38°C) for further instructions/treatment.

Bottom Line
Like it or not, your child is going to get a fever – and an infection – at some point, regardless of
all the healthy food and vitamins you provide. Remember that fever is important. It activates the
immune system, mobilizes white blood cells and kills off viruses and bacteria. Understanding the
basics about fever will eliminate unnecessary stress, unnecessary suppressive medications,
unnecessary doctor and emergency room visits and most of all, give your child’s immune system
the benefit of experiencing an infection-fighting fever. Ask yourself whether you are choosing
interventions to make your child more comfortable or to decrease your own anxiety.

Armed with this information, “fever phobia” can be eliminated from your household. A mantra to
follow is,

“The fever is helping now - and in the long run - so let it burn!”

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Contact information:
Medical Clinic:

Tenpenny Integrative Medical Center

7380 Engle Road

Middleburg Heights, Ohio 44130

440.239.3438

www.TenpennyIMC.com

info@tenpennyimc.com

www.Facebook.com/TenpennyIMC

For Vaccine Information and vaccine consults:

www.DrTenpenny.com

www.Vaxxter.com

www.FightingPharma.com (coming soon)

www.Facebook.com/vaccineinfo

www.Facebook.com/Vaxxter

Dr. Tenpenny is available for radio interviews and speaking events.

To schedule an event, send a request to DrTenpenny@gmail.com or call 440.239.1878.

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