If you ask most people what they think of fever they will usually tell you that it makes them feel unwell, that it is a sign of illness, that it can be dangerous and that it needs to be suppressed. If you consult most doctors with regard to fever, you will usually be given medication to control it. And if you tell most of your patients, as I do, that their child’s fever is of enormous value for his or her future health and generally should not be suppressed, you will usually be met with surprise, scepticism or alarm.
Fear of fever is so ingrained in most patients that it takes enormous effort to persuade them not to interfere in the febrile process and to observe the positive effects that it will have on their child’s health. Indeed, when parents have found the courage to follow this advice, they may be astounded to discover that the fever has subsided overnight, that the tummy cramps have disappeared or that the recurrent infections no longer occur.
Over many years of GP practice I can recall hundreds of such anecdotes. This, together with the current scientific research available, has convinced me without a shred of doubt that fever is an extremely powerful weapon of self-defence, self-preservation and self-healing. I am prepared to go further and say that constant suppression of fever will weaken the immune system and predispose the system to many chronic illnesses, including cancer.
In this article I will endeavour to show the importance of fever for the developing child. For if we are trying to enhance the child’s potential and optimise his or her health, it is vital that we acquire a new understanding of the role of fever in illness so that we can deal with it in a new way.
We will gain insight into the nature of the fever when we see it firstly in the context of the child’s journey through life. A raised temperature is a very common occurrence in the first 10 years of life and will thereafter generally lessen in frequency and severity. Why is this the case?
The developmental journey begins with conception. With birth, the child’s body has developed sufficiently to function in and connect with the physical world. The child will become progressively more aware of her own body and the world around it. Step by step she will connect with her inherited body (in the manner described in my article ‘Enhancing the developing child’s potential’, issue 3, page 47). The child begins to explore her outer and inner worlds, and thereby gains the capacity to transform herself and ultimately to master life. This is basic to the whole developmental journey which will continue throughout life and which is essentially a search for one’s true self. The child must learn to raise her head, crawl, stand, walk and talk and countless other developmental milestones.
She develops through connecting with her own body and the world which comes up against it. By the resistance she meets, she learns what is self and what is non-self and will gradually acquire self identity; this is expressed so eloquently in the third year of life when she learns to say ‘I’. The power inherent in this exploring self, imbued in this single letter, is the life-preserving power which guides this developmental journey.
On the physical level, it is primarily the immune system that carries out the task of determining what is non-self, i.e. what is foreign to the system. This is a highly complex defence system present through-out the body, comprising physical, chemical and biological components, e.g. specialised blood cells and powerful chemical sub-stances aimed at preserving the integrity of the human organism.
This system comes to ‘know’ what is self, learns to recognise non-self, and is constantly active in maintaining the healthy state, responding immediately to all kinds of hostile elements that pene-
trate the system. It is important to know that the immune system is only able to develop these abilities during the first 10 years, when the child is actively and continuously connecting herself to and exploring the internal and external environment. How do we know this?
DEVELOPMENT OF THE IMMUNE SYSTEM IN THE FIRST 10 YEARS
The immune process is based on certain blood cells called lymphocytes being stimulated by a foreign substance, e.g. pollen, a virus or some food particle. These cells are schooled by a small gland situated in the throat region called the thymus gland to recognise this as non-self and then to activate a protective action to remove the intrusive agent. Furthermore, the immune system will preserve the memory forever after to protect the body immediately against this foreign substance. It is also a well-known fact that the thymus gland disappears completely by the 10th year.
One can assume from this that the schooling process for the lymphocytes only takes place in the first 10 years of life. It is therefore of vital importance that during these years the child
be allowed to exercise and develop her immune system unimpeded, since it is chiefly this system that will safeguard health throughout life. It is a common fact that a dysfunctional immune system is the essential problem in most infectious and inflammatory illnesses, and there is growing scientific evidence to suggest that this is the fundamen-tal disturbance in a host of other conditions, e.g. cancer and auto-immune diseases.
WHAT DOES THE FEVER HAVE TO DO WITH THE DEVELOPMENTAL JOURNEY?
Fever is an expression of enhanced warmth in the system on both a physical and psycho-spiritual level. On the one hand, it is a manifestation of physical warmth as experienced in an increase in body heat; on the other, it is an expression of the activity of soul and spirit as it connects with the body. We all know how our emotions are connected with feelings of warmth or cold. We feel warm towards someone who is close to us and with whom we can connect, cool towards some-one with whom we cannot connect. We can burn with enthusiasm for some idea and even feel physically warm through experiencing feelings such as love and passion; or we can feel stone cold when we are disinterested or disenchanted with something or someone.
We may experience our inner core self in states of warmth. It is that element that can penetrate all states of matter – solid, liquid and gaseous. This makes warmth that vital element which the self uses to connect with the body and the surrounding world in its search for self identity and self mastery. And it is in the first 10 years of life that the child will experience warmth most intensively – through the fever!
From the time of Hippocrates – the father of modern medicine – to the 19th century, fever was viewed as being beneficial in illness. Parmenides, the illustrious Greek physician of antiquity, said: ‘Give me the power to produce fever and I will heal all illness’. Then in the 19th century, Claude Bernard, the great French physiologist, showed that high temperatures, 5 – 6ºC above normal, caused animals to die. Since that time the myth that fever is injurious to health has been dogmatically maintained. With the discovery of aspirin in the late 19th century, the means to control fever and body warmth, and thereby also to weaken the healthy integration of the self with the body, became medically available.
From a modern scientific standpoint, fever is an increase in body temperature brought about by chemical, immunological and neural factors in response to inner and outer changes. This has a wide range of metabolic, cardiovascular and immunological effects. These immunological consequences are of special relevance to this article. Numerous studies have shown that small increases in temperature bring about an increased immune response. For example, at 39ºC there is a 10-fold increase and activation in T-lymphocytes, an increase in B-lymphocytes, increased white blood cell activity and mobility, increased interferon production and an increase in anti-bacterial chemical substances.1-26
Other studies have shown that an increased temperature up to 40ºC has a number of beneficial effects.
■ Fever is associated with increased survival in animal studies and is regarded as a normal survival and adaptation mechanism. Suppressing fever, on the other hand, is associated with decreased survival and increased morbidity.27-39
■ Clinical studies show a correlation between fever and decreased morbidity and mortality rate during a variety of infections.36,40-46
■ Random double-blind trials comparing the effects of paracetamol and placebo in febrile children with viral infections show that there is no significant difference in duration of temperature between treated and placebo patients.47
■ Increased temperature is associated with swifter healing of burns. It is current policy of the burns unit at the Red Cross Children’s Hospital not to suppress fever in children with burn wounds (personal communication).
■ Studies of children with various kinds of viral infections showed that children who received paracetamol took longer to heal than placebo-treated patients.48-50
■ A recent study has found that patients who contracted infectious childhood illnesses such as measles, rubella, whooping cough, scarlet fever, and chickenpox as well as other febrile illnesses showed a lower incidence of cancer other than breast cancer in adult life.51
■ Temperature is an important diagnostic and prognostic clinical sign. Masking the fever changes the clinical picture and may negatively influence therapeutic judgement.52-54
But the big question for most parents is still: ‘Is the fever harmful?’. Current research states that there is no convincing evidence that naturally occurring fevers up to 40ºC are harmful.52-53,55-59 Of course, the major fear is the febrile convulsion which none of us welcomes, but other than physical injury caused by the child falling etc., it is in itself not injurious provided that it is short lived.
Four per cent of children between the ages of 3 months and 5 years who develop fever will have a single convulsion. Twenty-five per cent of these will have a recurrence.60-61 The risk of developing epilepsy does not seem to be higher in children who have had febrile convulsions. Epilepsy is certainly not produced by febrile seizures, but rather a disposition towards epilepsy can show itself for the first time in a febrile convulsion. There are also no studies to show that anti-fever medication prevents febrile convulsions.62
So why do patients and doctors rush for paracetamol when the temperature rises? I think the belief that fever is a part of the disease is so ingrained that many people believe that by removing the fever one is controlling the illness. Yet it is obvious that the fever is not the illness, but rather the healthy response of the body to some stress within the system. This is why the stress of teething, or a fall or even some emotional shock can result in fever.
Others believe that fever can cause potential complications such as brain damage or febrile convulsions which are dangerous. These are mythical concepts which are carried over from generation to generation and which are now being proved wrong by hard scientific facts; 63% of parents have what has been called ‘parental fever phobia’ and 85% give anti-pyretics for fevers less than 38.9ºC.62 This is one of the reasons why many informed doctors still routinely prescribe anti-pyretic drugs.
Finally, many people believe that by suppressing the fever one can reduce the discomfort brought about by the fever. Yet studies show that paracetamol does not improve comfort or behaviour in temperatures below 39ºC.55,57,63 Furthermore, by reducing discomfort you will disguise many of the disease symptoms and encourage a sick child to be more active than she should be.
SO IF THE FEVER IS OF SUCH VALUE, HOW SHOULD ONE DEAL WITH IT?
One should first ascertain whether there is a fever and how high it is. This will help parents and the practitioner to manage things properly. For this one requires a reliable thermometer, which one has learnt to read accurately. Taking the temperature under the arm is the least reliable measurement and is usually 0.5ºC lower than the internal body temperature. The best method in the young child is to take the temperature rectally by inserting the bulb fully inside the anus. In the older child and adult, the temperature can be measured with less indignity in the mouth.
Having ascertained that there is fever, one must decide whether to call the doctor or whether home nursing care can immediately begin. A temperature above 39ºC or other associated signs of illness require the supervision of your health practitioner. These include neck stiffness, severe headache, unusual rashes, vomiting, abdominal pain, persistent irritability and crying, muscle twitching, jerking of the limbs, convulsions, unusual sleepiness, difficulty in breathing, pain on passing urine, earache or other severe body pains. If there are no such signs and the caregiver feels confident in nursing a child with fever, the child can be nursed at home in the following way.
The cardinal management is bed rest and good home nursing. Although you cannot visibly see it, the child is going though an important developmental process with each and every fever, both physically (growing and exercising the immune system) and spiritually (connecting with the body). The healing process restores health and balance, thereby removing some previous weakness or disturbance.
For this process to proceed optimally, certain healing conditions are necessary:
■ The child should be put to bed if the temperature is high, or at least prevented from being too active.
■ One should not over-stimulate the nervous system or the metabolism since the healing process is impaired by certain activities, e.g. watching TV or audiovisuals, or excessive movement.
■ The digestive functions should also be relieved of strain since the fever is a product of the metabolic system and other metabolic activities such as excessive digestion and exercise interfere with this process. The diet ideally should be kept light and simple with plenty of fluids, avoiding animal protein, processed foods and excess sugar and milk.
■ The child should be dressed lightly, warm enough to prevent shivering but not too warmly so as to cause sweating.
■ A light enema in a young child can often bring the temperature down or help the child to cope better.
■ If the child is very distressed, or the temperature is well above 39ºC and the body surface is hot, the temperature can be reduced by tepid sponging, or by placing the child in a bath 1ºC below body temperature or by repeatedly applying cool compresses soaked in half-strength lemon juice or vinegar to the extremities (lower arms and legs). This does not suppress warmth production but removes excess heat. However, if the body surface is cool, the skin must be first rubbed or massaged
to bring warmth to the region before applying cool compresses.
■ Natural medicines in a variety of forms, i.e. herbal, homeopathic or anthroposophical remedies, can be administered by informed parents or practitioners to support the healing process.
Having said all this, I do believe that there is a place for anti-fever medication. Some children cannot tolerate fever well, and their sensitive nervous systems make them more prone to fever convulsions. When natural methods do not reduce the temperature adequately I will prescribe for such children, as well as for those who have had previous fever convulsions, a dosage sufficient to lower but not eliminate the temperature.
I usually also treat very high temperatures, above 40.5ºC, or persistent high temperatures with anti-pyretics, since there are studies which suggest that these fever states can weaken the immune response.58
Seen from a broader perspective one may say in summary that life is a journey of exploration for the human self to discover itself. It wants to know ‘Who am I?’. To discover this, we have to connect in a healthy way with our inner and outer physical worlds. Fever is a potent healing force which is an important part of this journey of discovery.
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