Fever in children is common and in most part caused by benign self-limiting infections, meaning the prognosis is good and it will run its own course.
It took DuBois an American physician remembered for his work on the physiology of fever, a lifetime of study on fever to finally come up with the statement: "Fever is only a symptom and we are not sure that it is an enemy. Perhaps it is a friend." (1).
Mothers intuition has always known this to be true. Naturopaths teach this. Fever in children is common and in most part caused by benign self-limiting infections, meaning the prognosis is good and it will run its own course. Many parents consult their general practitioner (GP) or accident and emergency (A&E) unnecessarily when their child has a mild temperature. Why parents worry so much about their children's temperature when their child indicates is perfectly healthy and fighting infection is another question. (2) Taking medicine to suppress the fever is associated with risks including asthma, eczema and increased mortality form many conditions. I offer natural medicine first aid plans that address managing fevers naturally without drugs.
Causes of a fever
Whilst infection is the most common cause of fever, abnormal elevation of body temperature in a child however should be evaluated as a potential symptom of an underlying condition. Although infection is the most common cause of fever, fever may be symptom of a serious underlying cause. (3) Fever of unknown origin (FUO) is a prolonged fever, originally as a disease condition of temperature exceeding 38.3 °C on at least three occasions over a period of at least three weeks, with no diagnosis made despite one week of inpatient investigation. An FUO may have an underlying diagnosis of malignancy, infection, or noninfectious inflammatory disease. (4) The main causes of FUO in paediatric and adult patients are autoinflammatory disease (AID). (5) Red flags symptoms require immediate medical attention. Red flag symptoms include for example symptoms of meningitis in seriously ill child needs immediate referral to A&E. These symptoms are easy to spot and can be learned by any parent.
What happens during a fever?
Febrile response is mediated by endogenous pyrogens (cytokines) in response to invading exogenous pyrogens, primarily microorganisms or their direct product toxins. These endogenous pyrogens act on thermosensitive neurons in the hypothalamus, which upgrade the thermostat set point via prostaglandins. Cytokines play a pivotal role in the immune response by activation of the B cells and T lymphocytes. A fever results in simultaneous lymphocyte activation which demonstrates the clearest and strongest evidence that fever plays a protective role. These protective processes are optimal at high temperature (around 39.5°C). (6, 7) Fever increases macrophages and monocytes phagocytic activity. (8) Antipyretics used to inhibit fever target multiple aspects of the inflammatory response besides temperature regulation and these are postulated to increase associated risks. (8)
Fever phobia is described as unrealistic fear and anxiety in parents of a child with a fever due to exaggerated misconceptions that leads to the overuse and abuse of antipyretic medicines. (9)
Fever: To suppress or not?
When it comes to fevers, there are two basic fields of thought. Either ever should be suppressed because its metabolic costs outweigh its potential physiologic benefit or fever is a protective adaptive response that should be allowed to run its course. (10) The latter approach, sometime referred to as the “let it ride” philosophy, has been supported by several recent randomised controlled trials (RCTs). (11)
Paracetamol is used worldwide for its analgesic (pain relieving) and antipyretic ( fever reducing/preventing). The exact mechanism of how paracetamol works remains unknown. The judicious use of antipyretics such as paracetamol is unlikely to causes problems however the overuse and abuse of antipyretics by anxious parents and the general public is widely acknowledged. A large Cochrane study concluded that paracetamol is not only widely ineffective, but that paracetamol is associated with increased mortality, cardiovascular outcomes including fatal or non-fatal heart attack, stroke, or fatal coronary heart disease, adverse gastrointestinal events including ulcers and upper gastrointestinal haemorrhage, and kidney disease. Non-overdose paracetamol resulted in twice the rate of acute liver failure leading to registration for transplantation than NSAIDs, patients taking paracetamol for chronic pain were four times more likely to have abnormal on liver function tests results with similar adverse event rates in paracetamol and ibuprofen use in arthritis existing. (12)
Animal studies found that when fever was inhibited with the antipyretic drug acetylsalicylic acid (aspirin) that 70% of acetylsalicylic acid-treated animals died as a result of infection, compared with only 16% of animals with a normal febrile response. (13)
Paracetamol risks in children
Several epidemiologic studies suggest that acetaminophen use might be a risk factor for asthma development and asthma exacerbation. (14, 15) Routine use of prophylactic paracetamol with vaccinations results in lower antibody titres to several vaccine antigens post vaccination and should not be routinely recommended. (16) A Mexican population based study found exposure to paracetamol significantly increased risk of rhinitis (colds and allergies) and possibly eczema. (17) A study on paracetamol use in chickenpox found lesions took longer to crust in the paracetamol group possibly due to prolonged viral shedding in the absence of fever. (7)
What defines a fever?
In general a temperature of 100.4°F (38°C) (oral) in adults and children and a temperature of 99.5°F (37.5°C) (oral) or 100.4°F (38°C) (rectal) in babies indicate a fever.
A low-grade fever for adults and children is when your body temperature is slightly elevated above normal. This is generally between 98.8°F (37.1°C) and 100.6°F (38.1°C).
High-grade fevers are a red flag symptom
A high-grade fever for adults is an oral temperature of 103°F (39.4°C). A high-grade fever for children over 3 months old is an oral temperature exceeding 102.2°F (39°C), or higher. A high-grade fever for children under 3 months old is a rectal temperature of 100.4°F (38°C), People with high-grade fevers should seek medical attention immediately. (18)
Red flag symptoms in a child
Red flag symptoms in a child include an oral temperature exceeding 102.2°F (39°C), or higher or a rectal temperature of 100.4°F (38°C) if the child is under 3 months old. Other red flag symptoms include having a fever lasting more than three days, if the child has reduced activity (unable to make eye contact, poor feeding, no smile, decreased response to stimuli, lethargy, weak high-pitched cry, restless and irritable), reduced urine output, has recently had one or more immunisations or has a serious medical illness or a compromised immune system or recently been in a developing country. (19)
Red flag symptoms in an adult
Red flag symptoms in adults include a body temperature exceeding 103°F (39.4°C). Other red flag symptoms include having a fever for more than three days, having a serious medical illness or a compromised immune system or having recently been in a developing country.
Online professional telephone advice
13 HEALTH (13 43 25 84) is a confidential phone service in Queensland Australia that provides health advice from a registered nurse over the phone to 24 hours a day, 7 days a week for the cost of a local call. Registered nurses (RNs) conduct a comprehensive telephone assessment over the phone resulting in a recommendation of a time and place of care. The service also provides evidence based healthcare information and targeted referral to other health care providers. RNs educate callers and guide them to appropriate care. By assessing callers by phone, nurses estimate symptom urgency, rather than diagnose the cause of the symptoms. (20) This service would help provide information on how to treat a fever at home and when should a child with a fever see a doctor.
Use antipyretic medicines sparingly and only when your child is in pain or discomfort from a fever over 102°F (38.8°C). Ask yourself whether you are administering the fever-reducing medicine to make your child more comfortable or to decrease your own anxiety.
From my personal experience, the official advice on what constitutes a fever is too cautious. For my naturopathic recommendations as a mother of 7 un-medicated children, who has seen and can treat all childhood diseases and manage fever naturally without drugs, book a natural medicine first aid plan to learn these skills. This plan includes what defines a normal fever, what temperature is an optimal to stimulate immunity, the natural progression of a fever, how to manage fever naturally (may include both raising and lowering temperatures to fall within the optimal ranges), convalescence, symptoms to cause concern during a fever, and how to avoid antibiotics by using highly effective natural remedies to treat bacterial and viral childhood illness and other childhood maladies.
Accident and emergency (A&E)
Fever of unknown origin (FUO)
Registered nurses (RNs)
General practitioner (GP)
1. Dubois HA. On the treatment of fever by a cold Unknown 1876.
2. Greenhalgh T, Taylor R. How to read a paper: Papers that go beyond numbers (qualitative research). 1997;315(7110):740-3.
3. Pathogenesis of Fever. In: El-Radhi ASC, James and Klein, Nigel, editor. Clinical Manual of Fever in Children. Berlin, Heidelberg: Springer Berlin Heidelberg; 2009. p. 47-61.
4. Unger M, Karanikas G, Kerschbaumer A, Winkler S, Aletaha D. Fever of unknown origin (FUO) revised. Wien Klin Wochenschr. 2016;128(21-22):796-801.
5. Attard L, Tadolini M, De Rose DU, Cattalini M. Overview of fever of unknown origin in adult and paediatric patients. Clinical and experimental rheumatology. 2018;36 Suppl 110(1):10-24.
6. Dinarello CA. Infection, fever, and exogenous and endogenous pyrogens: some concepts have changed. Journal of endotoxin research. 2004;10(4):201-22.
7. Meremikwu MM, Oyo‐Ita A. Paracetamol versus placebo or physical methods for treating fever in children. Cochrane Database of Systematic Reviews. 2002(2).
8. Evans SS, Repasky EA, Fisher DT. Fever and the thermal regulation of immunity: the immune system feels the heat. Nat Rev Immunol. 2015;15(6):335-49.
9. Gunduz S, Usak E, Koksal T, Canbal M. Why Fever Phobia Is Still Common? Iran Red Crescent Med J. 2016;18(8):e23827-e.
10. Ray JJ, Schulman CI. Fever: suppress or let it ride? Journal of thoracic disease. 2015;7(12):E633-E6.
11. Young P, Saxena M, Bellomo R, Freebairn R, Hammond N, van Haren F, et al. Acetaminophen for Fever in Critically Ill Patients with Suspected Infection. New England Journal of Medicine. 2015;373(23):2215-24.
12. Moore A. Paracetamol: widely used and largely ineffective: Cochrane UK; 2016 Aug 12 [Available from: https://www.evidentlycochrane.net/paracetamol-widely-used-ineffective/.
13. Kurosawa S, Kobune F, Okuyama K, Sugiura A. Effects of antipyretics in rinderpest virus infection in rabbits. The Journal of infectious diseases. 1987;155(5):991-7.
14. Graham GG, Davies MJ, Day RO, Mohamudally A, Scott KF. The modern pharmacology of paracetamol: therapeutic actions, mechanism of action, metabolism, toxicity and recent pharmacological findings. Inflammopharmacology. 2013;21(3):201-32.
15. Beasley R, Semprini A, Mitchell EA. Risk factors for asthma: is prevention possible? The Lancet. 2015;386(9998):1075-85.
16. Prymula R, Siegrist CA, Chlibek R, Zemlickova H, Vackova M, Smetana J, et al. Effect of prophylactic paracetamol administration at time of vaccination on febrile reactions and antibody responses in children: two open-label, randomised controlled trials. Lancet. 2009;374(9698):1339-50.
17. Barragán-Meijueiro M, Morfin B, Nava-Ocampo A. A Mexican population – based study on exposure to Paracetamol and the risk of wheezing, rhinitis, and eczema in childhood. Journal of investigational allergology & clinical immunology : official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunología. 2006;16:247-52.
18. Jill Seladi-Schulman P. Symptoms of Fever in Adults, Children, and Babies, and When to Seek Help: Healthline; 2019 [updated April 12, 2018. Available from: https://www.healthline.com/health/fever-symptoms.
19. Barbi E, Marzuillo P, Neri E, Naviglio S, Krauss BS. Fever in Children: Pearls and Pitfalls. Children (Basel). 2017;4(9):81.
20. Government Q. 13 HEALTH—Health advice over the phone 2019 [Available from: https://www.qld.gov.au/health/contacts/advice/13health.