Should You Lower Your Child’s Fever? What You Need to Know Before You Reach for the Tylenol

Baby Poop” excerpt first published on

165StethascopeEmillyeMothering“Fever does not cause brain damage. Fever is a good thing,” says pediatrician Scott W. Cohen, MD, author of Eat, Sleep, Poop.

Pediatrician Jo Ann Rohyans, MD, writes for “Most children can tolerate a temperature of slightly higher than 107°F without long-term effects from the fever itself.” She explains that this is unless the child is overdressed or trapped in a hot space.

The U.S. National Institutes of Health (NIH) post about children on their Medline Plus website: “Brain damage from a fever generally will not occur unless the fever is over 107.6°F (42°C). Untreated fevers caused by infection will seldom go over 105°F (40.5°C) unless the child is overdressed or trapped in a hot place.”

Pediatrician Barton Schmitt, MD, states in his American Academy of Pediatrics book, My Child is Sick, “Fevers with infections don’t cause brain damage. Only fevers above 108°F (42.3°C) can cause brain damage.” Need I go on?

A child stuck in a hot car can become heated to higher than 108 degrees Fahrenheit and suffer injury or death. Certain severe chemical poisonings can cause excessive, damaging temperatures. These are not infection-related fevers, rather they are unnatural overheatings. The body will not destroy itself through its own immune system process of warming up to kill infections.

Pediatrician Susan Markel, MD, in our book What Your Pediatrician Doesn’t Know Can Hurt Your Child, states,

Despite the common fear that fever can cause brain damage, this has never been confirmed by any scientific tests or investigations. Only in the rare cases of meningitis or encephalitis, conditions which themselves can cause brain damage, can the brain’s ability to control the body’s temperature be disrupted. In neurologically normal children, the brain has an internal regulatory mechanism that does not allow fever to rise out of control. Fevers produced by viral or bacterial infections will not cause brain damage or permanent physical harm, despite the myths about children being severely compromised by having a high fever.

Fever is not to be feared. Fever is useful. It’s the body’s means of getting itself better. We want baby to get well as soon as possible. Fever is one of the body’s immune system processes for killing infections. We want infections killed. There is no reason to block the body’s efforts to recover. The goal of caring for a sick child should be to keep her protected while her body tackles the infection and repairs itself. A child is not truly healthy and well just because she behaves better when her symptoms are covered up by some chemical medication—while the drug hinders her immune system—for the sake of short-term relief.

Some children experience febrile seizures. These are frightening to see, but according to the American Academy of Pediatrics, and other authorities, febrile seizures do not cause brain damage or other long-term harm. As well as having seizures, a child can experience hallucinations or suffer a “swimmy head” feeling when her fever is in higher ranges. These all come from the head being hot, when the benefits of fever are mostly needed for the rest of the body. A child’s head can be cooled by using cool cloths, bringing comfort without stopping the benefits of fever to the rest of the body.

We all get sick. It’s okay for a baby or child to feel uncomfortable sometimes. You don’t have to fix it. The best medicine for your child’s ill feelings is your warm affectionate attention and tender embraces. Your child will not only gain great comfort, but this is a special opportunity for your child to learn empathy and caring through your compassion, and have opportunity to really feel how much you care. Besides the emotional feel-good, your touch and especially skin-to-skin contact lead to oxytocin releases that invigorate the immune system. Baby’s neurological feedback systems are also designed to gain great relief and physiological normalizing through sucking. Whether on a finger, breast, bottle, or pacifier, help your sick baby or toddler achieve as much as desired.

Pain and Fever Medications

Pain and fever medications do not cure, reduce, or shorten illnesses. If anything, they may lengthen them. They stress baby’s liver and kidneys when he is already ill, and they put baby at slight potential risk for damage when we actually want him to be getting stronger. By causing a child to feel much better through the use of pain and fever reducers, his body will be prevented from telling him when to slow down and when to lie down. Unimpeded, the immune system tells the body when it needs rest in order to focus on efforts toward recovery. Masking of symptoms with drugs can also cover up important signs of worsening, which could possibly delay the pursuit of important medical attention.

Accidental medication overdoses are risky, of course, but each kind of fever and pain medication has its own health risks even at recommended doses, which is what I discuss here. NSAID is common lingo for a non-steroidal anti-inflammatory drug, which includes aspirin, ibuprofen (Motrin), and naproxen. Acetaminophen is another common, non-prescription pain medicine.

Also known as paracetamol, or Tylenol, this medication is not classified as an NSAID. All of these pain-reducing medications are also fever reducers. There are other drugs in these same categories with similar actions and side effects, but I will focus on these.

Aspirin is known to cause non-permanent liver damage in half of all who use it regularly. In a small number of children, more severe complications can occur. All of the above meds are known to pose slight and—on rare occasion—severe liver risks, even at recommended dosages. Ibuprofen and aspirin are known to occasionally cause gastrointestinal (GI) discomfort or bleeding in children. Acetaminophen can do the same but less often. Acetaminophen is labeled as safer overall than ibuprofen in some studies, although other studies claim it has worse side effects. NSAIDs and acetaminophen are also implicated in occasionally causing an autoimmune blood disease, thrombocytopenia, from which recovery is generally good.

Exposure to acetaminophen before the age of 15 months has been associated with an increased risk of later developing allergies or asthma.

Acetaminophen and other medications rarely can cause severe skin reactions such as Stevens-Johnson syndrome or toxic epidermal necrolysis. These can be fatal. If a medication ever causes a skin reaction, it should be stopped and never used again. In addition to these threatening skin reactions, there is also a risk of severe or fatal skin staph or strep infections when NSAIDs are used with chicken pox or shingles infections. A risk in using these medications for a child with diarrhea and vomiting of unknown origin is that they could be exhibiting early symptoms of chicken pox or shingles, though the chance of a child actually having chicken pox or shingles is low today in vaccinated young children. Shingles rates are higher in children over 10 years of age than before the era of chicken pox vaccination.

Further safety studies for these meds are sorely needed. Studies have been performed in animals with influenza and with pneumonia, finding increased death rates when fever reducers are used. In animal studies, fever reducers were found to lengthen the time of illness in diarrheal infections from Shigella. Small studies of humans with influenza have found prolonged illness with the use of fever reducers. Only three different microbes were included in this study so this finding doesn’t exclude such an effect with other infections.

Parents continue to be warned about the risk of Reye syndrome when giving aspirin to young children with chicken pox or other viruses. There are many dangers from giving medications to sick children, but this actually is not one of them. It’ll likely take another decade for this information to trickle its way into mainstream medical education. The whole aspirin and Reye syndrome connection has been fully debunked in the medical research literature since the year 2000 and, even a decade before that, it was strongly suspected that anti-vomiting drugs have been responsible for most of the serious effects in children who showed symptoms that were associated with Reye syndrome. Still, aspirin, like all of these medications, may rarely be linked to serious skin, organ, or neurological disorders, especially when combined with bacterial or viral infections.

Some parents may understandably have concern about seizures after witnessing one in their child, but a large review of studies found that fever reducers actually do not prevent the return of febrile seizures. These results also imply that they do not prevent a first febrile seizure. An even larger review looked at the use of all kinds of anti-seizure medications as well as fever reducers and found that no drugs reduced the return of febrile seizures or provided any benefits, yet a full 30% of children suffered adverse effects from such drugs. Although a very small percentage of children who experience febrile seizures go on to be diagnosed with epilepsy, there is no evidence that this occurrence can be prevented with drugs.

Cooling of the whole feverish body through cool bathing has also not been proven beneficial; if anything, it slightly increases complications.

Your affection, attention, close observation, avoidance of unnecessary drugs, and provision of good hydration and nourishment will see baby through her illness with healthy success.



Adair, S. M. Pacifier use in children: A review of recent literature. Pediatr Dent 25, no 5 (Sep/Oct 2003): 449–58.

Barzaga Arencibia, Z., & Choonara, I. Balancing the risks and benefits of the use of over-the-counter pain medications in children. Drug Saf 35, no. 12 (Dec 2012): 1119–25.

Baumann, R. J., & Duffner, P. K. Treatment of children with simple febrile seizures: The AAP practice parameter. American Academy of Pediatrics. Pediatr Neurol 23, no. 1 (Jul 2000): 11–7.

Bertuola, F., et al. Association between drug and vaccine use and acute immune thrombocytopenia in childhood: A case-control study in Italy. Drug Saf 33, no. 1 (Jan 2010): 65–72.

Bianciotto, M., et al.; Italian Multicenter Study Group for Drug and Vaccine Safety in Children. Drug use and upper gastrointestinal complications in children: A case-control study. Arch Dis Child 98, no. 3 (Mar 2013): 218–21.

Carey, J. V. Literature review: Should antipyretic therapies routinely be administered to patients with [corrected] fever? J Clin Nurs 19, no. 17–18 (Sep 2010): 2377–93.

Casteels-Van Daele, M., et al. Reye syndrome revisited: A descriptive term covering a group of heterogeneous disorders. Eur J Pediatr 159, no. 9 (Sep 2000): 641–8.

Cheelo M, Lodge CJ, Dharmage SC, Simpson JA, Matheson M, Heinrich J, Lowe AJ. Paracetamol exposure in pregnancy and early childhood and development of childhood asthma: a systematic review and meta-analysis. Arch Dis Child. 2015 Jan;100(1):81-9.

Civen, R., et al. The incidence and clinical characteristics of herpes zoster among children and adolescents after implementation of varicella vaccination. Pediatr Infect Dis J 28, no. 11 (Nov 2009): 954–9.

Doran, T. F., et al. Acetaminophen: More harm than good for chickenpox? J Pediatr 114, no. 6 (Jun 1989): 1045–8.

Eyers, S., et al. The effect on mortality of antipyretics in the treatment of influenza infection: Systematic review and meta-analysis. J R Soc Med 103, no. 10 (Oct 2010): 403–11.

Ferrandiz-Pulido, C., & Garcia-Patos, V. A review of causes of Stevens-Johnson syndrome and toxic epidermal necrolysis in children. Arch Dis Child 98, no. 12 (Jul 2013): 998–1003.

Goldman, R. D. Efficacy and safety of acetaminophen versus ibuprofen for treating children’s pain or fever: A meta-analysis. J Pediatr 146, no. 1 (Jan 2005): 142–3.

Gormally, S., et al. Contact and nutrient caregiving effects on newborn infant pain responses. Dev Med Child Neurol 43, no. 1 (Jan 2001): 28–38.

Good, P. Did acetaminophen provoke the autism epidemic? Altern Med Rev 14, no. 4 (Dec 2009): 364–72.

Greisman, L. A., & Mackowiak, P. A. Fever: Beneficial and detrimental effects of antipyretics. Curr Opin Infect Dis 15, no. 3 (Jun 2002): 241–5.

Harding, C. An evaluation of the benefits of non-nutritive sucking for premature infants as described in the literature. Arch Dis Child 94, no. 8 (Aug 2009): 636–40.

Hauck, F. R., et al. Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Pediatrics 116, no. 5 (Nov 2005): e716–23.

Jefferies, S., et al. Systematic review and meta-analysis of the effects of antipyretic medications on mortality in Streptococcus pneumoniae infections. Postgrad Med J 88, no. 1035 (Jan 2012): 21–7.

Kiekkas, P. Fever treatment in critical care: When available evidence does not support traditional practice. Nurs Crit Care 17, no. 1 (Jan–Feb 2012): 7–8.

Kluger, M. J., et al. The adaptive value of fever. Infect Dis Clin North Am 10, no. 1 (Mar 1996): 1–20.

Kuehn, B. M. FDA: Acetaminophen may trigger serious skin problems. JAMA 310, no. 8 (Aug 2013): 785.

Medoff-Cooper, B., & Ray, W. Neonatal sucking behaviors. Image J Nurs Sch 27, no. 3 (Fall 1995): 195–200.

Mikaeloff, Y., et al. Nonsteroidal anti-inflammatory drug use and the risk of severe skin and soft tissue complications in patients with varicella or zoster disease. Br J Clin Pharmacol 65, no. 2 (Feb 2008): 203–9.

Misurac, J. M., et al. Nonsteroidal anti-inflammatory drugs are an important cause of acute kidney injury in children. J Pediatr 162, no. 6 (Jun 2013): 1153–9, 1159.e1.

Moulis, G., et al.; French Association of Regional Pharmacovigilance Centers. Drug-induced immune thrombocytopenia: A descriptive survey in the French PharmacoVigilance database. Platelets 23, no. 6 (2012): 490–4.

Nelson, A. M. A comprehensive review of evidence and current recommendations related to pacifier usage. J Pediatr Nurs 27, no. 6 (Dec 2012): 690–9.

Offringa, M., & Newton, R. Prophylactic drug management for febrile seizures in children. Cochrane Database Syst Rev 4 (Apr 2012): CD003031.

Orlowski, J. P., et al. Is aspirin a cause of Reye’s syndrome? A case against. Drug Saf 25 (2002): 225–231.

Plaisance, K. I., et al. Effect of antipyretic therapy on the duration of illness in experimental influenza A, Shigella sonnei, and Rickettsia rickettsii infections. Pharmacotherapy 20, no. 12 (Dec 2000): 1417–22.

Plaisance, K. I., & Mackowiak, P. A. Antipyretic therapy: Physiologic rationale, diagnostic implications, and clinical consequences. Arch Intern Med 160, no. 4 (Feb 2000): 449–56.

Prescott, L. F. Effects of non-narcotic analgesics on the liver. Drugs 32, Supple 4 (1986): 129–47.

Rosenbloom, E., et al. Do antipyretics prevent the recurrence of febrile seizures in children? A systematic review of randomized controlled trials and meta-analysis. Eur J Paediatr Neurol 17, no. 6 (May 2013): 585–8.

Schror, K. Aspirin and Reye syndrome: A review of the evidence. Paediatr Drugs 9, no. 3(2007): 195–204. Review.

Soszy?ski, D. The pathogenesis and the adaptive value of fever. Postepy Hig Med Dosw 57, no. 5 (2003): 531–54.

Souyri, C., et al.; French Network of Pharmacovigilance Centres. Severe necrotizing soft-tissue infections and nonsteroidal anti-inflammatory drugs. Clin Exp Dermatol 33, no. 3 (May 2008): 249–55.

Titchen, T., et al. Adverse drug reactions to nonsteroidal anti-inflammatory drugs, COX-2 inhibitors and paracetamol in a paediatric hospital. Br J Clin Pharmacol 59, no. 6 (Jun 2005): 718–23.

Tolman, K. G. Hepatotoxicity of non-narcotic analgesics. Am J Med 105, no. 1B (Jul 1998): 13S–19S.

Varicella, herpes zoster and nonsteroidal anti-inflammatory drugs: Serious cutaneous complications. Prescrire Int 19, no. 106 (Apr 2010): 72–3.

Wickens, K., et al.; New Zealand Asthma and Allergy Cohort Study Group. The effects of early and late paracetamol exposure on asthma and atopy: A birth cAhort. Clin Exp Allergy 41, no. 3 (Mar 2011): 399–406.

Wiegand, T. J., et al.; Toxicology Investigators Consortium Case Registry Investigators. The Toxicology Investigators Consortium Case Registry: The 2011 experience. J Med Toxicol 8, no. 4 (Dec 2012): 360–77.


No Comments

Leave a Comment