The Doctor Speaks - Childhood Fevers

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By: Philip Incao, M.D.
Q. Pediatrician Daniel Alexander, MD (Brooklyn, NY), subsequent to reading Melissa L. Block's article in the magazine Mothering (July/August 2003) on Dr. Incao's fever recommendations, writes: "I have some concerns... about your recommendations against fever suppression and for bowel cleansing. When fever causes young children to refuse fluids, dehydration becomes a problem. Also, the use of suppositories for bowel cleansing can lead to further dehydration and electrolyte imbalances, leading to serious consequences."

A: This question raises an important point. The answer requires us to look at the process of acute inflammatory illness more closely. Every feverish illness proceeds in a rhythmical course with alternating cycles in which fever takes hold of us, then lets go, takes hold, lets go, etc. This is a primal biological process of contraction and expansion, like in-breathing and out-breathing.

As fever takes hold, a child contracts and concentrates her forces inward. She usually loses interest in play, food and drink and wants to curl up under the covers. As the body temperature rises, the child perceives its surroundings growing colder relative to its warming body and she starts to feel chilled or even shiver.

As the "Father of Western Medicine" Hippocrates rightly understood, this inward concentration of heat into the depths of the body betokens a cooking, digesting and

ripening process which he named pepsis in Greek. During this phase of inner contraction and cooking the child may be slightly dehydrated yet instinctively refuses to drink or eat, because her bodily energy is fully concentrated and engaged in the inner work of digesting of the illness. If a child is induced to eat or drink during this phase of the illness, she often vomits.

When the fever peaks or breaks and starts to come down, this signals the expansion and relaxation phase of the illness process. The child feels warm, may sweat and then, having perked up somewhat and thrown off the blankets, may announce that she's thirsty and hungry, and may need to go to the bathroom. This is the out-breathing phase, in which the waste products of the previous cooking-digesting phase are eliminated through sweating and mucus discharge as well as through the usual channels of bladder and bowels.

Hippocrates called this phase of the illness the catharsis, meaning the active throwing off and release of poisons from the body. Having detoxified somewhat, the child now feels better and may want to play and become active. Often however, the catharsis is merely a hiatus and not the end of the illness. After some hours the fever starts to rise again as the child, feeling unwell, draws her energy inward for the work of further digesting the illness.

The inner work of digesting an inflammatory illness is much easier for a child if its stomach and colon are relatively empty of food. A child will often have vomiting and/or diarrhea at the very beginning of an illness, and these will often abbreviate the illness or even prevent it altogether.

The various complications of an inflammatory illness, including dehydration, usually result from the incomplete digestion and/or the inadequate catharsis of the illness, causing the child to become "toxic."

Anti-inflammatory drugs like acetaminophen (Tylenol), ibuprofen, and aspirin work by interrupting the cooking-digesting phase of the inflammatory process, thus lowering the fever prematurely before the body is ready and ripe for a cleansing catharsis. This explains why such anti-inflammatory, fever suppressing drugs may increase the risk of toxic complications in an inflammatory illness. Reye's syndrome from aspirin and the invasive bacterial complications reported two years ago in New Zealand after ibuprofen treatment of children with chicken pox are examples. I would argue that dehydration is not caused by the fever itself, but by the inner toxicity which results when fever is unable to do its job.

In 30 years of treating children's feverish, inflammatory illnesses in the home, I have never recommended fever suppressants like Tylenol for fevers below 106 degrees and I have never seen dehydration as a problem, Nor have I ever seen dehydration result from judicious bowel cleansing with suppositories or Milk of Magnesia in toddlers and children.

To be sure, infants are vulnerable to dehydration, especially with repeated vomiting and diarrhea. I do not recommend Milk of Magnesia for infants under one year old. Using a glycerin suppository in a healthy feverish infant who hasn't had a bowel movement in the past 8 hours has always proved helpful in making the infant more comfortable and less restless, in my experience, and I believe it also helps the infant in getting over the illness. When infants under six months old become ill for any reason, I always recommend checking with your doctor.

PHILIP INCAO, M.D. maintains a medical practice in Denver, Colorado.

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