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Don't suppress that fever! (And why I don't like Tylenol) Tylenol has been linked to ADHD and Autism.

Don’t suppress that fever! (and why I don’t like Tylenol)

Annika, my 9 month old, got her first fever over Christmas. It went up to 105.8° F (on a temporal artery thermometer).

I can just hear the other parents now: “Yikes! 105.8? You gave her Tylenol, right?”

Nope. No Tylenol, no ibuprofen, nothing but extra cuddles and lots of nursing.

Her fever broke on its own a few hours later, and the next morning she was crawling around fast as her little knees could take her.

Fevers are not dangerous.  The infection may be!

It’s not unusual for children to have very high fevers. In fact, it is generally very helpful for kids to get robust fevers, as it signals a strong immune response which can quickly eliminate pathogens (the bad bugs). A fever isn’t intrinsically dangerous until it reaches 108° F (yikes that is high!), as that is the point at which brain damage can occur.

Febrile (fever) seizures can occur at temperatures below this point. Despite the fact that they are unbelievably scary, febrile seizures alone are not a reason to give Tylenol or other fever-reducers. In fact, febrile seizures in otherwise normal children are completely safe. (Except that they may raise the parent’s blood pressure!)

Many parents mistakenly give their children fever-reducing agents thinking that it is the best thing for their child.  In fact, many parents give Tylenol before their child has a fever!  Remember that it is not considered a fever until the temperature reaches greater than 100.4° F with a rectal, ear or temporal thermometer, or greater than 100° F with an oral thermometer.  (Rectal, ear and temporal thermometers are generally about a degree higher than oral thermometers.  That’s why the 105.8 degree temporal reading didn’t worry me as much.) Anything under that reading is considered a normal variation in body temperature.

Here are some guidelines for managing a high fever:

1. Pay more attention to how the child is looking/feeling than what the thermometer says.  A really sick looking kid is really sick, no matter what the temperature (high or low!).  Sometimes kids will get listless, stop crying, and cannot be stimulated.  Other times they will be incredibly irritable and cry uncontrollably.  Use your best Mom (or Dad) radar and follow your instincts!

2. Normal fevers are between 100 and 104° F.  Check with your child’s physician if it is higher than this.  Often times it will be just like Annika’s story and we can wait it out, but once in a blue moon a dangerous situation can arise suddenly.

3. Wait on the Tylenol. The brain has a set-point at which fever tops out – it is totally a myth that without treatment a fever will keep rising indefinitely.  Another myth: breaking the fever will stop the infection.  In fact, the cytokines that cause fever also signal the immune system to do its job – we don’t want to interfere with that process!

4. AGAIN – how your child looks is the most important determinant of whether your child has a serious infection.  Repeat after me: “It is not the number, but how my child looks that is important.”

5. All that said: it is NEVER normal for a newborn to have a fever.  Any infant under age 3 months with a fever (greater than 100.4° F) needs to be checked out immediately.

Don’t believe me? Check out this great article from Seattle Children’s Hospital: the Myths of Fever.

Why I don’t like Tylenol.

Any why does Dr. Erika not like Tylenol?  Oh this is a favorite subject of mine.  I truly loathe acetaminophen as an OTC drug (no fault to the makers of Tylenol, they’re just doing their job).  I have a whole long blog post (Just say “NO” to Tylenol: Acetaminophen causes autism?), but here is the simplified version:

Acetaminophen is hugely liver toxic.  And I don’t mean in a vague, naturopathic “oh that McDonald’s hamburger is bad for your liver.”  Acetaminophen is the number 1 cause of liver failure in the UK, and the number 2 cause in the US (of cases requiring liver transplantation).  It is more common than viral hepatitis leading to acute (sudden) liver failure.

Why? The liver converts acetaminophen into N-acetyl-p-benzoquinone imine (NAPQI) in an attempt to get rid of it. (“N-acetyl what??” Don’t worry about pronouncing it, there will be no test at the end of this blog).  The problem is that NAPQI requires huge amounts of a really important endogenous (body-made) antioxidant called glutathione in order to make it less toxic.  Glutathione is responsible for scavenging all the free radicals produced all over the body by various (often normal!) metabolic processes.  NAPQI chews up glutathione in massive quantities, leaving excess free radicals to burn and cause DNA and cellular damage all over the body.  The liver then has to deal with not only the lack of glutathione, but the highly toxic NAPQI.  Hepatocellular (liver cell) damage, necrosis (ugly cell death), and liver failure follows.

The super rad chemical structure and how it is converted in the body (for all you nerds out there). Paracetamol is just another name for acetaminophen.
The super rad chemical structure and how it is converted in the body (for all you nerds out there). Paracetamol is just another name for acetaminophen. GSH in an abbreviation for glutathione (the purple arrow). The blue arrows show other pathways the liver can use for detoxification too.

Okay, so you’ve taken Tylenol in the past and you didn’t die, so no harm, no foul, right?  Sort of.  The liver is an incredibly resilient organ, so in most normal people it takes the hit, waits until the acetaminophen passes, restores glutathione (if you eat right) and then rebuilds liver cells.  BUT, in small children, in anyone with liver damage, or in large doses it can lead to liver failure.

Acetaminophen has a much lower maximum daily dose than almost any other over the counter medication.  Adults should take NO MORE than 3,000 mg per day.  That is six 500-mg pills per day.  Children’s dose is at maximum 80 mg/kg per day.  Most people have no idea what that means, which is why pediatricians give you a dosing chart.  Do NOT exceed that dose!! The problem is that acetaminophen is in many combination products, including over the counter cough syrups, Nyquil, pain formulas and more.  Read the labels carefully!

I have more reasons to loathe acetaminophen, including the implications of depleting glutathione in developing children. Here is that follow-up blog post again: Just say “NO” to Tylenol: Acetaminophen causes autism?

Until then, here’s your review:

1. It’s not the degree of fever, but how your child looks that matters.

2. Avoid acetaminophen whenever possible.  When you do use it, read the label carefully and never exceed the recommended amount.  Check all your pain, flu and fever combination products for their active ingredients, and never combine Tylenol with other over-the-counter formulas.

Don’t believe me? Here’s a great article from Seattle Children’s Hospital about the Myths of Fever: https://www.seattlechildrens.org/conditions/a-z/fever-myths-versus-facts/

And here is another great post, written by my colleague, about how to overcome your Fever Phobia.

Avatar
Erika Krumbeck

Erika Krumbeck, ND is founder of NaturopathicPediatrics.com and the owner of Montana Whole Health, a naturopathic clinic in Missoula, Montana. She received her Doctorate of Naturopathic Medicine from Bastyr University and is a licensed physician in the state of Montana. Dr. Krumbeck is one of few physicians specializing in the treatment of chronic health conditions in children. 

Dr. Krumbeck likes to practice her own healthy lifestyle with her wonderful husband Jason, a physical therapist, and their children Annika and Leopold. 

She is a professional member of the Pediatric Association of Naturopathic Physicians.

Comments:

  • Avatar
    Charlie Schwartz
    August 9, 2019 at 6:26 pm

    You’re an imbecile if you think that Tylenol is not healthy and high fevers are. Not everyone has a strong immune system so to generalize everyone as needing “cuddles”, you’re hospitalizing them. And no I didn’t read the whole article because I was almost hospitalized with a 105.5 when I was a CHILD bc of my weak immune system but Tylenol saved us a $1,000 copay. And no I didn’t read your whole article Erika.

  • Avatar
    Jenna
    April 27, 2018 at 5:39 pm

    VERY interesting article. My son is 4 years old and gets febrile seizures. Every pediatrician & ER doctor we have ever met encourages us to alternate between Tylenol & Motrin every 3 hours if his temp. ever reaches 100.4. Sooooo, that’s what we’ve been doing!! Any recommendations on how we can help him to avoid another febrile seizure without giving Tylenol? Thanks for your time & expertise!! We really appreciate it.

  • Avatar
    Orsolya K Lazar
    April 5, 2018 at 7:22 am

    http://www.seattlechildrens.org/medical-conditions/symptom-index/fever-myths-versus-facts/.

    The link to the Seattle Children’s Hospital article does not work. This is the correct URL.

  • Avatar
    Sara
    October 30, 2017 at 9:24 am

    I believe in the bodies natural ways of healing, but 105.8 is extremely dangerous!! You are giving horrible advise !! That can kill an innocent child !! Plz parents don’t believe this . When a childs fever reaches 104.0 you HAVE to give them something! And no seizures are NOT okay ! I am a anti vaxer and believe in most homeopathic medicine, but this article is ridiculous! Ever hear of valley fever ?? It happens when a fever gets too high and the heart expands .. it causes DEATH ! Fevers are healthy to an extinct! But they can also kill if they get too high

  • Avatar
    Monica
    January 18, 2017 at 1:59 pm

    This might be a silly or strange question but is it strange that my son has never really had a fever? I think he’s only gotten to 101 once or twice and he’s 11 months old. He’s received all vaccines so far and goes to daycare full time so he’s definitely been sick. Would you consider this a sign that perhaps his body doesn’t fight bugs like it should be?

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    July 3, 2016 at 1:52 am
  • Avatar
    vannessa ramirez
    June 25, 2016 at 7:22 pm

    hi dr Erika

    my niece has chicken pox and my mother in law watches her and her sisters here at our house. as much as i would love for my son not to get it i cant control if he does or not i have been keeping him away and have cleaned our room and house but should he get it what do you recommend for the fever that may come with it.

  • Avatar
    Brittany
    February 26, 2016 at 3:55 am

    You said in your article that the max daily dose of acetaminophen for children is 80mg. The bottle says 80mg is the dose for a child between 24-35 pounds and it can be taken up to 5 times in 24 hours. Is this not correct?

      • Avatar
        DYFS
        October 25, 2016 at 10:51 pm

        Whoah I understand not using it for a mild fever but isn’t a fever that’s over 105 bordering on child neglect considering that’s high enough to start doing damage to the child’s brain (which is far more important than a damn liver) 101-103 I can understand but when you’re talking about a fever that is 105-106 I’d question your integrity as a doctor and you mind as well have saved yourself the cash you spent on a degree and opened a clinic pushing their holistic bs lol wow

        • Avatar
          Steve
          December 28, 2016 at 9:58 pm

          I would take your kid to a real doctor. I had a fever that high when I was a kid from equestrian encephalitis, it nearly killed me. But hey, if you don’t care about your kid dying or you are just too lazy or cheap to take them to the doctor, go for the online natro doctor. Christian Science helps a lot of kids die too, try that. If I was on a jury and your kid died because of this type of neglect, I would vote to put you in prison for life and not lose any sleep.

  • Avatar
    Jim
    February 13, 2016 at 5:23 am

    Acetaminophen plus low glutathione levels/synthesis plus exposure to styrene equals autism. I would explore toxicity at extremely low doses of acetaminophen. Does acetaminophen or its by products cross the placenta or blood brain barrier? Could this also cause Alzheimer’s?

  • Avatar
    Melissa Stanton
    October 13, 2015 at 8:02 pm

    If my child has a persistent fever that keeps hitting 104 should I give motrin? He is 8yo and has asd and asthma. Do I try and k6et the fever break on its own? At what point do I become concerned?

      • Avatar
        Nicole
        February 4, 2016 at 8:21 pm

        Doctor Erika, my daughter is 7 years old and has had a fever of 101.7 with an oral thermometer since last night. I gave her elderberry syrup. But I have given her tylenol twice now. Her fever is now almost 103. I just gave her more elderberry syrup and lots of water and tea. I don’t want to give her anymore tylenol since it can disrupt her healing but I am getting scared. So you have any reccomendations or natural remedies for the fever? Any advice would be much appreciated!

  • Avatar
    BTC
    August 31, 2015 at 4:36 am

    Not a great article when your kid is allergic to Motrin! #justsaying

  • Avatar
    diane
    July 21, 2015 at 3:53 am

    Thank you for the time you took to share this information! So helpful.

    My kiddo had a 105-degree fever when he was about a year old. He was breastfed militantly, but the fever persisted for days. After a bath (was a warm bath a bad move?), he started shaking and dropping his head. He became the clinical version of ‘listless.’ I feared meningitis.

    At the ER, the doctor said it was his first thought, too, because my child turned irate upon being touched by the doctor. Like nothing I’d ever seen from him.

    The doctors and staff would not let us leave the ER without giving my kiddo something to try to reduce his fever–“observe the fever curve”–and brought in multiple doctors to pressure us and look at us as if we were scum by not wanting to give him a fever-reducer. Prior to this, they’d prodded and poked at his little arms for an hour, trying to get a vein that would provide enough blood for them to analyze his blood cells. I held and fed him and watched his teary eyes for an hour of them handling him so gruffly. I hope the fact that my husband and I were there, me feeding him the entire time, helped, but it’s such a jarring memory.

    A year later, I still look back with regret. Should I have NOT taken him to the ER? What if it HAD been meningitis? Thank God it was the only sickness he has experienced (non-damaging viral roseola, in case anyone’s curious)–he doesn’t even get the sniffles, probably because of all the great breastfeeding. I look back and worry so much about the fever-reduction meds (Motrin) and his little liver. We didn’t have our boy on solids until after a year, and we are adamant about keeping GMOs out of his diet, but this always comes to mind when I mull over past decisions. I think back to the pressures and how those doctors looked at us with utter disbelief at our not wanting any meds for our boy, how one doctor turned into three just to pressure us (and Lord only knows what they said about us beyond the closed doors). The idea of ever going to the ER again terrifies me.

  • Avatar
    kc
    July 4, 2015 at 2:03 am

    My daughter was 3 months old when she got a low grade fever like 100 or 101 on monday then by wed it was 103 and she was becoming more sleepy but I just felt something was wrong as she had no other symptoms. I took her to the docs on wed but they said her fever wasn’t over 102 so they just sent us home and to give her tylenol. I did and every time the tylenol wore off her fever spiked fast and higher than the last time. By friday morning it was 105.5 she was also almost unable to stay awake and still no other symptoms. Took her to the ER and was admitted. After a lengthy and scary day of testing found out she had kidney infections from a ureter defect. She was on IV antibiotics for 3 days before her fever stopped coming back. She has rarely been sick since in 4 yrs , in fact only twice so far and I don’t give her anything during the day and if she is feeling really bad 1 small dose before bed but its never been over 103 either. Just thought I would share.

  • Avatar
    Petvet
    April 17, 2015 at 3:08 pm

    So is it not true that a fever over 100.4 in a newborn who is less than 2 months old should be treated as a medical emergency (ie, don’t give any meds and head straight to ER)? Not because the fever is dangerous, but because it can be indicative of something very serious in a baby this young like meningitis, sepsis, etc.? Surely a fever in a 4 week old baby doesn’t have to be above 100.4 to “count”?
    Also, I guess I don’t believe in being alarmists about fevers OR medications. Yes, fevers have their place, but medications like Tylenol (and by that i mean acetaminophen, not the brand) do too. Perhaps as a society we tend to think because a medication is OTC, it is harmless without any risks associated with their use. I actually, for the reasons you mentioned, do not think Tylenol should be an OTC drug, especially the way its in so many medications in combination with other drugs, so that people could be overdosing tylenol without knowing. It’s low margin of safety is scary!

    I guess I don’t think people should be terrified to use Tylenol or other OTC drugs, but rather, should be educated on when NOT to use it just as much as when to use it. And the indications should be very specific, so people have a more subjective way of deciding.

    As a side note, perhaps as a veterinarian I’m more concerned with this, but like animals, young babies can be in pain without the parent knowing because the signs of pain in an infant are more subtle than in an older child who can let you know where it hurts and how severe the pain is. I just don’t like the assumption that if an infant isn’t crying or fussing, s/he’s not hurting.

    I would be interested to see further studies about pain and the effectiveness of vaccines. I would think pain causes stress, and stress, in general, decreases the immune response, making me wonder if in certain situations, Tylenol or ibuprofen is warranted after vaccines. Also, I don’t think people should think that their child’s vaccines won’t work because they gave their child Tylenol. A lower titer doesn’t necessarily mean the child wouldnt be protected by the vaccine when realistically challenged.
    Haha, just the things I wonder when I let my mind wander:-)

  • Avatar
    Anna
    April 10, 2015 at 9:55 am

    Hi there, well written post and thank you! I have been reading up on fevers and stopped giving my son pamole last year … He seems to develop high fevers quickly but handles anything under 104 well. A couple of days ago he developed a fever with no other visible symptoms … 7 hours into his fever he had a febrile seizure. We took him to the doctor to make sure it wasn’t something vicious and they gave him pamole which reduced his fever from 39.7 to 37.6 in less than an hour. I didnt feel good about this at all but my husband was adamant. The next day I suspected the fever would return as it had in the past when I had used pamole, but there was no fever, not even the next night so we thought he was rid if any virus/bacteria. Two nights after tho he developed a fever which rose from normal to 105.08 within an hour. Over 104 he is pretty lethargic and after the seizure despite not feeling 100% about it my husband and I gave him a low dose of pamole which has bought it back to 100.4 in 3 hours. I know for sure that this prolongs his illness and I should be glad that he develops a temperature so rapidly. If I don’t give him anything then its usually all over in 12 – 24 hours but the seizure really shook us big time and we are not sure how to deal with this new challenge… Would you recommend using pamole in a 19 month old who is prone to seizures or could we try to take the edge off fevers over 104 … We’re not sure how to progress and I feel like we’re letting our son down by making decisions based on fear rather than fact…

  • Avatar
    Chris David
    April 2, 2015 at 3:31 am

    What about when the fever seems to prevent the child from sleeping? Would be benefit of rest outwiegh the negatives of tylenol? Let’s say this happens roughly once every month or two, as far as toxcicity levels go.

  • Avatar
    Amanda
    February 5, 2015 at 3:59 am

    I just hope no precious children are hurt by this article. My cousin is partially deaf because of an extremely high untreated fever she suffered as a toddler. Medicines like Tylenol can certainly be overused, but they can also be an absolute blessing. I hope anyone reading this article will not withhold medicine from their child when it is needed.

    Modern medicine is not an enemy to be avoided but rather a tool to be used properly when needed. I can only imagine how many hundreds of thousands of people up to this current generation could have been saved from death by a simple dose of Tylenol or Penicillin, and sadly today there is this huge movement to villainize things that really are helpful by fearmongers who want to sell you their all natural alternative (Dr. Mercola), or by innocent but misguided people who glorify all things natural. I bet if you could get in a time machine and go visit a Native American tribe hundreds of years ago they’d thank you kindly for a dose of Tylenol to save one of their sick children. And here we are turning up our noses at it today. Absolutely ridiculous. Let’s get off our high horses here and think about our children over our prideful ideals.

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    March 1, 2014 at 9:44 am
    • Avatar
      Karen Peters
      April 11, 2015 at 2:53 pm

      You are right, there are many ways to naturally treat a fever, I don’t understand how Dr. Krumbeck can warn us on the dangers of tylenol and then recommend it. No one should ever use tylenol, not when there are so many natural ways to treat a fever. Both motrin and tylenol are dangerous.To alternate between the 2 is even more dangerous. Motrin can cause kidney failure and tylenol can cause liver failure. Both will damage the gut and this can cause leaky gut and chronic illnesses. Tylenol use can increase your child’s chances of developing Autism, ADHD, allergies, and Asthma. It’s best to avoid both and use natural remedies. A functional medicine doctor who does nutritional response testing will treat your child naturally without using harmful over the counter medication. Here are natural ways to treat a fever.http://www.mommypotamus.com/natural-remedies-for-a-fever/

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  • Avatar
    Beatrice Bernardez
    June 6, 2013 at 1:43 pm

    Acetaminophen is used to treat many conditions such as headache, muscle aches, arthritis, backache, toothaches, colds, and fevers.’;-;

    Newly released article straight from our very own blog page
    <http://www.ideascollection.org

  • Avatar
    Kate @ Mommy Monologues
    February 16, 2013 at 9:22 am

    How do you feel about Ibuprofen?

  • Avatar
    Bridget Grusecki
    January 24, 2013 at 9:36 pm

    Love your website and blog!
    I am with you on respecting the wisdom of the body when it comes to safe fevers, and I am wary of acetaminophen in particular as well. I am interested in the theory that lowering fevers prolongs illness or impairs the immune system. I’ve looked for data on this, and unfortunately, there isn’t a lot out there. Here is a blurb from one article that questions the risk-benefit profile on antipyretics (with a link to the full article below).

    “Moreover, the relative cost of such symptomatic relief, in terms of drug toxicity and adverse effects of antipyretic agents on the course of the illness responsible for the fever, has never been determined. The importance of such information is underscored by reports that acetaminophen prolongs the time to crusting of skin lesions in children with chicken pox95 and that acetaminophen and aspirin increase viral shedding and nasal signs and symptoms while suppressing the serum-neutralizing antibody response in adults with rhinovirus infections.96- 97 Findings of studies in human volunteers imply further that the capacity of antipyretic agents to prolong the course of rhinovirus and varicella infections might extend to viruses such as influenza virus as well (K.I.P., S. Kudaravalli, MD, S. S. Wasserman, MD, and P.A.M., unpublished data, 1999).”
    Plaisance KI, Mackowiak PA (2000) Antipyretic therapy: physiologic rationale, diagnostic implications, and clinical consequences. Archives of Internal Medicine, 160, 449–456.
    http://archinte.jamanetwork.com.proxy.heal-wa.org/article.aspx?articleid=415390#qundefined

  • Avatar
    Maggie Luther
    January 15, 2013 at 2:55 pm

    Hi Dr. Erika

    Thank you for breaking down the fever phobia myth so eloquently. It is a shame how our knee jerk reaction is to lessen a fever at first sight, even to preemptively treat it. There is always a time and place for medications that suppress symptoms, but should not be the standard of care. The body is doing an amazing job at not only increasing the temperature so pathogens can’t live, but increasing the body’s immune response. We shouldn’t get in the way of that process unless absolutely necessary!

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