Treatment for Fever in Children with Epilepsy

Home Treatment for Fever in Children

The three goals of home care for a child with a fever are to reduce the temperature, prevent dehydration, and monitor for serious or life-threatening illness.  Children with epilepsy may have worsened seizures during fever, even at temperatures below 102°F (38.9°C), the temperature in which most pediatricians recommend treatment.

1)  The first goal is to make the child comfortable by monitoring and reducing the fever to under 102°F (38.9°C) or the temperature in which you and your doctor are comfortable with relevant to your child’s epilepsy condition and seizure patterns related to fever.

This is done using a thermometer and medications and dressing the child appropriately. A luke-warm water bath can also be helpful.  Do not immerse your child into cold water.  Put the child in a few inches of warm water and use a sponge or washcloth to wet the skin of the body and arms and legs. The water itself does not cool the child. The evaporation of the water off the skin does, so do not cover the child with wet towels. Contrary to the popular folk remedy to reduce fever, under no circumstances should rubbing alcohol be used in a bath or rubbed on the skin. Alcohol is poisonous to children.

  • To check your child’s temperature, you will need a thermometer. Thermometers available are glass mercury, digital, and tympanic (used in the ear).
  • Stay away from tympanic thermometers, accuracy is questionable.
  • Glass thermometers work well but may break and take several minutes to get a reading.
  • Digital thermometers are inexpensive and obtain a reading in seconds.
  • It is best to check an infant’s or toddler’s temperature rectally. If your child is unable to hold a thermometer in his/her mouth, check the temperature rectally.
  • Hold the child chest down across your knees.
  • Spread the buttocks with one hand and insert the thermometer lubricated with a water-soluble jelly about 1 inch into the rectum with the other hand.
  • Oral temperatures may be obtained in older children who are not mouth breathing or have not recently had a hot or cold beverage.
  • Acetaminophen (Children’s Tylenol) and ibuprofen (Children’s Advil, Children’s Motrin) are used to reduce fever.

Ask your pharmacist about rectal suppositories for acetaminophen to keep on hand if you need to reduce fever quickly or if child is unable to swallow.  Suppositories are also useful in the ketogenic diet.  Regular acetaminophen tablets (325 mg) should be used for the ketogenic diet instead of chewable tablets or liquids to avoid excessive carbohydrates.  Please discuss dose with dietician, pharmacist, pediatrician, or child neurologist.  The tablets can be cut to approximate correct dosage.

Dosing chart for Acetaminophen suppositories.

You will notice these doses tend to be a little higher than if given orally. This is safe for two reasons:

1. Suppositories are absorbed less consistently than an oral dose.

2. Suppositories are meant for short-term use (just while your child can’t tolerate oral intake) and giving a little higher dose for one day will not be harmful.

Doses are every 4-6 hours

  • Remember to continue to give the medication over at least 24 hours or the fever will usually return.  Regular (not long lasting) tylenol should be dosed every 4 – 6 hours.

  • Never give more than 50 mg/kg/day total – overdoses of acetaminophen can cause liver failure.

  • Ibuprofen lasts 8 hours and can be dosed between acetaminophen doses in high or treatment resistant fevers.  Do not give more than three doses of ibuprofen in one day and no more than maximal recommended daily dose of acetaminophen listed above.  Avoid liquid or some chewable forms of ibuprofen in the ketogenic diet.  Check with dietician, pharmacist, pediatrician or child neurologist on appropriate brand and dose.

This is the brand Motrin® dosage calculator for children:

http://www.motrin.ca/tools/dosage/english/calculator.html

  • Do not use aspirin to treat fever in children, especially for a fever with chickenpox. It has been linked to Reye syndrome which causes liver failure. Ibuprofen use in chickenpox is also being questioned.
  • Children should not be overdressed indoors, even in the winter.
  • Overdressing keeps the body from cooling using evaporation, radiation, conduction, or convection.
  • Most practical is to dress the child in a single layer of clothing and cover the child with a sheet or light blanket.

2)  The second goal is to keep the child from becoming dehydrated. Humans lose extra water from the skin and lungs during a fever.

  • Encourage the child to drink clear fluids such as non-carbonated drinks without caffeine or juice (not water). Water does not contain the necessary electrolytes and glucose. Other clear fluids are chicken soup, Pedialyte, and other rehydrating drinks available at your grocery or drug store.
  • If your child is on the ketogenic diet or a low carbohydrate, check with his or her dietician for recommendations during illness.
  • Tea or other caffeine-containing products should not be used. They act as diurectics and increase urination and fluid loss. This is not the effect you want.
  • Your child should urinate light-colored urine at least every four hours if well hydrated.

3)  The third goal is to monitor the child for signs of serious or life-threatening illness.

  • A good strategy is to reduce the child’s temperature to under 102°F (39.0°C).
  • Also, make sure the child is drinking enough clear fluids (not water).
  • If both these conditions are met and your child is still ill appearing, a more serious problem may exist.