Why does my child's body temperature still not go down after taking antipyretics? How to stop the fever from recurring?

Recently, various pathogens have come one after another, Mycoplasma pneumoniae has not yet ended, influenza, syncytial virus, adenovirus have come again, and the hospital is crowded with children with fever.

Even though I have given my child antipyretics, why can't my body temperature go down? How can I really reduce fever and stop it from recurring? Today, I will talk about this problem in detail.

What happens in our bodies when we have a fever?

This problem has to start with the regulation of body temperature.

A person's normal body temperature is controlled by the hypothalamic thermoregulatory center, which balances thermogenesis (mainly produced by the metabolic activity of the muscles and liver) with heat dissipation (through the skin and lungs), as shown in the figure below.

In a normal temperature environment, the thermoregulatory center can maintain a fairly stable body temperature, just like a smart air conditioner set at 37°C.

Fever is a thermoregulatory increase caused by the upward shift of the body temperature setting point under the action of pyrogens. This pyrogen includes not only various microorganisms from the outside world (bacteria, viruses, mycoplasma, chlamydia, etc.), but also various cytokines from our body's immune system.

When the pyrogen is transported to the brain and the thermostat point rises, the thermoregulatory center thinks that the body temperature is too low and initiates a series of reactions to raise the body temperature to a new point (just like an air conditioner is incorrectly set to 40°C). At this moment, people's feelings are chills and shivering (heat production > heat dissipation).

When the body temperature rises to a new setting point, which is around the false high temperature (40°C), the body thinks that this temperature is appropriate and continues to maintain this temperature, which may last from hours to weeks. At this time, "heat production = heat dissipation", people will no longer feel cold.

And this temperature is higher than usual, so we will feel the temperature of the skin increase, and we will see the capillaries of the skin dilate. These in turn re-stimulate the thermoreceptors, and the person feels that he is "hot".

Then, when the pyrogen is controlled and removed, or the setting point is restored to normal with drugs (the air conditioner is adjusted back to 37°C), the body initiates a heat dissipation reaction such as sweating (heat production < heat dissipation), and the body temperature is lowered.

In this way, the whole process of heating is completed: the body temperature rises first, then stabilizes at high temperatures, and finally falls.

Why can't I get rid of antipyretic medicine?

So back to our topic today: why can't my body temperature go down after taking antipyretics?

The root cause is: the pyrogen is still there. Specifically, there may be the following scenarios:

1. The body temperature is on the rise when you take the medicine

When taking medicine, during the period of "heat production > heat dissipation", the body temperature may continue to rise instead of subsided.

Although under the influence of drugs and the body's own regulation, the body temperature can still retreat, but the pyrogen is still there, so a new round of "air conditioning temperature determination war" began, heat production, heat dissipation continued to tug of war, body temperature retreated, rose and retreated, and repeatedly.

2. Inadequate dosage of medication

If the dose of the drug is insufficient, it will not be refunded. Among the commonly used antipyretic drugs for children, ibuprofen has a maximum dose of 10 mg/kg and acetaminophen has a maximum dose of 15 mg/kg. The maximum dose is usually not written on the outer box of the drug (for fear that if other combination drugs are used together, the drug will be overdosed).

3. Lack of fluid in the body

There is not enough fluid in the body, there is no way to dissipate heat through sweating, and the body temperature is not easy to retreat. When you have a fever, encourage your child to drink fluids in small amounts and often to stay hydrated.

4. Cover it too tightly

"Cover too tightly", the room temperature is high, wear too much, cover thickly, and the body is also unable to dissipate heat. When you are hot, you must not "cover your sweat", the room temperature should be cool, and clothing should be reduced to help dissipate heat.

To use an imperfect analogy: heating is like boiling water on a stove, and now that the water is boiling, the various antipyretic methods we use are like adding a large scoop of cold water to a kettle, and the water will naturally not continue to boil. But the fire on the stove was still burning, and after a while the water boiled again.

How can I really reduce fever and stop it from recurring?

Put out the fire so that the water does not continue to boil. How to extinguish the flame and control and remove the pyrogens. In this way, the body temperature will really go down and it will not recur.

That is, when the immune system in the body prevails and defeats the pathogens from the outside world. After the external pathogens are eliminated, the cytokines in the body will naturally calm down (the battle is over, they are all resting), and then the internal and external pyrogens have died down, and the body temperature has really improved.

Fever is not a disease, just a physiological reaction. For people without serious underlying medical conditions, fever can make people feel uncomfortable, but it will also increase the body's consumption and increase the demands on the cardiovascular and respiratory systems, but most of these have only mild consequences.

When the temperature rises, it can also slow down the growth and replication of bacteria and viruses to a certain extent, and enhance immune function, so the essence of fever is that the body wants to better resist infection.

Many times, moms and dads think that fever is harmful, that intervention is necessary, and that it must be lowered to normal body temperature, but there is no evidence that fever makes the condition worse, and there is no evidence that fever reduces the incidence of complications.

Therefore, if you want your child to have a fever that does not recur, it is better for you to focus on things like reducing fever, rehydration, and helping your child dissipate heat, rather than trying everything to reduce the body temperature to normal.

Antipyretics are used to make people comfortable and reduce fluid loss. Seeing the cause behind the fever is more meaningful to the treatment, seeing the child's mental state, alerting to the appearance of complications, and identifying the signs of severe illness than to dwell on the symptoms of fever itself. For the response to fever, you can refer to this article on what to do if your child has a fever under the epidemic?

What are the signs that it's time to see a doctor?

Be vigilant and seek medical attention if:

1. Infants under 3 months old have fever above 38°C;

2. Infants aged 3-6 months have a fever of more than 38.9°C, or a body temperature of no more than 38.9°C, but are unusually irritable, malaise or look unwell;

3. Children aged 6 months to 2 years old, with unexplained fever exceeding 38.9°C and persisting for more than 24 hours without fever, and there are no other obvious accompanying symptoms;

4. Children over 2 years old, if the child is in a normal mental state (can have normal interaction with adults) after taking antipyretic drugs and can consume sufficient fluids, then they can be observed at home.

However, if there is an abnormal mental state, such as unresponsiveness, persistent lethargy, or irritability, uncomfortable crying, labored breathing, frequent vomiting, inability to eat or drink any fluids, or fever that persists for more than 72 hours and still does not improve, it is necessary to seek medical attention promptly.

In addition, it is important to see a doctor as soon as possible to determine the cause if you have any of the following conditions:

1. Rash appears, but fever does not subside;

2. If you have a very uncomfortable condition such as earache, abdominal pain, headache, etc.

3. Labored breathing and shortness of breath;

4. Infants and young children have not had wet diapers for more than 6 hours, and older children have not urinated for more than 6-8 hours;

5. Fever with convulsions (convulsions).

Finally, in special cases, if the child has congenital heart disease, malignant tumor, lupus erythematosus and other underlying diseases, any degree of fever is worthy of attention and needs to be treated as soon as possible. 

| Reviewers

Sha Xiaodan

Zhuo Zheng pediatrician

Ph.D., Shanghai Medical College, Fudan University

| bibliography

1. Pathophysiology and treatment of fever in infants and children.

2.Uptodate.Pathophysiology and treatment of fever in adults.

3. Wang Jianzhi, Qian Ruizhe, Pathophysiology (9th Edition) [M] Beijing, People's Medical Publishing House, 2010

4.Cimpello, L, Goldman, D, Khine, H. Fever pathophysiology CLIN PEDIATR EMERG M. 2000; 1 (2): 84-93.

5.Kruse, J. Fever in children. AM FAM PHYSICIAN. 1988; 37 (2): 127-35.

| Content team

Medical Editor/Luka 

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