The time of year is coming when many children will have stuffy noses, coughs, and a number of them will have fevers to accompany their discomfort.  Often parents panic when their children get fevers and they rush to do whatever they can to bring the fever down.  Is it always a good idea to bring a fever down?  Are there benefits to leaving an elevated temperature elevated?

These questions were also on the mind of Dr. Michael Crocetti, director of pediatrics at the Johns Hopkins Bayview Medical Center in Baltimore, Maryland, who authored a study to investigate problems associated with bringing down fevers prematurely.  The study questioned 340 healthcare providers, including parents and grandparents, about their practices when their children had fevers.  The study indicated that 14 percent of parents gave acetaminophen (Tylenol) and 44 percent gave ibuprofen (Advil) at rates that were too frequent.  If the bottle suggested that the medication be administered every 4 hours, most parents gave it every 3 hours.  Ibuprofen is supposed to be administered no more frequently than every 6 hours, but parents often gave it every 4 or 5 hours.  It seems that caregivers panic when children’s fevers go up even slightly, and they rush to medicate them to bring their temperatures down to a more acceptable (to the parents) range.  The problem with the too-frequent dosing of children is that the children then are potentially at risk of toxicity from the medication.  Parents’ tendency to overreact to fevers most likely results from the fact that in the past fevers accompanied illnesses that were life-threatening, but today that is no longer necessarily true, according to Dr. Crocetti.   He says that parental practices need to catch up to medical science.

There are benefits to elevated body temperature, as strange as that might sound.  It was hard for me to break the thought patterns of my own upbringing when I went to chiropractic school, but when I actually started to study the body and how it works to preserve its own health, my interest piqued.  The body was designed to be a self-healing, self-regulating organism, and raising temperature is one of the body’s mechanisms for doing that.  Normal body temperature is the optimum temperature for the survival of some microbial invaders, so when they are detected by the body in any form, the body’s core will heat up to just a few degrees above normal and sustain that temperature for a long enough period of time to kill its enemy.  If the temperature is brought down prematurely, the infection might even be allowed to thrive in the body rather than die as it would have if it were left to be handled naturally by the body.  The body also uses fever to turn on the immune system.  It stimulates the inflammatory response which sends a myriad of antibodies all through the system to help protect the area of invasion from microbes and viruses.  In fact, according to Paula Elbert, M.D., assistant professor of pediatrics at Mount Sinai Medical Center, “taking away a fever might even hamper the induction of the immune system to do its job…the fever can have a positive function.”

Rather than being a sign of sickness, having a fever is actually a sign that the body is working properly.  The problem with fever for most is that having one causes body aches and general discomfort.  Some guidelines suggested by pediatric researchers for the appropriate points at which to be concerned about fever are: 1) If a child is younger than 8 weeks old and has a temperature above 100.4 degrees, 2) If a skin rash accompanies the fever, and 3) If the child’s core temperature is above 102.2 degrees.  Otherwise, it is all right to let the fever do its job and fight infection naturally.  Lowering a fever will not make the process of healing the infection happen any faster.  As I stated earlier, it might even prolong the illness.  The only real effect of decreasing the body temperature will be that of easing the discomfort of body aches and generally feeling cruddy that come with fever.  If you can just ride out the unpleasant feelings, the body will usually regulate fever and kill any invaders without medicating faster than it will if the temperature is brought down.

“It is going to take a real concerted effort on behalf of pediatricians and other healthcare providers to help parents understand what fever is and how to handle it,” according to Dr. Crocetti.  This week’s column is my share of the effort to let parents know that rushing to lower fever is not always such a great idea. Use these guidelines, pay attention to the body’s signals, and be much healthier in the process.  Treat your body and those of your children well.

I am acutely aware that school is in full swing.  Moms have been pouring into our office requesting letters for their children to be able to carry safer backpacks to school this year.  Although it came around more quickly than usual, it’s that time of year again – new school schedules, football games, band practice, studying for exams, and homework.  All of this means that your kids will be carrying heavy loads all around with them in their backpacks, and this can pose a serious health risk to them if backpack safety is not addressed by you. 

I have seen a number of children in our area with scoliosis, a lateral curvature of the spine, and they certainly don’t need to be carrying backpacks loaded with heavy books and other items all over the place.  I took the liberty of weighing a child’s pack in our office just before school was out last year, and was astonished to find that a 60 pound child was carrying a hefty 27 pounds on his back.  This could bring about strained muscles at the very least and become quite uncomfortable for him.  I have learned that some children are “punished” by being denied access to their lockers, thereby forcing them to carry all of their books around all the time during their time of punishment.  Some children think it is cool to play the role of martyr and compete for parents’ attention by seeing how many books they are “required” to bring home.  Either way, children are carrying too much around on their backs.  Although children definitely heal faster than we do, long-term stress-type injuries can occur when they require their bodies to do more than they were designed to do.  According to the Consumer Product Safety Commission, there were over 12,000 visits to emergency rooms alone in 1998 for backpack-related injuries to 5- to 18-year-olds.  This figure does not take into account the number of visits to general pediatricians, orthopedists, or chiropractors. 

There are several sources for the safely allowed amount of weight for children to carry on their backs.  The range is 10 to 20 percent of their body weight.  Keep in mind the fact that children’s bodies vary in muscular composition, and some are inherently heavier than others and have larger frames.  According to Mark D. Widome, M.D., a general pediatrician and professor of pediatrics at Penn State’s College of Medicine in Hershey, PA, a good rule of thumb is to allow 15 percent of the child’s body weight in his backpack.  This means that the 60 pound child I mentioned before should carry no more than 9 pounds on his back.   

Weight is not the only hazard with backpacks.  It seems that kids think it is “cool” to wear the backpacks on only one shoulder.  The trouble with this is rather obvious, but kids do it anyway.  A functional scoliosis, which is one that develops as a result of some outward stress as opposed to a congenital scoliosis which one is born with, can develop as a result of carrying heavy weight on one side of the body rather than distributing weight evenly.  There are two solutions to this problem: 1) distribute weight evenly, and 2) carry the weight for equal amounts of time on both sides of the body.  Most of us pick up objects habitually with one hand or the other, so solution #2 is not really a viable one unless you are very well-disciplined and can remember to pick up the heavy object with the opposite hand each time you carry it.  There is usually no one to walk behind your children all day at school and remind them to switch hands.

Backpacks can become a problem for those other than their carriers, too.  Imagine walking down a very crowded hallway full of children when one of them suddenly turns to yell at a friend and swings her 20 pound pack, hitting you squarely on the shoulder.  This is a real issue in crowded schools.  Kids are unaware of the bulk on their backs, and can pose hazards to their neighbors.  Bulky packs are a problem in the classroom when they aren’t in use.  Unless plans have been made for storage, backpacks are often dropped beside desks and create tripping hazards.  The best solution to this and many other backpack-related issues is to purchase a small backpack which can easily fit under a desk or chair.  This will leave the aisles clear and make it much safer for everyone to walk in them. 

Backpacks are available with lumbar supports and multiple compartments to help distribute heavy loads more evenly.  For heavier loads, a hip strap is available to help keep the pack close to the body. This allows some of the weight to be carried by the hips rather than overloading the back.  Look for a pack with wide, padded shoulder straps that are easy to adjust.  The American Chiropractic Association has information regarding a line of backpacks made by an Australian company for Samsonite.  The line of packs, called Chiropak, is designed for comfort, efficiency, and protection for the spine against the damage that can be caused by overstuffed packs.   The correct way to carry heavy loads is to carry them close to the body, so heavier books should be inserted into the pack first.  To decide which pack is best for your child, have the child try it on for comfort first, then put a few books or something moderately heavy in it to see how your child will go about carrying his or her load.  Make sure the pack can be carried with the child standing upright and not leaned over forward or off to one side.

Remember that “as the twig is bent so grows the tree.”  Take the extra time to weigh your child’s backpack.  Discuss these safety issues now, and you just might save some serious trouble down the road.  Treat your body and those of your children well.

Few issues present more embarrassment for children and more frustration for parents than nocturnal enuresis, or night-time bedwetting.  For children it becomes quite a social burden when they are old enough to be invited to sleepover parties only to dodge the invitation due to possible bed-wetting problems.  Some children even go so far as to stay up all night in such situations just to avoid the possibility of embarrassment.  Friends can’t be invited over without lengthy explanations of all the preparations for bed, and no adolescent wants his or her friends to know that they have to wear pull-up diapers every night.  It is a real issue for them. 

Parents are left feeling frustrated by the turmoil the problem of nocturnal enuresis causes at home, too.  Extra loads of laundry have to be done, plastic sheets have to be arranged to avoid ruining mattresses, extra expense of pull-up diapers must be borne, alarms must be set in the middle of the night to wake up their children to get them to the bathroom, and the list goes on.  Add to this list the worry about what might be causing the problem in the first place, and the frustration mounts.  Parents have to be very patient, balance their irritation with their concern, and be careful not to scold children for something that is completely beyond their control.  If you are one of these parents, you are not alone.  According to Claudia Anrig, D.C., author of a textbook on chiropractic pediatrics, approximately 2-3 million children in the U.S. are afflicted with this disorder.  About 10 to 15 percent of 5 year olds and 5 percent of 10 year olds suffer.  The cause is largely unknown, although there is a hereditary component in some cases.

First handling for nocturnal enuresis should always be ruling out organic causes for the problem.  Your child’s pediatrician will know where to turn to make sure there is no urological or neurological cause.  Once these systems have been cleared as being the primary cause of night-time bedwetting, doctors often will prescribe medications for the problem.  Sometimes the medications are temporarily effective, but are not without their side effects and often the problem returns when the medication stops.  So there is no long-term effectiveness against which to weigh the down-sides of medications.  Night-time alarms are also used in the treatment of bed-wetting, but they don’t do anything to stop the problem.  They warn many times only when it is too late.  Often nocturnal enuresis is a self-limiting problem, or one which a child seems just to “grow out of”.  The questions are, however, “When will the child grow out of it?’ and “How much more of this can I take?” 

There is some evidence both clinical and published that chiropractic treatment might help those with nocturnal enuresis.  In the peer-reviewed Journal of Manipulative and Physiological Therapeutics, a study was published that was performed at the Palmer Institute of Graduate Studies and Research in Davenport, Iowa.  The study included a group of enuretic children who received a series of chiropractic treatments and a control group which received no chiropractic adjustments, and showed a 50 percent decrease in bedwetting episodes- measured by frequency of wet nights as reported by parents. Other studies report similar findings, while still others report a smaller decrease but a decrease nonetheless.  Most often the area of spinal manipulation that has shown to be the most effective in aiding those with nocturnal enuresis is the lumbar, or lower back, region of the spine.  The nerves in the lumbar spine supply the kidneys and bladder, so if there is a spinal misalignment in that area which is putting pressure on the lumbar nerve roots which supply those organs, the interference could cause them to malfunction.  It is the job of your chiropractor to locate the areas of misalignment and make the necessary corrections in order to restore the proper nerve flow to the body.  Proper nerve function helps us rest assured that our body’s self-healing, self-regulating properties are at work the way nature intended for them to be.

Getting adjusted can cause a number of positive effects on the body’s nervous system, and helping to decrease the episodes of bedwetting is one of those possibilities.  Ask your chiropractor about the many wonders of correcting interferences in your child’s nervous system.  You will be glad you did.  Treat your body well.