First, I'm not an ER nurse. I'm a FNP in primary care.

I recently found out that our local ER routinely uses ice packs on kids with fever over about 102. I'm not talking about heat stroke, fever of 106, febrile seizures, or anything unusual; I'm talking about the kid with fever from otitis, UTI, viral illnesses, whatever.

My question: is this common practice??

"Back in the day" when I was in the hospital- including a stint in Pedi ICU- we only used cooling blankets with very high fevers (over 105) or in patients with head injuries or brain surgeries who were having fever from hypothalmic dysfunction. That's been a while back so things could have changed.

I was taught that using ice packs or cold water to try to reduce fever would produce shivering and could actually raise core temperature.

I did a Google search on ice packs for fever and didn't find anything to support their use except in case of heat stroke, but it wasn't an extensive search and maybe I've missed something.

I hope that some of you ER folks can help me out with this. Thanks!

Specializes in pediatrics.

Hi there!

I've worked in Pediatrics for 20 years with Kids with Cancer and normal kids. The only time we used ice was with a child who had an extreme temp but we used a fan over the ice. If the child is chilled at all we give them blankets to prevent shivering and spiking. Ice seems drastic unless you are not wanting to use antipyretics. We had a naturopathic family who did that.

Specializes in NICU.

Interesting thread to me. We had a 3y/o in ER following an hour of seizing. Pt had hx of seizure disorder, hydrocephalus, and developmentally delayed. I don't work in ER, went to help, the child was being transferred to another hospital to a PICU. His legs were like ice, then I realized he had ice packs by both legs. He doesn't walk, so his legs were chilled to the bone.

Even though I have worked peds, I have never seen ice packs used before. I will be asking questions when the opportunity presents itself.

Glad this thread came up!

Specializes in ER, ICU, L&D, OR.

Used to use total immersion in the old days a lot; even used ice packs for severe cases. Doesn't get that radical anymore.

Specializes in Cardiac, ER.

Guess what? I went to a ped/infant assessment class today as part of my orientation to er. We were told in class that unless the child has a head/brain injury, or is less than 28 days old, or has been locked in a hot car all day;

1. There is no documented research that we should even treat fever.

2. Temps will almost never spike above 105, and that the idea of "brain damage" from high temps has never been documented.

3. Febrile seizures are harmless, not pleasant to watch, but cause no harm or increase your chances of having other seizure activity.

She stated that giving Motrin/Tylenol for comfort was obviously not a bad thing, but fever was there for a reason, and that 99% of the time, in otherwise healthy kids the peds Dr won't treat fever unless the parents insist.

Guess I've always heard this line of thinking, just really didn't expect to hear it today.

Specializes in ED, ICU, PSYCH, PP, CEN.

No ice, just Tylenol/Motrin, strip the kid as far down as possible, and lots of parent education.

I was just reading this discussion and I didn't know ice packs weren't used on kids....funny because my daughter, who like one poster above mentioned a kid who was dd and had ice packs..........my daughter is dd & had this done as well when she was in major teaching hspital PICU before with pyelonephritis/urosepsis.....tylenol & motrin were not touching her temp.....she is normally hypothermic (90-92.9 normal temp...but feels as warm as anyone with normal temp) and they actually did use ice packs in the pits with her. Wow this is a very interesting topic ...and I learned alot from it.....I just "assumed" they did this with everyone who had high temps that didn't go down ....hmmmm.

Specializes in Emergency.
RN-Cardiac said:

She stated that giving Motrin/tylenol for comfort was obviously not a bad thing, but fever was there for a reason, and that 99% of the time, in otherwise healthy kids the peds Dr won't treat fever unless the parents insist.

Guess I've always heard this line of thinking, just really didn't expect to hear it today.

Our protocol specifies only treating fevers over 101.

Specializes in ER, ICU, L&D, OR.
gonzo1 said:
No ice, just Tylenol/Motrin, strip the kid as far down as possible, and lots of parent education.

That's the hard part, parental Education. Almost impossible with stressed out parents.

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