[santhony44]

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!

[CritterLover]

We don't use them routinely. Actually, I've never seen anyone use ice packs in a kid, and we see some fairly high temps in kids -- 103, 104. Haven't even seen ice packs for febrile sz, though the kids usually have the sz at home and they don't repeat when they get to the ER. Maybe if they were still seizing.

I, too, thought the use of ice packs was really falling out of favor, except for a select few instances (TBI for one).

Generally, just give tylenol/motrin.

[NicoleRN07]

With my pedi patients, I generally do not use ice packs for fever, unless the child as had a febrile seizure. I simply administer Tylenol or Motrin per protocol, and generally I undress the child to their diaper, or underwear, and put on a light pedi gown or cover them with a sheet only. There are still people out there who think you should "sweat out the fever". It seems to me, that ice packs on pedi patients with temps of 102, could cause an unsafe drop in body temp, especially newborns.

[traumaRUs]

I worked level one trauma center for 10 years and NEVER saw ice packs used on kids except for breaks and even then, we used cooling blanket, not ice packs. I found this article and could not find any evidence or even articles discussing ice packs for febrile kids:

"Patients presenting with status epilepticus should be treated with airway management and anticonvulsants as necessary.
Patients presenting with history and physical examination findings consistent with a simple febrile seizure should have frequent neurologic examinations to monitor mental status.
Other causes of seizure should be ruled out.
The cause of the febrile illness should be sought and treated.
Antipyretics should be considered.
Parental anxiety needs to be addressed."

http://www.emedicine.com/emerg/topic...tion~treatment

[antidote]

I originally began in the ER and I must say I've never seen an ice pack used on a child with a high-fever. In fact, I never seen them used at all with the exception of keeping my lunch cool!

[Altra]

I've seen fevers in adults & kids up to 105.x and never once have we used ice packs, just cooling blankets.

We do use ice packs to quickly cool a post-arrest patient, according to our post-arrest hypothermia protocol.

[TazziRN]

In all my years I've never seen ice packs used for kids with fevers. In fact, we recommend against it, on the premise that temps that drop too suddenly are just as dangerous as temps that spike too suddenly. Undress 'em, medicate, and maybe a cooling bath with room temp water.

[Myxel67]

Not even for adults! I learned it the same way as OP; don't use because may cause chills & shivering..... However, I have seen many nurses and CNA's use them on adults. For baby or child at home, I have given tepid bath along with ibuprofen.

[nuangel1]

i have never seen icepaks used for kids with fevers ,btreaks yes fevers no.i can only remeber few times in icus where i saw icepaks used but that was adults and fevers over 105 accompanied by use of coolinkblankets .the nurses would put the icepaks along the sides of the patient .i also remember 1 pt where we used 2 cooling blankets ,while continuosly monitoring pts temp.,1 under pt one above but the pt had t 106.

[UKRNinUSA]

I have never understood the logic behind the use of icepacks. Ice causes vasoconstriction and shivering which both raise the body temperature. Tepid sponging seems much more logical - the evaporation of the water takes away the excess heat with it, shivering is not induced and so the body cools.