packing a child in ice for a fever of 105 degrees?

jmtndl · Mar 1, 2008

As far as I know this is an old practice that was abandoned years ago. We did it when I worked a pediatriac emergency room in 1978. Then it became known that rebound temps could ocur, plus it is like some kind of torture to stick a kid who has a fever in ice! I have always done tepid baths, actually starting the kid out in a warm bath so they don't freak out then gradually adding cool water till it is tepid. And there is always Tylenol and Motrin.Where was this done? Why was it so urgent to get the temp down so fast. This is not something I would do.Poor baby!

clhRN2b2010 · Mar 1, 2008

Ditto. I was just told in class that we had a 5 yr ld boy die recently at local ER because his parents put him in the ice bath at home to bring down high fever.

Maybe because they were able to monitor him closely in the hospital, it was acceptable? Seems incongruous to me.

wonderbee, BSN, RN · Mar 1, 2008

In neuro critical care, we would use a temperature controlled cooling blanket for raised ICP. Maybe this would be an alternative?

When I was a child, I had spiked a temp >105 degrees. At the hospital, they put me on an "ice mattress". I remember it feeling like torture.

santhony44, MSN, RN, NP · Mar 1, 2008

Anything that can produce shivering can actually raise core temperature.

Why were they in such a hurry to bring it down? The main concern with fever is the cause; fever itself is a symptom. I don't think 105 is high enough to produce brain damage; fever high enough to do that is pretty rare. And, at 8 years old, the child is highly unlikely to have febrile seizures (which are not usually serious, and which are more likely to occur with a rapid rise in temp rather than at a certain level of temp).

And I'm quite sure that the kid was miserable.

As for research- which is a good idea- I'd try looking at the American Academy of Pediatrics, the Mayo Clinic, and places like that.

sharona97, BSN, RN · Mar 1, 2008

I remember during the early eighties I would use tepid water and lye the towels over the child. It sure didn't take long for those soaked towels to heat up. I was always concerned with seizure on a kiddo with a high temp. Sounds as though things have really changed. I do agree with the shiver factor producing an even higher temp.

leslie :-D · Mar 1, 2008

no, do not give ice baths.

from medscape, Treatment of Fever

http://www.medscape.com/viewarticle/551192_4

Fever in Children Treatment

http://www.emedicinehealth.com/fever_in_children/page6_em.htm

Your Child and Fever: A Parents' Guide

http://www.pediatricspec.com/Pediatrics/Articles/fever.asp

leslie

cmonkey · Mar 2, 2008

In neuro critical care, we would use a temperature controlled cooling blanket for raised ICP. Maybe this would be an alternative?
When I was a child, I had spiked a temp >105 degrees. At the hospital, they put me on an "ice mattress". I remember it feeling like torture.

I got a tub of ice water and I remember the cubes floating around my knees. Then I got a CSF tap and a needle phobia. Good times.

b eyes · Mar 2, 2008

the only thing I have recently packed in ice was a corpse..while waiting for the procurment team to arrive.

JennaRN1006 · Mar 2, 2008

Does this only apply to children? I ask because I work with oncology pts. A few weeks ago, I had a pt actively dying. He was nonresponsive and was placed on comfort care. When pts are on comfort care, we only do vitals q shift. Well, at 8pm he spiked a temp. He wasnt able to take anything orally and had a rectal abscess, so a tylenol suppository was also not an option. When I called the nurse practitioner, she came and evaluated the pt and told me to place some cold packs in wash clothes and apply them to his groin and axillary. His temp came down from 39.2 to 38. Was I wrong to do it? Or was it more to make the family feel like we were doing something? Any thoughts would be helpful. Thank you

Rach101 · Mar 2, 2008

there was a child on my ward just yesterday- 7yr old with mystery illness spiking temps over 40 degrees celcius and having febrile seizures.

The nurse looking after her applied cooling measures- damp washcloths and a fan. Parents were emphatic about not wanting a fan in the room. Parents then proceded to give kid a freezing cold bath. I was like hmmm not sure thats a good idea and explained to nurse looking after her about shivering causing increase in core body temp. what do you know kid starts shivering and the temperature keeps rising.

TiredMD · Mar 2, 2008

I think the underlying fear is that a very high temperature can cause brain damage. However, I was taught that, unless a person had a brain injury resulting in hypothalamic dysfunction, the body will never be able to raise its temperature high enough to cause harm. Even then, you would have to be in the 107F range. A child or adult with a physiologic fever in response to an infection is simply not going to be hurt by their high fever. Our Chief of Infectious Diseases used to literally yell at us if we did the whole ice-packs-to-groin-and-axillae thing, since it is extremely unpleasant and unnecessary.

I think this is an example of us treating a number instead of the patient. Probably not right to torture the patient just so we feel better.

There's a lot of great evidence that making a person hypothermic is useful in a lot of other situations though. Neurosurgical patients are a great example cited earlier. Another is acute MI, although we don't use it very often. And of course anyone with an exogenous cause of fever (ie - heat stroke) needs some form of external cooling.