When talking to parents about managing fever in their children, physicians should emphasize that there's no need to normalize the child's temperature, researchers say.
By Kristina Fiore, Staff Writer, MedPage Today
Published: February 28, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
When talking to parents about managing fever in their children, physicians
should emphasize that there's no need to normalize the child's temperature,
Rather, parents should focus therapeutic efforts on making the child comfortable, according to a new clinical guidance on talking to parents about fever from the American Academy of Pediatrics.
Contrary to what most parents think, there's no evidence that fever itself can increase the risk of adverse outcomes like brain damage, wrote Janice E. Sullivan, MD, of the University of Louisville, and Henry C. Farrar, MD, of the Arkansas Children's Hospital, and colleagues.
"Appropriate counseling on the management of fever begins by helping parents understand that fever, in and of itself, is not known to endanger a generally healthy child," they wrote.
§ Explain that new guidance from the American Academy of Pediatrics seeks to disabuse parents of the popular belief that all fever requires immediate treatment.
§ Note that the Academy recommends that parents not wake children to provide medication, and should also be cautioned about giving other cough and cold products that contain an antipyretic at the same time, which could result in overdose.
According to the guidance, which was published in Pediatrics, physicians should help parents understand that fever is not a primary illness; rather, it is a physiologic mechanism that has beneficial effects in fighting infection. It retards the growth and reproduction of bacteria and viruses, enhances neutrophil production and T-lymphocyte proliferation, and aids the body's acute-phase reaction.
However, it appears to be a common belief among parents that they must attempt to normalize their child's temperature to prevent danger. Parents should also be instructed that antipyretic use does not prevent febrile seizures.
Thus, physicians should communicate that the primary goal in treating fever should solely be to improve the child's overall comfort level, the researchers said.
The best way to do so is with antipyretics such as acetaminophen or ibuprofen, according to the guidance. The recommended dose for acetaminophen is 10 to 15 mg/kg per dose every 4 to 6 hours, and ibuprofen is recommended in a 10 mg/kg dose.
Current evidence suggests there's no difference between the two medications in efficacy of reducing the symptoms of fever, the researchers said.
There's some evidence that combining these two products -- by giving them in alternate doses -- may be beneficial, but researchers warn that this may be associated with more adverse effects. They caution that the regimen may be more confusing for parents to keep track of.
Sullivan and Farrar note that the drugs could have some rare side effects. Ibuprofen may carry a risk of nephrotoxicity, but more so in children with dehydration or complex medical illnesses.
Hepatotoxicity with acetaminophen has been observed in the setting of acute overdose, and hepatitis may present in chronic overdose.
In order to avoid giving too much medication, physicians should emphasize proper dosing techniques, the researchers said, although this is particularly a challenge given that dosing is presented in mg/kg instead of units that parents are more familiar to parents.
The researchers also advise that parents should not wake children to provide medication. They should also be cautioned about giving other cough and cold products that contain an antipyretic at the same time, which could result in overdose.Parents should, however, be advised to continually monitor their children for signs of serious illness. Moreover, parents should be careful to keep children properly hydrated.