How do I manage a fever in children?

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Managing Fever in Children: Best Practices and Guidelines

Introduction to Fever Management in Children

Fever is a common symptom in children and often causes significant concern among parents. Effective management of fever is crucial to ensure the child's comfort and to prevent complications. This article synthesizes the latest research and guidelines on managing fever in children, providing clear and actionable advice for parents and healthcare providers.

Accurate Temperature Measurement in Children

Recommended Methods for Temperature Measurement

For infants under 4 weeks old, the axillary (underarm) measurement using a digital thermometer is recommended. For children aged 4 weeks and older, both axillary and tympanic (ear) measurements using an infrared thermometer are suitable. When parents measure temperature at home, the axillary method with a digital thermometer is advised for all age groups.

Recognizing Fever

Children who are afebrile when seen by a clinician but reported to have had a fever by caregivers should be considered febrile. High fever can sometimes indicate severe bacterial infections, necessitating further medical evaluation.

Use of Antipyretics

When to Use Antipyretics

Antipyretics such as paracetamol (acetaminophen) or ibuprofen should be used only when fever is associated with discomfort. The dose should be based on the child's weight rather than age, and oral administration is preferred over rectal administration whenever possible.

Specific Considerations

Paracetamol: Safe for use in most febrile children, including those with asthma.
Ibuprofen: Not recommended for children with chickenpox or dehydration.
Newborns: Should always be hospitalized if they have a fever due to the high risk of severe disease. Paracetamol may be used with dose adjustments based on gestational age.

Avoiding Combined or Alternating Use

The combined or alternating use of paracetamol and ibuprofen is discouraged due to insufficient evidence supporting its safety and efficacy.

Physical Methods for Reducing Fever

Efficacy of Physical Methods

Physical methods such as sponging and bathing are generally not recommended due to limited benefits and potential discomfort for the child . However, in cases of hyperthermia or in high environmental temperatures, these methods may be warranted.

Parental Education

Parents should be educated on the body's natural physiological responses to fever and how to support these responses without unnecessary interventions.

Hospitalization and Antibiotic Use

Criteria for Hospitalization

Infants under 28 days: Should be hospitalized for parenteral antibiotic therapy if they appear toxic or have a fever without a clear source.
Infants 28 to 90 days: May be managed as outpatients if they meet specific low-risk criteria and close follow-up is assured.

Antibiotic Treatment

For children aged 3 to 36 months with a fever of 39.0°C or higher and a white blood cell count of 15,000/mm³ or more, a blood culture and antibiotic treatment pending culture results are recommended.

Parental Practices and Misconceptions

Common Misconceptions

Many parents have unrealistic fears about fever, such as concerns about brain damage, febrile convulsions, and death from mild to moderate fever . These fears often lead to inappropriate management practices, such as overuse of antipyretics and unnecessary sponging .

Importance of Accurate Information

Parents often base their fever management practices on inaccurate temperature readings and misinformation. Consistent and accurate information from healthcare providers is essential to improve parental knowledge and practices .

Conclusion

Effective management of fever in children involves accurate temperature measurement, judicious use of antipyretics, and avoiding unnecessary physical methods. Education and clear communication from healthcare providers are crucial to address parental misconceptions and ensure appropriate fever management practices. By following these guidelines, parents and healthcare providers can work together to ensure the well-being and comfort of febrile children.