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 suitable1. When parents measure temperature at home, the axillary method with a digital thermometer is advised for all age groups1.
Recognizing Fever
Children who are afebrile when seen by a clinician but reported to have had a fever by caregivers should be considered febrile1. High fever can sometimes indicate severe bacterial infections, necessitating further medical evaluation1.
Use of Antipyretics
When to Use Antipyretics
Antipyretics such as paracetamol (acetaminophen) or ibuprofen should be used only when fever is associated with discomfort1. The dose should be based on the child's weight rather than age, and oral administration is preferred over rectal administration whenever possible1.
Specific Considerations
- Paracetamol: Safe for use in most febrile children, including those with asthma1.
- Ibuprofen: Not recommended for children with chickenpox or dehydration1.
- 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 age1.
Avoiding Combined or Alternating Use
The combined or alternating use of paracetamol and ibuprofen is discouraged due to insufficient evidence supporting its safety and efficacy1.
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 child3 5. However, in cases of hyperthermia or in high environmental temperatures, these methods may be warranted3.
Parental Education
Parents should be educated on the body's natural physiological responses to fever and how to support these responses without unnecessary interventions3.
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 source2.
- Infants 28 to 90 days: May be managed as outpatients if they meet specific low-risk criteria and close follow-up is assured2.
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 recommended2.
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 fever4 6. These fears often lead to inappropriate management practices, such as overuse of antipyretics and unnecessary sponging4 6.
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 practices4 6 8.
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.
Sources and full results
Most relevant research papers on this topic
Management of fever in children: summary of the Italian Pediatric Society guidelines.
The Italian Pediatric Society guidelines recommend using paracetamol or ibuprofen for fever associated discomfort, based on the child's weight, and caution in cases of severe hepatic/renal failure or malnutrition.
Systematic Review
Highly CitedPractice guideline for the management of infants and children 0 to 36 months of age with fever without source. Agency for Health Care Policy and Research.
These guidelines suggest that febrile infants under 28 days of age should be hospitalized for parenteral antibiotic therapy, while febrile children aged 3 to 36 months should have blood cultures and antibiotics pending results.
Meta-AnalysisHighly CitedNursing management of fever in children: a systematic review.
Sponging and paracetamol use in children with fevers is not routinely supported by evidence, and individualized care is needed to maximize comfort while weighing potential harms.
Systematic ReviewManagement of childhood fever by parents: literature review
Despite successful educational interventions, little has changed in parents' fever management knowledge, attitudes, and practices.
Systematic ReviewHighly CitedPhysical methods for treating fever in children.
Tepid sponging may help reduce fever in children, but more studies are needed to confirm this finding.
Meta-AnalysisDrivers for inappropriate fever management in children: a systematic review
Parents' inappropriate fever management in children is influenced by multiple factors, requiring a consistent approach from healthcare professionals and timely, accurate information.
Systematic Review
Rigorous JournalManagement of feverish children at home.
Paracetamol is more effective and more acceptable than unwrapping or sponging for controlling fever in children at home, with warm sponging reducing fever more quickly.
RCTReliability of health information for the public on the world wide web: systematic survey of advice on managing fever in children at home
Only a few web sites provided complete and accurate information on managing fever in children at home, suggesting an urgent need to check public-oriented healthcare information on the internet for accuracy, completeness, and consistency.
Observational StudyHighly CitedManagement of the child with fever.
Children with fever should be comforted and their comfort should be balanced against the risk of harm.
HOME MANAGEMENT OF FEVER IN CHILDREN: RATIONAL OR RITUAL?
Parents in this study were well-educated, but most were misinformed about fever recognition, administration of antipyretic drugs, and frequency of checking children's temperatures.
Observational Study