Getting a Grip on "Fever Phobia"

Fever in a child is one of the most common clinical symptoms managed by pediatricians and other health care providers, and is a frequent cause of parental concern. In a clinical report published in Pediatrics, the American Academy of Pediatrics provides guidance for parents and families about how to best manage fever.

According to authors Janice E. Sullivan, MD, and Henry C. Farrar, MD, of the AAP Section on Clinical Pharmacology and Therapeutics, and Committee on Drugs, fever is not the primary illness but is a physiologic mechanism that has beneficial effects in fighting infection. There is no evidence that fever itself worsens the course of an illness or that it causes long-term neurologic complications.

Although many parents administer antipyretics such as acetaminophen or ibuprofen to a child to reduce fever, the report emphasizes that the primary goal should be to help the child feel more comfortable, rather than to maintain a “normal” temperature.

Current evidence suggests that there is no significant difference in the safety and effectiveness of acetaminophen and ibuprofen in the care of a generally healthy child with fever. There is evidence that combining these two products is more effective than the use of a single agent alone; however, there are concerns that combined treatment may be more complicated and contribute to the unsafe use of these drugs, wrote Sullivan and Farrar. As with all drugs, they should be used cautiously to minimize the risk of adverse drug effects and toxicity.

Other guidelines for pediatricians and other providers who treat children with fever include the following:

• When counseling a family on the management of fever in a child, pediatricians and other health care providers should minimize fever phobia and emphasize that antipyretic use does not prevent febrile seizures.
• Pediatricians should focus instead on monitoring for signs/symptoms of serious illness, improving the child’s comfort by maintaining hydration, and educating parents on the appropriate use and dosing of antipyretics.
• Pediatricians should stress the importance of safe storage of antipyretics to avoid accidental ingestions.
• To promote child safety, pediatricians should advocate for a limited number of formulations of acetaminophen and ibuprofen and for clear labeling of dosing instructions.

Finally, it is important that parents are instructed not wake up a sleeping child to administer a fever-reducer.

To access the Pediatrics report, click here.