Communicate to parents that their goal is to alleviate a child's discomfort and monitor for signs of serious illness rather than simply lowering their child's temperature, an American Academy of Pediatrics report.
Although fever is normal and often beneficial to the immune system, “fever phobia” remains prevalent, and pediatricians must redirect overblown parental concerns about their child's fever, reported Dr. Janice E. Sullivan of the University of Louisville (Ky.) and Dr. Henry C. Farrar of Arkansas Children's Hospital, coauthors of the report with the AAP section on clinical pharmacology and therapeutics and the committee on drugs (Pediatrics 2011;127:580-7).
Fever is a sign of illness, but “our focus on gathering that information gives the message to parents that fever is bad,” Dr. Sullivan said in an interview.
If the focus is solely on the fever, she added, lowering that fever may reassure the parent that the child is stable when really that parent should be watching for signs of serious illness. These worrisome signs include dehydration, a fever of at least 103° F, or a fever that persists. Encourage parents to treat fever in exceptional populations, such as patients with cardiomyopathy.
Encourage proper hydration and think carefully before recommending the use of antipyretics such as acetaminophen and ibuprofen, the report urged. The most important goal should be “to improve the child's overall comfort,” not to lower temperature, and the report cited the lack of evidence that “reducing fever reduces morbidity or mortality from a febrile illness.” Although alternating or combining antipyretics is common, “questions remain regarding the safety of this practice as well as the effectiveness in treating discomfort, which is the primary end point,” according to the report.
“If we're treating discomfort, one agent should be adequate,” Dr. Sullivan said.
The report urged pediatricians to “advocate for a limited number of formulations of acetaminophen and ibuprofen.” Dr. Sullivan added that the availability of two different concentrations of acetaminophen and the lack of appropriate measuring devices may account for the high percentage of incorrect dosages.
Dr. Sullivan reported no relevant financial disclosures.