Pediatrics: Get Over Your 'Fever Phobia'

The journal "Pediatrics" has just put out a report pointing out to parents that fever itself is nothing to fear — it's just the body's germ--fighting mechanism — and arguing that if a child has a low-grade fever and is in no discomfort, there's no need to try to bring the fever all the way down to normal.

The study also discusses the common fever-fighting practice of alternating doses of Motrin and Tylenol, and warns that while it appears to work, it could lead to dosing mistakes. The Associated Press sums up some fever guidelines from the study's authors — including the different rules for infants -- here.

My personal takeaway: It's useful to know that there's no reason to try to bring a low fever down to normal, and that alternating Tylenol and Motrin can be tricky. But overcome my fever phobia? Would that I could! Fever calls for vigilance, and for the life of me I can't figure out how to be vigilant without being a touch terrified. I even wrote this Boston Globe story back in 2009 so I could seek advice about my phobia. This helped most:

Dr. William Coleman, chair of the American Academy of Pediatrics' committee on psychosocial aspects of child and family health, said that "feverphobic" parents should keep in mind that "it is the natural state of the child to be ill with minor acute illnesses." They should know, too, that experienced pediatricians pay more attention to "the general state of the child" than the number on the thermometer: Is the child inconsolable? Unresponsive? Unable to drink? Those are the biggest warning signs of something possibly more serious. A fever, up to a certain extent, is just a "normal and healthy response" to infection, he says.

But really, what I came away with was the conviction that it's possible to be vigilant without fear only if the patient is not your own child...

Anyway, the Pediatrics study is worth reading in this flu-laden season, and here's the abstract:

Fever in a child is one of the most common clinical symptoms managed by pediatricians and other health care providers and a frequent cause of parental concern. Many parents administer antipyretics even when there is minimal or no fever, because they are concerned that the child must maintain a “normal” temperature.

Fever, however, 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. Thus, the primary goal of treating the febrile child should be to improve the child’s overall comfort rather than focus on the normalization of body temperature.

When counseling the parents or caregivers of a febrile child, the general well-being of the child, the importance of monitoring activity, observing for signs of serious illness, encouraging appropriate fluid intake, and the safe storage of antipyretics should be emphasized.

Current evidence suggests that there is no substantial 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 2 products is more effective than the use of a single agent alone; however, there are con- cerns that combined treatment may be more complicated and contrib- ute to the unsafe use of these drugs. Pediatricians should also promote patient safety by advocating for simplified formulations, dosing instructions, and dosing devices.

This program aired on February 28, 2011. The audio for this program is not available.

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Carey Goldberg Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth section.



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