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Pediatricians should emphasize comfort relief when dealing with fever

Sullivan JE. Pediatrics. 2011;127:580-587.

Fever is not always a bad thing and, contrary to popular belief, is not usually tied to long-term adverse outcomes. In fact, in some cases, a fever can be a friend, and pediatricians should emphasize the importance of keeping patients comfortable rather than normalizing temperature.

Janice E. Sullivan, MD, of the University of Louisville, and colleague Henry C. Farrar, MD, of the Arkansas Children’s Hospital, wrote in a report released online this week that it may be more important to monitor children for symptoms of serious illness and avoiding dehydration rather than focusing on lowering a temperature.

The researchers said clinicians must help parents understand that fever in itself may actually have some beneficial effects, such as retarding the growth of bacteria and viruses and enhancing neutrophil production. Pediatricians should educate parents that overmedicating a child could actually prolong illness duration.

In their guidelines, Sullivan and Farrar advise pediatricians to stress easing discomfort through the use of acetaminophen at 10 to 15 mg/kg per dose every 4 to 6 hours or ibuprofen in a 10-mg/kg dose. The researchers said although there is some evidence that alternating between acetaminophen and ibuprofen is effective, this regimen gets complicated and there are safety questions regarding this practice. The researchers also said to use proper measuring devices, rather than kitchen spoons to measure dosing.

The guidelines also said to avoid waking a child to administer a dose of medication. If the child is sleeping, then they are comfortable and could use the sleep to stave off the infection. The guidelines also advise pediatricians to urge parents to continually monitor signs and symptoms for more serious illness and to contact pediatricians if the fever is more than 100.4·F in infants younger than 2 to 3 months or with a fever of more than 103·F in a child of any age.

Disclosure: The researchers reported no relevant conflicts of interest.

What is summarized in this brief synopsis reflects at least 50 years worth of common sense and routine practice by general pediatricians across the United States.

– Douglas Baker, MD
Infectious Diseases in Children Editorial Board

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