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Parents unable to accurately define fever in children
According to a recent survey of caregivers, 0% were able to define the threshold for fever between 38°C and 38.3°C, whereas 19% of surveyed caregivers defined fever as >38.3°C.
In a recently published policy statement, AAP concluded that there was no evidence to recommend the use of antipyretics to reduce temperature in a febrile child; rather, the most important goal of antipyretic use should be to provide overall comfort.
Matthew B. Wallenstein
“Fever phobia likely explains why the vast majority of fevers are treated with antipyretics, both at home and in hospital settings,” Matthew B. Wallenstein, MD, of the department of pediatrics at the Lucile Packard Children’s Hospital at Stanford, and colleagues wrote. “Despite the widespread use of antipyretics, there is no evidence that treating fever reduces morbidity or mortality, with one exception for critically ill children with low metabolic reserve. In fact, available evidence suggests that not treating fever may improve outcomes, as viruses and bacteria have more difficulty replicating in febrile hosts.”
To assess the percentage of caregivers who could correctly identify the threshold for fever, the researchers enrolled 105 caregivers from two pediatric urgent care clinics in a 13-question survey.
Survey questions were predominantly multiple choice and included topics related to demographics, reason for the present visit, parental knowledge of fever and home use of antipyretics. The primary outcome of the survey was obtained by the following inquiry: “What is a fever? A fever is any temperature above [fill in the blank].”
Additionally, the researchers asked parents to rate the importance of giving antipyretics for a variety of conditions, using a Likert-type scale in which 1 represented not at all important and 5 represented extremely important. Caregivers were not given any assistance in answering the questions provided.
According to survey results, 81% of participants defined the threshold for fever as <38°C, 0% correctly defined fever between 38°C and 38.3°C, and 19% defined fever as >38.3°C.
“Our finding that 0% of parents could accurately define fever was shocking,” Wallenstein told Infectious Diseases in Children. “Clinicians discuss fever with parents literally every single day. Those discussions become meaningless, or even dangerous, if parents don’t know what we mean by the term fever. The question, ‘Has your child had a temperature above 38°C?’ is much clearer to parents than, ‘Does your child have a fever?’”
In addition, the survey revealed that 93% of participants believed that high fever could cause brain damage. When asked what action they would take for a comfortable-appearing child with fever, 89% of caregivers reported that they would give antipyretics and 86% would schedule a clinic visit.
“Aggressive educational campaigns for appropriate antipyretic use should be targeted toward physicians and nurses,” Wallenstein and colleagues wrote. “The ‘Choosing Wisely’ campaign is a great example of an educational initiative that is designed to combat overuse in health care. The campaign has generated a list of ‘five things physicians and patients should question’ from a total of nine specialty societies thus far. Given the high incidence of fever in children and the impact fever phobia has on our health care system, inclusion of fever and antipyretics on such a list would be an important step toward changing behavior.”
Disclosure: The researchers reported no relevant financial disclosures.
