Clinical Report-Fever and Antipyretic Use in Children

PEDIATRICS (Impact Factor: 5.47). 02/2011; 127(3):580-7. DOI: 10.1542/peds.2010-3852
Source: PubMed


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 concerns that combined treatment may be more complicated and contribute to the unsafe use of these drugs. Pediatricians should also promote patient safety by advocating for simplified formulations, dosing instructions, and dosing devices.

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    • "BSA is independent of diuresis and will not compensate for possible dehydration that some infants with fever may exhibit. However, infants in our study did not exhibit weight loss or signs of dehydration and adequate fluid intake is, often together with antipyretics, a well-established first therapeutic intervention by parents and pediatricians [38]. Nonetheless, in our study both normalization parameters, creatinine and body surface area, and raw data showed significant differences between tetranor-PGEM levels in urine from infants with fever and their age-matched, healthy controls (Fig. 3, Supplementary Table 1). "
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    ABSTRACT: We have investigated the clinical feasibility of the major urinary metabolite of prostaglandin (PG) E2, tetranor-PGEM, as a biomarker of inflammation in infants with fever. We tested two different and clinically relevant sampling methods, using self-adhesive urinary bags or gauze pads, with respect to stability of tetranor-PGEM and ease of sampling from infants. Liquid chromatography tandem mass spectrometry (LC-MS/MS) analysis was used to quantify tetranor-PGEM in urine, and different normalization parameters, i.e., urinary creatinine and body surface area, were investigated. To study inflammation, infants (1 month - 1 year) that were hospitalized with fever of unknown origin at admittance (n=14) were compared to age-matched healthy controls (n=14). Levels of urinary tetranor-PGEM in infants with viral induced fever were increased compared to controls (102.4 ± 56.2 vs. 37.0 ± 21.6 pmol/ml/m2 body surface area, p<0.001). We conclude that urinary tetranor-PGEM is a potential non-invasive biomarker of inflammation in infants.
    Prostaglandins Leukotrienes and Essential Fatty Acids 09/2014; YPLEF1619(6). DOI:10.1016/j.plefa.2014.09.006 · 2.35 Impact Factor
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    • "There have, however, been rare case reports of reversible renal insufficiency in children with febrile illness treated with ibuprofen or other NSAIDs, largely associated with volume depletion [60–62]. Dehydration is common in children with fever [63] and is an important risk factor for NSAID-induced acute renal failure; this has led some experts to recommend caution with ibuprofen use in children with dehydration or pre-existing renal disease [1, 22]. Recently, a retrospective chart review of 1,015 children with AKI managed over an 11.5-year period concluded that 27 cases (2.7 %) were associated with NSAID use (predominantly ibuprofen), and that younger children (<5 years of age) were more likely to require dialysis or admission into intensive care units [64]. "
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    ABSTRACT: Fever is a common symptom of childhood infections that in itself does not require treatment. The UK's National Institute for Health and Care Excellence (NICE) advises home-based antipyretic treatment for low-risk feverish children only if the child appears distressed. The recommended antipyretics are ibuprofen or paracetamol (acetaminophen). They are equally recommended for the distressed, feverish child; therefore, healthcare professionals, parents and caregivers need to decide which of these agents to administer if the child is distressed. This narrative literature review examines recent data on ibuprofen and paracetamol in feverish children to determine any clinically relevant differences between these agents. The data suggest that these agents have similar safety profiles in this setting and in the absence of underlying health issues, ibuprofen seems to be more effective than paracetamol at reducing NICE's treatment criterion, 'distress' (as assessed by discomfort levels, symptom relief, and general behavior).
    Drugs in R & D 06/2014; 14(2). DOI:10.1007/s40268-014-0052-x · 1.71 Impact Factor
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    • "The views and wishes of parents and carers should be taken into consideration.” [37,38]. "
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    ABSTRACT: Background Childhood fever represents a frequent cause to consult a primary care physician. “Fever phobia” describes a fearful and irrational view of fever shared by many parents with different cultural backgrounds. The study aims to explain the experiences of mothers of children having a fever and to analyze the role of the mothers’ cultural background with regard to their experiences by comparing the accounts of mothers with a German with those from a Turkish background. Disease and context specific knowledge about the influence of culture can be important for effective counselling. Methods We applied a qualitative approach using in-depth interviews with 11 mothers with a Turkish and 9 with a German background living in Germany. The interviews were conducted at the participants´ homes from May to October 2008. Data was audio-recorded and transcribed verbatim. Grounded Theory was used as a framing methodology including open, axial and selective coding. Analysis was performed in a group with members of different professional and cultural backgrounds. Results Mothers experienced their child’s fever not merely as elevated temperature but as a potentially dangerous event. A deeply rooted urge to protect the child from harm was central to all participants’ experience. The caregiving system model offers a good theoretical foundation to explain the findings as it incorporates the unique relational quality of care giving mothers to their children. The cultural background represents an important context variable influencing the explanatory models and strategies of dealing with fever. The identified culturally influenced concepts sometimes match and sometimes conflict with medical knowledge. Conclusion By applying the caregiving system model which is a part of attachment theory (Bowlby) maternal actions can be understood as an understandable attempt to protect the child from harm. The mothers´ decisions what to do when a child has a fever can be culturally influenced. This may lead either to a frequent use of services or to an underestimation of the child’s state of health. The mothers´ caring role and emotional state should be acknowledged; her concerns, explanatory models and strategies should be elicited and taken seriously in order to maintain a trustful relationship, provide effective counselling and thereby insuring optimal care for the children.
    BMC Family Practice 03/2013; 14(1):35. DOI:10.1186/1471-2296-14-35 · 1.67 Impact Factor
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