Fever and Antipyretic Use in Children

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 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.

Association between prenatal exposure to perfluorinated compounds and symptoms of infections at age 1–4years among 359 children in the Odense Child Cohort

“…A key concern in these studies is how infection is defined and reported. In children, fever is an almost universal sign of infection, and other causes of elevated body temperature are rare in temperate countries (Sullivan and Farrar 2011).…”

Acetaminophen in Children: Which Dosage, Which Route?

“…In case of using high dose of rectal acetaminophen (30 mg/kg) in children at high risk for fever, this high dose should be used just once and repeating the same doses should be avoided because more efficacies has not been proven and the risk of increased cumulative doses and poisoning will be followed. It should be noted that the maximum daily-allowed dose of acetaminophen is 90 mg/kg for up to 3 consecutive days or 75 mg/kg for longer use [3,15].…”

“…In addition, fever in 2% to 4% of children aged 6 months to 5 years can cause seizures. Therefore, the fever should be controlled as soon as possible in children with the above-mentioned risk factors, although in other children, control of the fever with a rectal degree temperature of 39ºC or when the child feels uncomfortable, is recommended [2,3]. However, Ibuprofen is similarly or more efficacious than acetaminophen for treatment of pain and fever in adults and children and was equally safe, yet still, Acetaminophen is considered as first-line therapy for the treatment of fever and mild-to-moderate pain in infants and children according to international guidelines and recommendations [4,5].…”

A Clinical Perspective in Evolutionary Medicine: What We Wish We Had Learned in Medical School

“…However, students often find it hard to conceptually distinguish host defenses (e.g., fever) from true pathological defects (e.g., seizures) in disease. For example, while fever was once viewed as pathological, current recommendations advocate against treating fever in children (Sullivan and Farrar 2011), correctly noting that "fever…is not the primary illness but is a physiologic mechanism that has beneficial effects in fighting infection." Fever is increasingly viewed as an adapted facultative response (Kluger et al 1996).…”