Management Of Fever In Children Research Articles

Spatial analysis of determinants of choice of treatment provider for fever in under-five children in Iganga, Uganda

Although health facilities and drug shops are the main alternatives to home management of fever in children in Uganda, the influence of distance on the choice of treatment provider by caretakers is still unclear. We examined the spatial distribution of choice of treatment provider for fever in under-five children and the influence of household and geographical factors. Spatial and regression analysis of choices of treatment provider was done using data from a 2-week recall survey conducted in the Iganga–Mayuge Health and Demographic Surveillance Site. Of 3483 households with febrile children, 45% of caretakers treated the child at home, 33% took the child to a health facility, and 22% obtained treatment at drug shops. The distance to access care outside the home was crucial as seen in the greater preference for treatment at home or at drug shops among caretakers living more than 3km from health facilities. The influence of proximity to health facilities in the choice of treatment provider highlights the need for greater access to health care services. The current Uganda Ministry of Health threshold of 5km for access to health facilities needs to be reviewed for rural areas.

Ethnic Differences in Parental Perceptions and Management of Childhood Fever

In this cross-sectional study, the authors surveyed a convenience sample of 487 parents with children enrolled in two urban hospital-based clinics in Baltimore, MD regarding their perceptions and management of fever. The authors were specifically interested in parents' definition of fever, level of concern, and management of fever. Only 44% of parents identified fever temperature as 38–41.67°C (100.4–107°F); 67% of parents treated fevers < 38°C (100.4°F). Eighty-five percent of parents would awaken a child to treat a fever, and 68% of parents were very worried about fevers.

Ketoprofen versus Paracetamol (Acetaminophen) or Ibuprofen in the Management of Fever

Background: Fever is a common symptom in children and one of the major concerns of parents of younger and preschool-age children. Objective: To compare the efficacy and safety of ketoprofen with that of paracetamol (acetaminophen) and ibuprofen in the treatment of febrile conditions in children. Methods: Two prospective, randomized, double-blind, double-dummy, repeated-dose, multicentre, phase III studies with two parallel groups in each study were conducted in primary-care outpatient clinics. Children aged 6 months to 6 years presenting with a febrile condition and an oral body temperature of >38.8°C or rectal temperature of ≥39°C were eligible for inclusion. Patients were randomized to receive either ketoprofen syrup 0.5mg/kg, ibuprofen suspension 5 mg/kg or paracetamol suspension 15 mg/kg every 6 hours by the oral route. The primary outcome measure was the change in temperature at 3 hours (H3), compared with baseline (H0). Results: All three treatments provided similar mean maximum decreases of 1.4–1.5°C in body temperature at H3 compared with H0. Use of ketoprofen was not associated with any increased risk of adverse events compared with the two reference compounds. Conclusion: Ketoprofen 0.5 mg/kg appeared to be equivalent to the standard antipyretic doses of the reference products ibuprofen 5 mg/kg and paracetamol 15 mg/kg. Ketoprofen at the 0.5 mg/kg dose should be an effective and safe option for symptomatic management of fever in children.

Dose-Finding Studies of Ketoprofen in the Management of Fever in Children

Ketoprofen is a highly effective NSAID with antipyretic and analgesic properties for the symptomatic management of pain and fever in both adults and children. To compare three dose levels of ketoprofen with paracetamol (acetaminophen) in the management of fever in children. Two prospective, randomized, single-blind, comparator-controlled, single-dose, multicentre, phase II studies with four parallel groups in each study were conducted in primary-care outpatient clinics. Children aged 6-24 months and 2-6 years presenting with a febrile condition (rectal body temperature > or =39 degrees C) were included in the studies. Patients were treated with either ketoprofen syrup 0.25 mg/kg, 0.5 mg/kg or 1 mg/kg, or paracetamol drinkable solution 15 mg/kg, both administered orally. The primary outcome measure was the maximal reduction in body temperature before re-medication compared with baseline during the 6-hour study period. In the ketoprofen groups, the mean maximal temperature decreases in the younger/older age groups were 1.6/1.6 degrees C, 2.0/1.9 degrees C and 1.9/2.2 degrees C with doses of 0.25 mg/kg, 0.5 mg/kg and 1 mg/kg of ketoprofen, respectively, compared with 1.8/1.8 degrees C with paracetamol 15 mg/kg. In the older children, ketoprofen provided antipyretic efficacy in a dose-dependent manner. Ketoprofen was found to have a significant antipyretic efficacy in children. The lowest dose of ketoprofen syrup that provided a meaningful antipyretic effect in both groups was 0.5 mg/kg. At this dose the antipyretic efficacy was equal to that of paracetamol 15 mg/kg. Based on these data, a dose of 0.5 mg/kg of ketoprofen was selected for future evaluation in phase III studies in the symptomatic management of fever in children.

Diagnosis and Management of Dengue Fever in Children

1. Ashlesha Kaushik, MD* 2. Carol Pineda, MD* 3. Helen Kest, MD, MPH, CPH† 1. *Department of Pediatrics, St Joseph's Children's Hospital, Patterson, NJ. 2. †Division of Pediatric Infectious Disease, Department of Pediatrics, St. Joseph's Children's Hospital, Patterson, NJ. After completing this article, readers should be able to: 1. Describe the epidemiology and clinical spectrum of dengue viral infections. 2. Recognize when to consider dengue in the differential diagnosis of acute fever. 3. Discuss the diagnosis and management of this common tropical illness. 4. Identify other diseases that can mimic dengue viral infections. A 17-year-old Hispanic girl presents with a 5-day history of temperature of 39.4°C to 40.5°C and a 4-day history of severe bifrontal and intermittent headaches. She also has a 3-day history of malaise, generalized body aches, and mild epigastric pain. On the day of admission, she develops a dark reddish-purple, nonpruritic, and nonblanching rash over her arms and thighs and is brought to the emergency department. There is no cough, sore throat, vomiting, or diarrhea. She denies illicit drug use, tick exposure, sexual activity, or allergies. On physical examination, the girl appears alert, oriented, and in no acute distress. Her temperature is 38.5°C, heart rate is 119 beats/min, respiratory rate is 18 breaths/min, and blood pressure is 130/68 mm Hg (90th to 95th percentile). Capillary refill time is less than 2 seconds. A petechial rash is present over her arms and anterior thighs. She has mild epigastric tenderness, with no rebound tenderness, guarding, hepatosplenomegaly, or masses. Tourniquet test is positive. Kernig and Brudzinski signs are negative. The remainder of the physical examination findings are normal. Her white blood cell count is 3.5×103/mcL (3.5×10 9/L) with 59% neutrophils, 33% lymphocytes, 6% monocytes, and 1% eosinophils; hemoglobin is 13.4 g/dL (134 g/L); hematocrit is 39.6% (0.396); platelet count is 126×103/mcL (126×10 9/L); and erythrocyte sedimentation …

Diagnosis and Management of Dengue Fever in Children

Diagnosis and Management of Dengue Fever in Children

Parents' Perception, Knowledge and Self-Efficacy in Management of Childhood Fever

Purpose: Fever is a common symptom of illness in children that is often misunderstood and inappropriately managed by parents. The purposes of this study were to investigate perception, knowledge of childhood fever and fever management and self-efficacy in fever management by parents and to identify the relationship between knowledge of childhood fever and fever management, and self-efficacy in management of fever. Methods: A descriptive correlation study was used with 101 parents of children ages 3 months to 5 yr who were seen in a pediatric outpatient clinic. Data were collected using a self-administered questionnaire. Descriptive statistics, t-test or ANOVA, and Pearson correlation coefficients were used for data analysis. Results: Many parents reported a high level of fear about fever and its possible complications. Most parents used over-the-counter medications to reduce fever even when their children had mild to moderate fever. The mean correct percent on the knowledge scale was 51.0%. Most parents did not recognize the benefits of fever. There were statistically significant positive correlations between knowledge of fever and fever management and self-efficacy in management of fever. Conclusion: The results indicate a need to develop and evaluate educational programs that will provide parent education on fever and fever management.

Fever and Fever Management in Children: A Literature Review

Purpose: The purposes of this review were to identify whether available evidence supports the nursing interventions that are commonly used to reduce fever in children and to introduce research findings into practice. Methods: Journal databases and clinical guidelines from 1990 to 2009 were searched. The search terms were fever, febrile convulsion, fever management, fever phobia, child, antipyretics, temperature, external cooling, tepid sponge bath, and physical treatment. Results: Evidence suggests that uncomplicated fever is relatively harmless, but it is an important immunological defense. Antipyretics should not routinely be used with the sole aim of reducing body temperature in children with fever who are otherwise well. Currently a lack of evidence supports the practice of alternating acetaminophen and ibuprofen, and the routine use of tepid sponge bath. Conclusion: Currently, fever management in children does not reflect research evidence. Pediatric nurses can play an important role by encouraging clinical research in this area and also by enhancing research utilization in their practice. Moreover, pediatric nurses can educate parents about evidence-based fever management. Evidence-based educational interventions for pediatric nurses need to be developed and evaluated to improve the quality of nursing care in the management of childhood fever.

Management of fever in children: Summary of the Italian pediatric society guidelines

Objective: This article summarizes the Italian Pediatric Society guideline on the management of the signs and symptoms of fever in children, prepared as part of the National Guideline Program (NGLP). Methods: Relevant publications in English and Italian were identified through searches of MEDLINE and the Cochrane Database of Systematic Reviews from their inception through December 31, 2007. Based on the consensus of a multidisciplinary expert panel, the strength of the recommendations was categorized into 5 grades (A–E) according to NGLP methodology. Summary: In the health care setting, axillary measurement of body temperature using a digital thermometer is recommended in children aged <4 weeks; for children aged ≥4 weeks, axillary measurement using a digital thermometer or tympanic measurement using an infrared thermometer is recommended. When body temperature is measured at home by parents or care-givers, axillary measurement using a digital thermometer is recommended for all children. Children who are afebrile when seen by the clinician but are reported to have had fever by their caregivers should be considered febrile. In special circumstances, high fever may be a predictive factor for severe bacterial infection. Use of physical methods of reducing fever is discouraged, except in the case of hyperthermia. Use of antipyretics—paracetamol (acetaminophen) or ibuprofen—is recommended only when fever is associated with discomfort. Combined or alternating use of antipyretics is discouraged. The dose of antipyretic should be based on the child's weight rather than age. Whenever possible, oral administration of paracetamol is preferable to rectal administration. Use of ibuprofen is not recommended in febrile children with chickenpox or dehydration. Use of ibuprofen or paracetamol is not contraindicated in febrile children with asthma. There is insufficient evidence to form any recommendations concerning fever in children with other chronic conditions, but caution is advised in cases of severe hepatic/renal failure or severe malnutrition. Newborns with fever should always be hospitalized because of the elevated risk of severe disease; paracetamol may be used, with the dose adjusted to gestational age. Use of paracetamol or ibuprofen is not effective in preventing febrile convulsion or the adverse effects of vaccines.

Ethnic Differences in Parental Perceptions and Management of Childhood Fever

To explore knowledge and management of childhood fever among ethnically diverse parents and identify opportunities for educational intervention, we administered a cross-sectional survey to a convenience sample of 487 parents of children enrolled in 2 urban hospital-based pediatric clinics. Outcomes included parental definition of fever, level of concern, and management of fever. Latino parents were least likely to identify a temperature as nonfebrile from 97-100.3 degrees F (adjusted odds ratios [AOR] 0.06) or identify a fever as a temperature from 100.4-107 degrees F (AOR 0.52). African Americans were least likely to believe that fever can cause death or brain damage (AOR 0.4). African Americans were more likely to dose ibuprofen more frequently than recommended (AOR 1.97). All ethnicities are equally likely to treat normal temperatures and dose acetaminophen too frequently.Therefore continued education of all families about fever is necessary, and there are opportunities to develop ethnically sensitive strategies to target educational interventions.

Case Management of Childhood Fever by Traditional Healers in Southwest Nigeria: Identification of Training and Collaborative Needs

Traditional healers play an important role in the provision of healthcare in many communities in Africa. This study aimed to improve home management of malaria in children by assessing the healer's knowledge and practice. A semi-structured questionnaire interview of 127 traditional healers selected by proportionate sampling technique from two rural and two urban local government areas (LGAs) of southwestern Nigeria was followed by a training program. Malaria ranked first (87%) among the illnesses managed by the healers. Diagnosis of fever was often (72%) based on client history, physical examination (24.4%), consulting oracles (18.9%), and interpretation of dreams (3.1%). Treatment of malaria was with boiled herbs ("agbo"; 72%), ground herbs ("agunmu"; 14%), and incisions and scarifications (3%). Forty-one (32.5%) healers had referred febrile children to a health facility. Younger healers and those who had at least a secondary education were more likely to refer patients (p < 0.05 in both cases). Thirty-six healers (28.4%) had previous formal training on management of fevers, most of whom were the younger (p < 0.05), educated healers (p > 0.05), with fewer years of practice (p > 0.05). Research into traditional herbs (48%), better acknowledgment by government (23.6%), and collaboration with other health sectors were suggestions to improve practice. Traditional healers, especially the older, less-educated, and long-practicing healers, urgently require formal training and collaboration with other healthcare providers to improve knowledge and promote early referral of children with fever.

Parents’ childhood fever management: community survey and instrument development

This paper is a report of a study to explore Australian parents' knowledge, beliefs, practices and information sources about fever management and develop a scale to measure parents' fever management practices. Parental fever phobia and overuse of antipyretics to reduce fever continue. No scales to measure parents' fever management practices are available. A community-based, postal survey was carried out in 2005 with 401 Australian parents of well children aged 6 months-5 years. Respondents were recruited through advertising (48.4%), face-to-face (26.4%) and snowball (24.4%) methods. A 33-item instrument was developed; construct and content validity were determined by an expert panel and item reliability by test-retest. Moderate fever (40.0 +/- 1.0 degrees C) was reported to be harmful (88%), causing febrile convulsions (77.7%). Usual practices targeted temperature reduction, antipyretic administration (87.8%), temperature monitoring (52.5%). Fewer evidence-based practices, such as encouraging fluids (49.0%) and light clothing (43.8%), were reported. Positive changes over time (36.4%) included less concern and delayed or reduced antipyretic use. Negative practice changes (22.7%) included greater concern and increased antipyretic use. Medical advice was sought for illness symptoms (48.7%) and high (37.4%) or persistent (41.5%) fevers. Fever management was learnt from doctors, family and friends and working experience, while receiving conflicting information (41.9%) increased concerns and created uncertainty about best practice. Parents need consistent evidence-based information about childhood fever management. The Parental Fever Management Scale requires further testing with different populations and in different cultures and healthcare systems to evaluate its usefulness in nursing practice and research.

Promoting evidence‐based childhood fever management through a peer education programme based on the theory of planned behaviour

This study examined effectiveness of a theoretically based education programme in reducing inappropriate antipyretic use in fever management. Paediatric nurses' inconsistent, ritualistic antipyretic use in fever management is influenced by many factors including inconsistent beliefs and parental requests. Determinants of antipyretic administration, identified by the theory of planned behaviour, were belief-based attitudes and subjective norms. A quasi-experiment explored group effects of a peer education programme, based on the theory of planned behaviour, on factors influencing paediatric nurses' antipyretic administration. Surveys and chart audits collected data from medical wards at experimental and control hospitals one month pre and one and four months postpeer education programme. All nurses employed in targeted wards were eligible to participate in surveys and all eligible charts were audited. The peer education programme consisted of four one-hour sessions targeting evidence-based knowledge, myths and misconceptions, normative, attitudinal and control influences over and rehearsal of evidence-based fever management. All nurses in experimental hospital targeted wards were eligible to attend. Peer education and support facilitated session information reaching those unable to attend sessions. Two-way univariate anovas explored between subject, experimental and control group and within subject factors, pre, post and latency data. Significant interactions in normative influence (p = 0.01) and intentions (p = 0.01), a significant main group effect in control influence (p = 0.01) and a significant main effect between audit data across time points (p = 0.03) highlight peer education programme effectiveness in behaviour change. Normative, control and intention changes postpeer education programme were maintained in latency data; mean temperature was not. The peer education programme, based on a behaviour change theory, initiated and maintained evidence-based intentions for antipyretics use in fever management. The promotion of evidence-based change in organizational unit intentions and behaviour highlights the crucial role peer support and education can play in continuing educational programmes.

Effect of an evidence‐based education programme on ED discharge advice for febrile children

This study aimed to examine the effect of an educational intervention on discharge advice given to parents leaving the emergency department with a febrile child. Childhood fever is a common reason to seek emergency care. Many children are discharged from the emergency department with fever as a significant component of their illness; therefore, it is vital that emergency department medical and nursing staff provide accurate and reliable information about childhood fever management. A pre/post-test design was used. The outcome measure was parental advice regarding paediatric fever management and the intervention for the study was an educational intervention for emergency department nursing staff that consisted of two tutorials. Data were collected using structured telephone interviews. Data were collected from 22 families during the pretest period and 18 families during the post-test period. The number of parents leaving the emergency department with no advice decreased by 48% (p = 0.002). Reports of written advice increased by 69.7% (p < 0.001) and there was a 38.4% increase in reports of verbal advice (p = 0.014). Parents leaving the emergency department with both written and verbal advice increased from 0 to 55.6% (p < 0.001). Reports of advice by nursing staff increased by 52% (p < 0.001) and there were significant increases in specific instructions related to oral fluid administration (22.7 vs. 77.8, p = 0.001) and use of antipyretic medications (27.2 vs. 77.8, p = 0.001). Evidence-based education of emergency nurses improved both the amount and quality of discharge advice for parents of febrile children. Parents and health care professionals alike need to better understand the physiological benefits of fever and the potential harmful effects of aggressive and often unwarranted treatment of fever.

Over‐the‐counter medication use for childhood fever: A cross‐sectional study of Australian parents

To report Australian parents' medication (paracetamol, ibuprofen and homeopathic) use in childhood fever management. A cross-sectional survey of 401 Queensland parents of children aged between 6 months and 5 years recruited through advertising (48.4%), face-to-face (26.4%) and snowball (24.4%) methods was conducted. A 17-item instrument was developed; construct and content validity were determined by an expert panel; and item reliability by test-retest with nine parents. Areas targeted were medication use and influences on and barriers to medication use. Most participants were female, had tertiary education and lived in a major city (mean age 34.6 years). Reducing children's fever with over-the-counter medications was common (91%): 94% of parents reported using paracetamol and 77% reported using ibuprofen. A few (3.7%) used homeopathic remedies. Dosage was determined by weight (86.3%), age (84.3%), temperature (32.4%), illness severity (31.4%) and lethargy (20.9%). Frequency was determined by instructions on the medication label (55.3%), temperature (40.6%) and well-being (27.7%). Ibuprofen was administered too frequently by 31.5% (four hourly by 22.8%), and paracetamol by 3.8%. Fifty-two per cent had alternated medications, 65.8% of these for temperatures below 38.5 degrees C. Decisions to alternate were influenced by information from doctors/hospitals (49.5%) and children remaining febrile post-antipyretic (41.7%). Most parents reported over-the-counter medications as potentially harmful (73.2%), citing liver (38.2%), stomach (26.4%) and kidney (18.6%) damage and overdose (35.7%) as concerns. When medications were refused or spat out (44.0%), parents used force (62.4%), different methods (29.5%) or suppositories (20.8%). Most parents used over-the-counter medications to reduce fever, often below 38.5 degrees C. The belief that these medications were harmful was overridden by fears of harmful outcomes from fever.

Managing childhood fever and pain – the comfort loop

Parents can transmit their anxiety to their child, and just as children can pick up on parental anxiety, they can also respond to a parent's ability to stay calm in stressful situations. Therefore, when treating children, it is important to address parental anxiety and to improve their understanding of their child's ailment. Parental understanding and management of both pain and fever – common occurrences in childhood – is of utmost importance, not just in terms of children's health and welfare, but also in terms of reducing the economic burden of unnecessary visits to paediatric emergency departments. Allaying parental anxiety reduces the child's anxiety and creates a positive feedback loop, which ultimately affects both the child and parent.In this review, the integral role of parental perception of the child's condition and the efficacy of treatment in the management of childhood fever and pain will be discussed.

Review of NICE guideline 47: assessment and management of feverish illness in young children

This article considers the recently published guidance from the UK’s National Institute for Health and Clinical Excellence (NICE) on the assessment and management of fever in children under 5years old. It highlights the key areas that will help reduce inconsistency in current clinical practice.

Influences on parents’ fever management: beliefs, experiences and information sources

To identify parents' knowledge, beliefs, management and sources of information about fever management. Despite numerous studies exploring parents' management of childhood fever; negative beliefs about fever and overuse of antipyretics and health services for mild fevers and self-limiting viral illnesses continue to be reported. Qualitative design using semi-structured interviews and discussions. Fifteen metropolitan parents whose children were aged six months to five years, volunteered to participate in individual interviews or group discussions. Recruitment was through Playgroup Queensland's online newsletter and letters from two childcare centres to all parents. Verbatim and audio data were collected by an experienced moderator using a semi-structured interview guide. Two transcripts were independently analysed by two researchers; categories, sub-headings and codes were independently developed, crosschecked and found comparable. Remaining transcripts were analysed using developed categories and codes. Fever, determined through behavioural changes, was perceived as 'good', a warning that something was wrong. High fever, reported as 38.0-39.1 degrees C, was considered harmful; it must be prevented or reduced irrespective of concerns about antipyretics. Positive febrile experiences reduced concern about fever. Negative experiences such as febrile convulsions, media reports of harm, not receiving a definitive diagnosis, inaccessibility to regular doctors and receiving conflicting information about fever management increased the concerns. Parents seek information about fever from multiple sources such as doctors, books and other parents. Parents' experiences with and information sources about fever and fever management influenced their knowledge, beliefs and practices. Positive experiences reduce concerns, health service usage and sometimes antipyretic usage. Negative experiences increase concerns, monitoring and antipyretic and health service usage. Health professionals need to update their fever management knowledge ensuring that it is based on the latest scientific knowledge. They must provide parents of young children with consistent, reliable information preferably before their first child's first febrile episode.

021–Nursing Management of Fever in Children

021–Nursing Management of Fever in Children

Local illness concepts—Implications for management of childhood pneumonia in eastern Uganda

Background Pneumonia is one of the major killers of children under 5 years. Prompt and appropriate management is crucial; yet, the care a sick child receives depends on caretakers’ perception of illness and action taken. Hence, understanding of local illness concepts on pneumonia and caretakers’ response is crucial for interventions aimed at improved management. Objective To elucidate local illness concepts involving childhood fever, cough and difficult/fast breathing and how these concepts’ influence management of children with potential pneumonia. Methods Key informant interviews with eight health workers and eight traditional healers and five focus group discussions, including presentation of a DVD showing children suffering from respiratory problems, with mothers of children under 5 years old in Iganga/Mayuge Demographic Surveillance Site (DSS) in eastern Uganda. Results Many terminologies were used to refer to symptoms of pneumonia. Difficult/fast breathing was considered severe but was not presented among common childhood illnesses. Mothers were likely to interpret any condition involving fever as malaria and had different preferred actions for difficult/fast breathing in their children. Although mothers mentioned using drugs at home for pneumonia related symptoms, they gave examples only of antipyretics. Health workers said mothers would use antimalarials and sometimes antibiotics to treat breathing problems. Conclusions There is a community knowledge gap on symptoms and biomedical treatment for pneumonia. To promote appropriate management of childhood fever, pneumonia and malaria as two separate illnesses should be highlighted, the role of antibiotics must be emphasized and local illness concepts should be addressed in behaviour change communication.