Temperature In Children Research Articles

Fever Phobia: A Survey of Children's Parents in a Pediatric Outpatient Clinic.

PURPOSE: Purposes of this study were to identify the level of parental fever phobia and to investigate the relationship between level of parental concern about fever and related variables.METHODS: Participants were 151 parents of children who visited a pediatric outpatient clinic. A self-reported structured questionnaire was used for data collection and data were analyzed using descriptive statistics and chi2-test.RESULTS: Almost half of participants defined a minimum temperature for fever as 37.8degrees C and a minimum temperature for high fever as 38.9degrees C. About 75% of participants identified harmful effects of fever as seizure and brain damage, were 'very worried' about fever, measured their child's temperature every hour or less, provided tepid massage and woke children to give antipyretics during febrile illness. There were significant relationships between level of parental concerns about fever and prior experience of febrile seizures, and/or being parents of a single child.CONCLUSION: Results indicate that fever phobia is prevalent among parents. Further studies are needed to develop and evaluate childhood fever management educational programs for parents. Considering health care providers as a primary information resource about fever management, health care providers should play a vital role to reduce parental unrealistic concerns about fever.

Turkish parents’ management of childhood fever: A cross-sectional survey using the PFMS-TR

To explore Turkish parents' practices in childhood fever management. A cross-sectional study with 205 randomly selected Turkish parents of febrile children 6-months to 5-years from the paediatric hospital and two family health centres in Sakarya, Turkey in 2009. Data explored general fever management practices on the 8-item Parents' Fever Management Scale - Turkish version (5-point Liket scale; 1=never to 5=always) and socio-demographics. Parents wanted to know their child's temperature (61.5%), took temperatures (60%), slept in the same room (58.5%) and sought medical advice (53.7%). Non-evidence-based-practices included over-the-counter medications (42.4%); waking children during the night for fever reducing medication (33.2%). Evidence-based-practice ensured febrile children had plenty to drink (30.2%) and febrile children were checked during the night (59%). Parents' reports indicate high levels of concern about fever, overuse of over-the-counter medications and health services. Practices increase parents' burden of care, are disruptive of family life and lead to parental fatigue. The study confirms the appropriateness and applicability of the fever management instrument, a simple tool to incorporate into assessment of febrile children, in identifying Turkish parents' fever management practice.

Student voice: First lessons.

I will never forget the day that I upset a child for the first time. I was a first-year nursing student and asked by the staff nurse to take a child's temperature. Off I went, delighted that I was to be of some use on the ward.

Galinstan Thermometer Is More Accurate Than Digital for the Measurement of Body Temperature in Children

The mercury thermometer (MT) was considered the reference standard for the evaluation of body temperature; however, since April 2009, it has no longer been available in Italy. This study aimed to evaluate the accuracy of digital thermometer (DT) and galinstan thermometer (GT) in comparison with the MT. We prospectively recruited 284 children (age, 1 month to 17 years; mean, 8.5 years) seen in the emergency department of a tertiary pediatric hospital between November and December 2010. For each patient, body temperature was measured sequentially in the right axilla in a randomized fashion using DT, GT, and MT. Fever was defined as an axillary temperature of 37.5°C or greater. The temperature readings with DT and GT were compared statistically with those of MT (reference standard). No statistically significant difference in mean temperature was found between MT and GT in pairwise comparison (P = 0.06), whereas significant differences were found between MT and DT (P < 0.001) and between GT and DT (P < 0.001). Sensitivity and specificity of DT were 67.5% and 98.0%, respectively. When considering children with a temperature of 39°C or higher, the false-negative rate was 65.4% with DT and 30.8% with GT. Although both DT and GT had good specificity and positive predictive value compared with MT, GT had higher sensitivity and a lower rate of false-negative rates. Galinstan thermometer is more accurate in the measurement of body temperature compared with DT or MT.

Metabolic Risk Factors Are Associated With Stiffness Index, Reflection Index and Finger Skin Temperature in Children

Childhood metabolic syndrome (MetS) has been found to predict adulthood MetS, type 2 diabetes and cardiovascular disease, emphasizing the early identification of children at increased risk of these diseases. Children with clustering of metabolic risk factors have been reported to have a mild arterial stiffness and endothelial dysfunction, but limited evidence is available from population-based samples of children. The associations of metabolic risk factors with arterial stiffness, tone and endothelial function were studied in 173 prepubertal children (90 girls) 6-8 years of age. MetS was assessed both by continuous MetScore and dichotomously. Stiffness index (SI), reflection index (RI) and finger skin temperature (FST) were measured before and after maximum exercise test, and percent change was calculated for RI (RI%Δ) and FST (FST%Δ). MetScore (r=0.26, P=0.001), fasting insulin (r=0.24, P=0.002), fasting triglycerides (r=0.20, P=0.009), systolic (SBP; r=0.24, P=0.002) and diastolic blood pressure (DBP; r=0.19, P=0.013) correlated with SI. MetScore (r=-0.17, P=0.024, r=0.21, P=0.006), waist circumference (r=-0.19, P=0.012, r=0.23, P=0.003) and SBP (r=-0.16, P=0.035, r=0.21, P=0.005) correlated with RI and FST. High-density lipoprotein cholesterol correlated with FST (r=-0.22, P=0.004) and FST%Δ (r=-0.24, P=0.002). RI decreased and FST increased with exercise (P<0.001). Waist circumference correlated inversely with RI%Δ in boys (r=-0.22, P=0.046) and directly with RI%Δ in girls (r=0.27, P=0.011). Metabolic risk factors are associated with arterial stiffness, tone and endothelial function in prepubertal children.

A43 The effect of hydrocortisone on the growth of preterm infants on prolonged mechanical ventilation

Background and Aims: Heart rate is known to increase by approximately 10 beats per minute (bpm) per degree centigrade increase in body temperature in children. A higher heart rate than would be expected for a given level of fever may therefore be more suspicious for an infection compared to conventional heart rate cut-off values. Very few data exist on the relationship between temperature and heart rate in newborns. We aimed to evaluate the role of fever on heart rate in newborns during the first three days of life. Methods: We included all newborns hospitalised at our tertiary care teaching neonatal intensive care unit within the first three days of life during a four-year period. Temperature was measured every two to four hours and heart rate was recorded continuously. Results: Of 863 newborns included 69 (8%) had fever during the first three days of life (rectal temperature >38.5°C), 45 of them had culture proven and clinical early onset sepsis (65%). There was a positive correlation between temperature and heart rate (r = .314, p = .009) with an increment in heart rate by 17.5 bpm (CI 95% 4.6–30.4) with each 1°C increment in temperature. In the subgroup of sepsis positive newborns the increment in heart rate was higher compared to sepsis negative newborns (21.5 bpm (4.9–38.1) vs. 10.5 bpm (−11.7–32.6), respectively). Conclusions: Our results suggest a relationship between pulse rate and temperature in febrile newborns. Further studies might better explore the possible utility of a temperature dependent interpretation of heart rate in this age group.

Fever control and application of hypothermia using intravenous cold saline

To describe the use and feasibility of cold saline to decrease body temperature in pediatric neurocritical care. Retrospective chart review. Pediatric tertiary care university hospital. Children between 1 wk and 17 yrs of age admitted to the pediatric intensive care unit with acute brain injury and having received intravenous cold saline between June and August 2009. None. Eighteen subjects accounted for 20 infusions with mean infusion volume 18 ± 10 mL/kg. Eight subjects had traumatic brain injury, two had intracranial hemorrhage, six had cardiac arrest, and one each had ischemic stroke and status epilepticus. The mean age was 9.5 ± 4.8 yrs. Temperature decreased from 38.7 ± 1.1°C to 37.7 ± 1.2°C and from 37.0 ± 2.0°C to 35.3 ± 1.6°C 1 hr after infusion for fever (n = 14; p < .05) or hypothermia induction (n = 6; p = .05), respectively. Cold saline was not bloused but rather infused over 10-15 mins. Mean arterial blood pressure and oxygenation parameters (PaO2/FIO2 ratio, mean airway pressure) were unchanged, but heart rate decreased in those with hypothermia (121 ± 4 beats per minute vs. 109 ± 12 beats per minute; p < .05). Serum sodium concentration and international normalized ratio were significantly increased after cold saline infusion. There were no differences between preinfusion and postinfusion serum glucose and hematocrit, or between cerebral perfusion pressure and intracranial pressure in traumatic brain injury patients. Cold saline was an effective method of reducing temperature in children with acute brain injury. This approach can be considered to treat fever or to induce hypothermia. A prospective study comparing safety and efficacy vs. other cooling measures should be considered.

Signs and symptoms predicting influenza in children: a matched case–control analysis of prospectively collected clinical data

We aimed to determine whether there are signs or symptoms that could help clinicians to distinguish between influenza and other respiratory infections. The clinical data for this matched case-control analysis were derived from a 2-year prospective cohort study of respiratory infections among children aged≤13 years. At any signs of respiratory infection, the children were examined and nasal swabs were obtained for virologic analyses. Cases were 353 children with laboratory-confirmed influenza and controls were 353 children with respiratory symptoms who tested negative for influenza. Cases and controls were matched for gender, age, and timing of the visit. In the multivariate conditional logistic regression analyses, fever was the only sign that independently predicted influenza virus infection, with odds ratios ranging from 13.55 (95% confidence interval [CI], 6.90-26.63) to 50.10 (95% CI, 16.25-154.45), depending on the degree of fever. In all analyses, the predictive capability of fever increased with incremental elevations in the child's temperature. The likelihood ratio of fever≥40.0°C in predicting influenza was 6.00 (95% CI, 2.80-12.96). Among unselected children seen as outpatients during influenza outbreaks, fever is the only reliable predictor of influenza virus infection. The optimal use of influenza-specific antiviral drugs in children may require virologic confirmation.

Mother and child in synchrony: Thermal facial imprints of autonomic contagion

Mothers’ ability to empathically share offspring's emotional feelings is considered integral to primary affective bonds and a healthy socio-emotional development. What neurobiological mechanism is responsible for this ability in humans? It has been proposed that the psychological and neural components of affective experiences are strictly associated with autonomic-visceral changes. Hence, the vicarious response of empathy may also embody a sharing of changes in body physiology. The present study aimed at investigating whether maternal empathy is accompanied by a synchrony in autonomic responses. We simultaneously recorded, in an ecological context with contact free methodology, the facial thermal imprints of mother and child, while the former observed the latter when involved in a distressing situation. The results showed a situation-specific parallelism between mothers’ and children's facial temperature variations, providing preliminary evidence for a direct affective sharing involving autonomic responding. These findings support a multidimensional approach for the comprehension of emotional parent–child relationships.

Brain-systemic temperature gradient is temperature-dependent in children with severe traumatic brain injury

To understand the gradient between rectal and brain temperature in children after severe traumatic brain injury. We hypothesized that the rectal temperature and brain temperature gradient will be influenced by the child's body surface area and that this relationship will persist over physiologic temperature ranges. Retrospective review of a prospectively collected pediatric neurotrauma registry. Academic, university-based pediatric neurotrauma program. Consecutive children (n = 40) with severe traumatic brain injury (Glasgow coma scale of <8) who underwent brain temperature monitoring (July 2003 to December 2008) were studied after informed consent was obtained. A subset of children (n = 24) were concurrently enrolled in a randomized, controlled clinical trial of early-moderate hypothermia for neuroprotection. Data extraction of multiple clinical variables, including demographic data, body surface area, and rectal and brain temperature at recorded at hourly intervals. Paired brain and rectal temperature measurements (in degrees Celsius, n = 4369) were collected hourly and compared by using Pearson correlations. Patients were stratified according to body surface area (<1.0 m, 1.0-1.99 m, 2.0-2.99 m, and >3.0 m) and based on brain temperature (≤34.0, 34.1-36.0; 36.1-38, ≥38.1). Body surface area and brain temperature were compared between groups by using Pearson correlations with correction for repeated measures. Mean brain temperature-rectal temperature difference was calculated for stratified brain temperature ranges. Overall, brain and rectal temperatures were highly correlated (r = .86, p < .001). During brain hyperthermia, brain temperature-rectal temperature was similar to that reported in previous studies with brain temperature higher than rectal temperature (1.75 ± 0.4; r = .54). Surprisingly, this relationship was reversed during brain hypothermia (brain temperature-rectal temperature = -1.87 ± 0.8; r = .37), indicating a reversal of the brain-systemic temperature gradient. When stratified for body surface area, the correlation between rectal temperature and brain temperature remained strong (r = .78, 0.91, 0.79 and 0.95, respectively, p < .001). However, the correlation between brain temperature and rectal temperature was substantially decreased when stratified for brain temperature (r = .37, 0.58, 0.48, 0.54, p < .001). In particular, during moderate brain hypothermia (brain temperature ≤34), the correlation between brain temperature and rectal temperature was weakest, indicating the greatest variability during this condition which is often targeted for therapeutic trials. Brain temperature and rectal temperature are generally well-correlated in children with traumatic brain injury. This relationship is different at the extremes of the physiologic temperature range, with the temperature gradient reversed during brain hypothermia and hyperthermia. Given that studies showing neuroprotection from hypothermia in animal models of brain injury generally target brain temperature, our data suggest the possibility that, if brain temperature were the therapeutic target in clinical trials, this would result in somewhat higher systemic temperature and potentially fewer side effects. This relationship may be exploited in future clinical trials to maintain brain hypothermia (for neurologic protection) at slightly higher systemic temperatures (and potentially fewer systemic side effects).

Esophageal, Tympanic, Rectal, and Skin Temperatures in Children Undergoing Surgery With General Anesthesia

The purpose of this study was to determine the degrees of agreement between various sites of temperature measurement and examine the trend of body temperature in children during surgery under general anaesthesia. Thirty-six consecutive children who underwent surgery with general anaesthesia, had temperatures measured at the oesophagus, skin, ear canal and rectum at baseline, every 15 minutes for the first hour and every 30 minutes thereafter. Spearman correlation and Bland-Altman analyses were used to compare data and trends of mean differences assessed by line graphs. The median age of the sample was 48 months. There were 575 temperature measurements taken. The inter-method correlation coefficients was highest for the oesophageal vs rectal (r = 0.96) temperature and lowest for rectal vs skin (r = -0.11) temperature. The lowest mean difference (95% CI) in temperature at commencement of surgery was between the oesophageal and rectal sites, -0.03°C (-0.08, -0.01) while the highest mean difference (95% CI) temperature was between oesophageal and skin sites, 3.24°C (2.65, 3.85). The trend in differential temperatures between sites remained throughout the duration of surgery. Bland-Altman plots showed that the least difference (bias) at baseline (0.3°C) was between the oesophageal and tympanic temperatures while at 1 hour (0.13°C ) was between the oesophageal and rectal temperatures. The oesophageal site was the closest to rectal for monitoring core temperature while the skin was the least reliable site in the study population. In the situation where oesophageal probe is not routine or functioning, rectal or tympanic temperatures may be used.

Fever detection in under 5 children in a tertiary health facility using the infrared tympanic thermometer in the oral mode

Monitoring of body temperature is an important clinical procedure in the care of sick children, especially the under-5 children, as many disease conditions present with fever. The oral mercury-in-glass thermometer which has relatively good accuracy cannot be used in children less than 5 years because it requires their cooperation. This study was aimed at using the infrared tympanic thermometer (IRTT) in oral mode to measure temperature in febrile and afebrile children less than 5 years. Rectal and tympanic temperatures were measured consecutively in 400 febrile and 400 afebrile under-5 children matched for age, using the mercury-in-glass thermometer and the IRTT in oral mode respectively. In the febrile children, the mean tympanic temperature was 38.6 ± 0.9°C, while the mean rectal temperature was 39.0 ± 0.8°C. In the afebrile group, the mean tympanic temperature was 37.0 ± 0.4°C, while the mean rectal temperature was 37.4 ± 0.3°C. The mean difference between rectal and tympanic temperatures in both groups was statistically significant. There was good correlation between the two temperatures. The tympanic thermometer used in the oral mode had a sensitivity of 87.3% and a specificity of 96.5%. The IRTT (oral mode) may not be reliable in estimating 'core' body temperature in children under the age of five years, but with a fairly good sensitivity and specificity, as well as its other advantages such as short duration of measurement, convenience and safety, it is a useful instrument for screening children with fever in a busy setup.

Evaluation of Children's Thermal Sensation in an Outdoor Swimming Pool during Swimming Class-Multiple Effects of Environment, Morphological Characteristics and Swimwear Condition-

During exercise in water children's body temperature are especially likely to be affected by a cold water environment because of their morphological characteristic. There is a lack of information about the recommended environmental condition for elementary school swimming classes based on scientific objective data. This study investigated multiple effects of the environmental condition, morphological characteristics, and swimwear condition on children's thermal sensation during an elementary school swimming class. The sixth-grade elementary school children (n=68) participated in a swimming class conducted in the outdoor pool eight times. They wore a normal swimsuit or a partial coverage wetsuit. During the swimming class, water temperature and ambient temperature were continuously measured. children's thermal sensation was asked at the poolside immediately after each swimming class. Multiple regression analysis was performed to make an estimation equation of children's thermal sensation. The equations contain three predictors of water temperature, swimwear condition, and their morphological characteristics. The result of standardized regression coefficients indicated that, water temperature was the greatest contributor to their thermal sensation, followed by the swimwear condition, and morphological characteristics. On the basis of the analysis, presumably the thermal effect of a partial coverage wetsuit was equivalent to the increase of water temperature by 2.1°C and it makes children feel warmer thermal sensation. Additionally, the thermally comfortable area was indicated as the relationship between water temperature and children's morphological characteristics for each swimwear condition.

Exhaled air temperature in children with bronchopulmonary dysplasia

Because they have similar functional and clinical profiles, bronchopulmonary dysplasia (BPD) survivors are often treated as asthmatic patients. In truth, very little is known about the possible biochemical and inflammatory mechanisms playing a part in BPD survivors' lungs. The aim of this study was to measure exhaled breath temperature in BPD survivors by comparison with asthmatic cases and healthy controls. Three groups of age-matched adolescents (n = 17 each), that is, BPD survivors (gestational ages <31 weeks, birth weights <1,500 g), asthmatic subjects and healthy controls, underwent exhaled breath temperature and exhaled nitric oxide measurements, and spirometry. Exhaled breath temperature was significantly lower in the BPD survivors (26.72°C [25.11-27.57]) than in the asthmatic patients (29.60°C [29.20-30.02], P < 0.001), while no significant difference emerged by comparison with healthy controls (26.97°C [26.58-27.38]). Considering the whole study population, a significant correlation was found between exhaled breath temperatures and exhaled nitric oxide concentrations (R = 0.42, P = 0.004). Spirometry revealed an obstructive lung function pattern in both the asthmatic cases and the BPD survivors, with lower parameters in the latter. Exhaled breath temperatures and exhaled nitric oxide concentrations are significantly lower in BPD survivors than in asthmatic cases, suggesting that different pathogenetic mechanisms characterize these two chronic obstructive lung diseases.

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.

Hyperthermia in the pediatric intensive care unit – is it malignant hyperthermia?

To determine the characteristics of calls made to the Malignant Hyperthermia Association of the United States (MHAUS) Hotline regarding pediatric patients in the intensive care unit setting. Retrospective, cohort study conducting analysis of included cases to identify the cause of elevated temperature in the pediatric intensive care unit. The etiology of hyperthermia in the pediatric intensive care unit (ICU) is multifactorial and often difficult to diagnose. Review of all MHAUS logs for the years 1997-2005 for children, 18 years of age and younger, with elevated temperature presenting in the intensive care setting. Sixty-three of 1883 (3.3%) calls met inclusion criteria and these cases were characterized. Patient temperature values ranged from 38.0 to 45.0 degrees C. Malignant hyperthermia (MH) was considered 'definite' in five cases and 'probable' in three cases. An infectious diagnosis was given to 16 cases, and a central fever was diagnosed in nine cases. The diagnosis was unknown in the remaining 30 cases. Dantrolene was administered prior to the Hotline call in 32 cases. The recommendation to continue or stop dantrolene varied according to the clinical situation. In six cases, the Hotline expert recommended initiation of dantrolene. In 17 cases, the Hotline expert recommended initiation or continuation of dantrolene as a nonspecific antipyretic, even though MH was not considered as a leading diagnosis. Cases of elevated temperature in children in an intensive care unit setting reported to the MHAUS Hotline were rarely considered to be MH related. Although MH does not represent a significant portion of diagnoses related to hyperthermia, when hyperthermia occurs in children exposed to anesthetic agents, MH should be considered in the differential diagnosis.

Evaluation of the Cadi ThermoSENSOR Wireless Skin-Contact Thermometer Against Ear and Axillary Temperatures in Children

The Cadi ThermoSENSOR skin-contact thermometer measures body temperature continuously and transmits readings wirelessly to a central server. This study evaluated the ThermoSENSOR against ear temperatures (ETs) measured by a Braun ThermoScan ear thermometer and axillary temperatures (ATs) measured by a Terumo digital clinical thermometer. The test participants consisted of 109 children aged 6 months to 16 years from a pediatric ward. The sensor was attached to the lower abdomen at least 15 minutes before the first measurement. ET, AT, and ThermoSENSOR temperatures (TTs) were recorded up to three times at the usual measurement times. The TTs differed from ETs by −0.23°C ± 0.47°C (mean ± standard deviation, n = 271) and from ATs by +0.21°C ± 0.46°C (n = 270). The ETs differed from ATs by +0.43°C ± 0.42°C (n = 315). These results suggest that the TTs were comparable to the ETs and ATs.

Fever Determination in Young Infants

Pediatricians routinely advise parents to seek immediate medical attention if their young infant develops a fever. Many parents rely on palpation to assess their child's temperature. Our objective was to determine the prevalence and accuracy of parental palpation for fever in young infants. We enrolled a convenience sample of infants younger than 3 months presenting to a pediatric emergency department with any complaint. Parents answered questions regarding their usual fever determination practices and palpated their infants to assess for fever. Parental predictions were then compared with the standard rectal temperature obtained at triage. Ninety-six infants were enrolled. Fifty-seven percent of parents reported palpation as a usual method of fever assessment, with 87% palpating for fever at least occasionally. Of the 78% of parents who owned a thermometer, nearly half used palpation regularly. As compared with the "gold standard" of rectal thermometry, parental palpation for fever had a sensitivity of 81%, specificity of 82%, positive predictive value of 59% and negative predictive value of 93%. After eliminating from analysis those infants whose parents had used a thermometer at home, we found a sensitivity of 67%, specificity of 84%, positive predictive value of 33%, and negative predictive value of 95%. Many parents rely on palpation as a usual method of fever determination in young infants, including nearly half of those who own a thermometer. Parental palpation overestimates the presence of fever, but is likely to be accurate when parents report that their baby is not febrile. As a sole method of determining fever, parental palpation is unreliable.

THE INFLUENCE OF ROOM HEATING CHARACTERISTICS ON THE PHYSIOLOGICAL REACTION OF YOUNG CHILDREN AND THEIR MOTHER

This paper investigates young children's thermoregulatory capabilities through a comparison of young children's thermal responses and heat balances with their mother's. The following results were obtained: 1) The majority of children's local skin temperatures were significantly higher than that of the mother's during the 24°C and 32°C conditions. 2) In the 32°C and 28°C condition there was no significant difference between the child and mother's thermo-physiological responses. However there was a difference in blood flow to the skin through contraction of blood vessels in the cold conditions of 24°C and 20°C, which suggested an undeveloped thermo-physiological response in the children. 3) It was found when investigating the heat diffusion of children and mothers that there were significant differences in the 24°C and 32°C conditions in regards to metabolic rate, convection, radiation and evaporation.

Parental fever phobia and its evolutionary correlates

This study aimed to identify parental views of fever in their children aged 1-6 years and to consider these and associated behaviours from an evolutionary perspective. Fever is a common symptom of illness in children; however, many parents express high levels of anxiety. This has previously been reported in several countries, most notably the USA. The purpose behind this study was to look at parental views and examine these from an evolutionary perspective to explain the persistence and ubiquity of parental fears of fever. A questionnaire was administered to 181 parents of children attending a paediatric outpatients department at a London teaching hospital. Many parents expressed high levels of worry and its possible complications. These manifest themselves in the frequency with which parents measured their child's temperature, and the aggressive nature of their treatment. Many reported over-using antipyretic drugs, or using non-evidence based practices such as sponging. However, in many cases they were also making appropriate behavioural alterations, for example, encouraging fluids and rest. While many parents expressed high levels of worry about fever and used inappropriate treatments, this must be balanced against benefits such as increased vigilance and close attention to hydration. Lay health beliefs, such as those reported in this study, may be judged unduly negatively if individual aspects are seen in isolation. High levels of worry have been reported internationally, suggesting that they may form part of a conserved response to fever. Although many parents reported aggressive treatment of fever, they also used appropriate symptomatic interventions. Nurses and other healthcare professionals should act to reduce the fear of fever and concentrate upon accurate diagnosis and the appropriate treatment of the underlying illness.