In addition, there is
no evidence that fever in itself increases the risk of parentally-feared adverse events such as febrile convulsions selleck kinase inhibitor or brain damage [18], and lowering temperature with antipyretics does not appear to be effective at preventing febrile convulsions [19, 20]. Based on such data, recent guidelines emphasize the need to treat only the symptoms of fever in children who are either in discomfort or distressed, and not to focus on normothermia [1–3]. Despite this, an elevated body temperature (whatever site or method of measurement is used), even below 38 °C, continues to be a cause of concern for many parents [7]. Unfounded concerns contribute to reports that the vast majority of caregivers would give antipyretic medication to a feverish child,
even if the child appeared otherwise comfortable [7, 13, 21]. Overall, it seems that parental misconceptions around fever and Dinaciclib molecular weight ‘fever phobia’ have changed little since this problem was first recognized over 30 years ago [6]. Overcoming such concerns and gaining parental acceptance of current recommendations not to give antipyretics simply to reduce fever in children, but only to alleviate Ilomastat distress [2, 22], is clearly a major challenge. 3 Treating the Distressed, Feverish Child While reduction of fever should not be the primary indication for antipyretic treatment according to NICE guidelines, when a child is distressed, treatment with antipyretics is likely to ease symptoms. The distress experienced by feverish children may in fact be due to the mismatch in body and environmental temperatures, as well as any illness-associated
pain. It is clear to see why alleviating these symptoms could reduce the distress associated with fever. 3.1 Fever Reduction Despite recommendations to treat distress rather than fever, ‘fever phobia’ means that fever itself is currently the target of therapy for many parents, with a rapid and prolonged effect being their likely priority for comforting their child and to minimize medication. Overall, meta-analyses suggest that ibuprofen provides more rapid and longer lasting fever reduction in children compared with paracetamol [23–25]. Sorafenib order In a large, randomized, blinded study of paracetamol plus ibuprofen for the treatment of fever in children (PITCH), involving 156 children who were being managed at home, ibuprofen was shown to provide faster fever clearance and longer time without fever in the first 24 hours compared with paracetamol [26]. 3.2 Symptomatic Relief Given that the NICE guidelines do not recommend the use of antipyretic treatment solely to reduce temperature, the primary consideration in antipyretic choice should be relief of distress (i.e., the recommended indications for antipyretic use in childhood fever).