According
to Elkon-Tamir et al., fever is the chief complaint in up to one third of
pediatric office visits. Elkon-Tamir et al., further explain that
many parents and caregivers have fever phobia. This fever phobia is
a result of general caregiver misunderstanding such that fevers themselves can
cause central nervous system damage, seizures, and death, without fully
understanding the physiology behind fevers and the greater concern of
associated symptoms and underlying causes.
In
the article, “Fever and Antipyretic Use in Children”, authors Dr. Sullivan, Dr.
Farrar and their team of researchers, address the use of antipyretics in the
pediatric population in cases of fever. They address this because
despite in depth knowledge of the physiology of fever, the use of antipyretics
are frequently given “even though there is either minimal or no
fever.”(Bilenko, 2006)
According
to the article, antipyretic use may relieve discomfort in patients with fevers
and reduce water loss, however, associated risk with antipyretic use is that
lowering the fever may delay diagnosis of underlying condition and may lead to
drug toxicity. Furthermore, the researchers point out that much of
the phobia surrounding fevers comes from the undistinguished difference between
fever and hyperthermia. Fever is described as a physiological action
from the hypothalamus versus a hyperthermia which “is a rare and
pathophysiologic response with failure of normal homeostasis” (Sullivan, 2011) that
may increase risk of brain damage, delirium, convulsions.
The
authors emphasize that physicians monitor for antipyretic effect to improve
activity and feeding. They also focused on the use of
acetaminophen, ibuprofen, and a combination of both and explained how these
drugs are commonly alternated in children with fever. They further
expressed that proper dosing for each medication in accordance to guidelines
and medical direction are crucial in order to reduce toxic effects. (Sullivan,
2011)
Because
of this fever phobia noted in parents and caregiver, healthcare professionals
should do their best to improve communication and
education. There are many ethnic, cultural, and language barriers that can
disrupt the effective medical direction and advise. These barriers
should be over come in order to apply the principle of beneficence for the
pediatric patient and in order to apply the principle of autonomy to the
parents who are usually the ultimate medical decision makers. I
believe that many resources exist within our hospitals and clinics that aim to
improve medical knowledge of those receiving the services and therefore should
be used appropriately.
References
Bilenko, N., Tessler, H., Okbe, R.,
Press, J., & Gorodischer, R. (2006). Determinants of antipyretic
misuse in children up to 5 years of age: A cross-sectional study. Clinical
Therapeutics, 28(5), 783-793.
doi:10.1016/j.clinthera.2006.05.010
Elkon-Tamir, E., Rimon, A., Scolnik, D., & Glatstein, M.
(2017). Fever Phobia as a Reason for Pediatric Emergency Department Visits:
Does the Primary Care Physician Make a Difference? Rambam Maimonides
Medical Journal, 8(1), e0007. http://doi.org/10.5041/RMMJ.10282
Sullivan, J. E., & Farrar, H. C.
(2011). Fever and Antipyretic Use in Children. PEDIATRICS, 127(3),
580-587. doi:10.1542/peds.2010-3852
Hello Livia,
ReplyDeleteThank you for this interesting blog. I remember how frightening a very high fever seemed when I was a new mom. I remember my daughter's first high fever. It was late in the evening, around 10pm, when her fever spike to 103.5°F. At the time, I was a Lieutenant in the Air Force and the closest hospital was on base. Unfortunately, that same night, the base was on lockdown due to a terrorist threat and although I knew I could eventually get on base to the emergency room, I was uncertain how long it would take to get through the security checkpoint. Unwilling to risk my daughter’s health while waiting in a line of cars to get to the hospital, I called the pediatric health hotline run. I explained the situation to the nurse who answered my call. Although I knew how to treat a basic fever, I was terrified that a fever above 103°F would cause irreparable damage. The nurse calmed my fears and said that, given my daughter had only spiked this fever over the period of one day, there was no need to bring her to the hospital unless it rose above 105°F or she started to have a seizure. Having the nurse tell me that my daughter could have a seizure was certainly not comforting! However, I kept her at home and treated her fever with acetaminophen and ibuprofen. Because of that nurse’s advice, I’ve never been to the emergency room because of a fever. After I read your blog, I looked up guidelines for when a fever is considered dangerous. The website HealthyChildren.org, a site run by the American Academy of Pediatrics, recommends that children be evaluated by a medical professional when the fever is accompanied by certain other dangerous symptoms such as a stiff neck, severe headache, severe sore throat, severe rash, ear pain, or repeated vomiting or diarrhea. Additionally, the child should be seen in the emergency room if he/she experiences a seizure, has a persistent fever, or has a fever that rises above 104°F repeatedly.
References:
https://www.healthychildren.org/English/health-issues/conditions/fever/Pages/Fever-Without-Fear.aspx