Clinical Report—Fever and Antipyretic Use in Children

Fever in a child is one of themost common clinical symptomsmanaged 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. Pediatrics 2011;127:580–587 INTRODUCTION Fever is one of the most common clinical symptoms managed by pediatricians and other health care providers and accounts, by some estimates, for one-third of all presenting conditions in children.1 Fever in a child commonly leads to unscheduled physician visits, telephone calls by parents to their child’s physician for advice on fever control, and the wide use of over-the-counter antipyretics. Parents are frequently concernedwith the need tomaintain a “normal” temperature in their ill child. Many parents administer antipyretics even though there is either minimal or no fever.2 Approximately onehalf of parents consider a temperature of less than 38°C (100.4°F) to be a fever, and 25% of caregivers would give antipyretics for temperatures of less than 37.8°C (100°F).1,3 Furthermore, 85% of parents (n 340) reported awakening their child from sleep to give antipyretics.1 Unfortunately, as many as one-half of parents administer incorrect doses of antipyretics; approximately 15% of parents give supratherapeutic doses of acetaminophen or ibuprofen.4 Caregivers who underJanice E. Sullivan, MD, Henry C. Farrar, MD, and the SECTION ON CLINICAL PHARMACOLOGY AND THERAPEUTICS, and COMMITTEE ON DRUGS