Who's afraid of fever?

The nurses on the children’s ward used to have a very fixed approach to fever in young children. If the child had a temperature of 38°C, they would strip the child down and ask the junior doctor on duty to write up some paracetamol. If the child had a temperature of 39°C, they would ask the doctor to write up ibuprofen as well as paracetamol. The doctors would readily comply with these requests. These practices raise a number of questions. Why are we trying to reduce body temperature in a child with fever? Is fever dangerous in itself? Is a child with a high fever more likely to have a serious underlying cause? What are the benefits of trying to reduce a child’s fever? Conversely, and given that fever is part of the body’s natural response to infection, should we try to reduce a child’s temperature at all? Are physical methods of cooling effective? Are antipyretic drugs effective, and, if so, which ones should we use? Are they safe? Are two agents better than one? We (the authors) are two of the developers of the National Institute for Health and Care Excellence (NICE) evidencebased guidelines on feverish illness in young children. 2 As such we looked at all of the above questions in both the original 2007 guideline and its 2013 update. Systematic reviews were carried out on all of the most important questions. In this article, we will look at the answers we found to these questions. We will also look at more recent evidence.