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New Guidelines For Treating Fever In Children

March 1, 2011

According to a new report from the American Academy of Pediatrics (AAP), researchers say parents should not immediately rush for medicines when their child displays signs of fever, as fever alone is not a cause for intervention.

Reuters reports that new guidelines urge parents to recognize fever as a sign that the body is working to fight off infection and does not need to be feared.

Instead, they say the main objective in treating fever in kids should be to keep them comfortable while looking for signs of serious illness rather than focusing on keeping body temperature with a “normal” range.

“The focus should be on comfort and not on absolute temperature,” Dr. Janice Sullivan, a professor at the University of Louisville and head of the AAP’s section on clinical pharmacology and therapeutics, and lead author of the report, told Reuters Health.

That’s because fever can help fight illness, working to slow the reproduction of bacteria and viruses and stimulating the body’s immune response. “That’s a benefit of fever,” said Sullivan, “and may shorten the time that your child remains ill.”

“Fever makes many parents do whatever they can to bring their child’s fever down into a normal range. Fever is not a danger itself; it usually is a benefit,” Henry Bernstein, MD, chief of general pediatrics at the Cohen Children’s Medical Center of New York, said in an email to Reuters.

“Parents need to know that fever is not something to fear, but more of a friend that shows the body is fighting the infection,” said Bernstein.

The new guidelines on treating fever with over-the-counter medications are the first the AAP has released.

The authors reviewed studies on the safety and effectiveness of acetaminophen and ibuprofen.

Although some studies suggest that alternating doses of ibuprofen and acetaminophen may be more effective at lowering temperature, researchers say there are too many questions regarding the safety of doing so, and if it is even effective enough in improving discomfort.

“The possibility that parents will either not receive or not understand dosing instructions, combined with the wide array of formulations that contain these drugs, increases the potential for inaccurate dosing or overdosing,” said Sullivan.

Acetaminophen is the most common single ingredient involved in emergency room visits for medication overdoses in children, according to researchers. More than 80 percent of these overdoses are the result of unsupervised ingestion.

“They must be given in the correct dose at the right times based on a child’s weight, age, and overall health,” Bernstein said, referring to acetaminophen and ibuprofen.

Sullivan said parents should recognize that fever is a sign that a child is ill, and they should check for other symptoms — such as lethargy, pain or dehydration — to see if a call to the doctor is needed.

“We discourage parents from waking their children to give them antipyretics (fever-reducing medications), because if their child is sleeping, there’s no sign of discomfort,” Sullivan said.

Yet the vast majority of parents will wake their child to give him or her fever reducing medications, according to one study.

“A lot of families have fever phobia,” Claire McCarthy, a pediatrician at Children’s Hospital Boston, told Reuters Health. “What’s really important is making the child feel comfortable.”

When parents feel medicine is necessary, guidelines recommend that they use children’s formulas, not those made for adults. People often give their children too much or not enough medication, said Sullivan. Her report stresses that dosing should be measured by weight, not age or height.

“I think that a lot of people don’t realize how possibly dangerous acetaminophen can be,” said McCarthy. Overdoses can cause harm to the liver.

Johnson and Johnson, the maker of children’s Tylenol, recalled a large number of its product due to safety concerns. Sullivan said Tylenol and other children’s fever reducers are safe, as long as parents give them in correct doses.

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