Downloaded from adc.bmj.com on August 29, 2014 - Published by group.bmj.com
ADC Online First, published on March 31, 2014 as 10.1136/archdischild-2013-305853 PostScript
LETTER
Is fever phobia driving inappropriate use of antipyretics? Fever is a common medical complaint in children; 20–40% of parents report feverish illness each year.1 In 1980, Schmitt used the term ‘fever phobia’ to describe parents’ misconceptions and anxiety about fever.2 We conducted a single-centre crosssectional study at the Children’s Assessment Unit (CAU) of the Children’s Hospital for Wales, Cardiff. Over 3 weeks, a self-administered anonymous 23-item written semistructured questionnaire regarding beliefs, concerns and management of fever was distributed to a convenience sample of 78 parents/caregivers of children aged 0–10 years, attending with acute medical problems. This questionnaire had been validated in emergency department setting.3 We found that parents held strong beliefs about fever and had low thresholds for seeking medical advice or treating fever (figure 1). The risk of dehydration caused the most concern (78.2%; 95% CI 69.0% to 87.4%), with 87.2% of parents (95% CI 79.8% to 94.6%) appropriately giving their child more fluid during a febrile episode;1 65.4% of parents were concerned about seizures (95% CI 54.9% to 75.9%), and 29.5% (95% CI 19.4% to
Figure 2 (n=78).
Sources of information and advice used by parents about fever and its management
39.6%) worried about brain damage, coma and/or death. Antipyretics such as paracetamol and ibuprofen were the most popular treatment used (94.9%; 95% CI 90.0% to 99.8%). Both drugs are advocated for childhood fever, but their concurrent or alternating use is not recommended.1 Despite this, combined use was common (51.3%), as were other non-evidence-based practices, such as cold-sponging and tepid-sponging (33.3% and 30.8%, respectively). Parents admitted
Figure 1 Temperatures above which parents would consider treating a fever, would seek medical attention and above which believe fever could have harmful consequences for their child (n=78).
using paracetamol and ibuprofen more frequently than recommended with 6.4% (95% CI 1.0% to 11.8%) and 42.3% (95% CI 31.3% to 53.3%), respectively, giving their child more than the recommended 4-hourly or 6-hourly, placing their children at risk of toxicity. Parents who had attended hospital previously with a febrile child (25.6%) answered ‘brain damage’, ‘coma’ and ‘death’ as consequences of fever more frequently than those who had not (40.0%; 95% CI 18.5% to 61.5% vs 25.9%; 95% CI 14.7% to 37.1%). These parents also used paracetamol and ibuprofen together more frequently (60.0%; 95% CI 38.5% to 81.5% vs 48.3%; 95% CI 35.4% to 61.2%). These findings suggest fever-related anxiety among this group may be associated with inappropriate management. Medical staff are the most popular source of information and advice about fever, in our study (figure 2) (76.9%; 95% CI 67.6% to 86.2%) and others, and thus have a vital responsibility to reassure and educate parents about fever; the fact that parents remain anxious despite previous attendance suggests opportunities to address the fever phobia demonstrated here are being missed. Previous work from the Children’s Hospital for Wales4 highlighting staff misconceptions, particularly regarding consequences and management of fever, suggests that health professionals may be contributing to parents’ fever phobia. As a cross-sectional survey, our study may have been subject to biases from convenience sampling and
Arch Dis Child Month author 2014 Vol 0(or No 0their employer) 2014. Produced by BMJ Publishing Group Ltd (& RCPCH) under licence. 1 Copyright Article
Downloaded from adc.bmj.com on August 29, 2014 - Published by group.bmj.com
PostScript Accepted 10 March 2014
may not be representative of the population as a whole: anxious parents may simply be frequent attenders, or more likely to take part in surveys to voice concerns. However, it is imperative that parent and staff education about fever, aiming to reduce inappropriate hospital attendances for well children and improve home management, is implemented and assessed. Alexandra R Teagle,1 Colin V E Powell2 1
Department of Medicine, Brighton and Sussex University Hospitals NHS Foundation Trust, Brighton, UK 2 Department of General Paediatrics, The Children’s’ Hospital for Wales, Cardiff, UK Correspondence to Dr Colin Powell, Department of
2
General Paediatrics, Children’s Hospital for Wales, Heath Park, Cardiff CF14 4XW, UK; [email protected]
Arch Dis Child 2014;0:1–2. doi:10.1136/archdischild-2013-305853
Contributors ATR conceptualised and designed the study, collected and analysed the data, drafted the initial manuscript, and approved the final manuscript as submitted. CVEP supervised data collection, critically reviewed and revised the manuscript, and approved the final manuscript as submitted.
REFERENCES 1
Competing interests None. Ethics approval
2
Provenance and peer review Not commissioned; externally peer reviewed.
3
To cite Teagle AR, Powell CVE. Arch Dis Child Published Online First: [please include Day Month Year] doi:10.1136/archdischild-2013-305853
4
National Institute for Health and Care Excellence. Feverish illness in children: assessment and initial management in children younger than 5 years. NICE clinical guideline 160, May 2013. Schmitt BD. Fever phobia: misconceptions of parents about fevers. Am J Dis Child 1980;134:176–81. Poirier MP, Collins EP, McGuire E. Fever phobia: a survey of caregivers of children seen in a pediatric emergency department. Clin Pediatr (Phila) 2010;49:530–4. Wood N, Powell C. Healthcare staff views on fever: are we contributing to fever phobia? Welsh Paed J 2011;35:40–3.
Arch Dis Child Month 2014 Vol 0 No 0
Downloaded from adc.bmj.com on August 29, 2014 - Published by group.bmj.com
Is fever phobia driving inappropriate use of antipyretics? Alexandra R Teagle and Colin V E Powell Arch Dis Child published online March 31, 2014
doi: 10.1136/archdischild-2013-305853
Updated information and services can be found at: http://adc.bmj.com/content/early/2014/03/31/archdischild-2013-305853.full.html
These include:
References
This article cites 3 articles, 1 of which can be accessed free at: http://adc.bmj.com/content/early/2014/03/31/archdischild-2013-305853.full.html#ref-list-1
P
ADC Online First, published on March 31, 2014 as 10.1136/archdischild-2013-305853 PostScript
LETTER
Is fever phobia driving inappropriate use of antipyretics? Fever is a common medical complaint in children; 20–40% of parents report feverish illness each year.1 In 1980, Schmitt used the term ‘fever phobia’ to describe parents’ misconceptions and anxiety about fever.2 We conducted a single-centre crosssectional study at the Children’s Assessment Unit (CAU) of the Children’s Hospital for Wales, Cardiff. Over 3 weeks, a self-administered anonymous 23-item written semistructured questionnaire regarding beliefs, concerns and management of fever was distributed to a convenience sample of 78 parents/caregivers of children aged 0–10 years, attending with acute medical problems. This questionnaire had been validated in emergency department setting.3 We found that parents held strong beliefs about fever and had low thresholds for seeking medical advice or treating fever (figure 1). The risk of dehydration caused the most concern (78.2%; 95% CI 69.0% to 87.4%), with 87.2% of parents (95% CI 79.8% to 94.6%) appropriately giving their child more fluid during a febrile episode;1 65.4% of parents were concerned about seizures (95% CI 54.9% to 75.9%), and 29.5% (95% CI 19.4% to
Figure 2 (n=78).
Sources of information and advice used by parents about fever and its management
39.6%) worried about brain damage, coma and/or death. Antipyretics such as paracetamol and ibuprofen were the most popular treatment used (94.9%; 95% CI 90.0% to 99.8%). Both drugs are advocated for childhood fever, but their concurrent or alternating use is not recommended.1 Despite this, combined use was common (51.3%), as were other non-evidence-based practices, such as cold-sponging and tepid-sponging (33.3% and 30.8%, respectively). Parents admitted
Figure 1 Temperatures above which parents would consider treating a fever, would seek medical attention and above which believe fever could have harmful consequences for their child (n=78).
using paracetamol and ibuprofen more frequently than recommended with 6.4% (95% CI 1.0% to 11.8%) and 42.3% (95% CI 31.3% to 53.3%), respectively, giving their child more than the recommended 4-hourly or 6-hourly, placing their children at risk of toxicity. Parents who had attended hospital previously with a febrile child (25.6%) answered ‘brain damage’, ‘coma’ and ‘death’ as consequences of fever more frequently than those who had not (40.0%; 95% CI 18.5% to 61.5% vs 25.9%; 95% CI 14.7% to 37.1%). These parents also used paracetamol and ibuprofen together more frequently (60.0%; 95% CI 38.5% to 81.5% vs 48.3%; 95% CI 35.4% to 61.2%). These findings suggest fever-related anxiety among this group may be associated with inappropriate management. Medical staff are the most popular source of information and advice about fever, in our study (figure 2) (76.9%; 95% CI 67.6% to 86.2%) and others, and thus have a vital responsibility to reassure and educate parents about fever; the fact that parents remain anxious despite previous attendance suggests opportunities to address the fever phobia demonstrated here are being missed. Previous work from the Children’s Hospital for Wales4 highlighting staff misconceptions, particularly regarding consequences and management of fever, suggests that health professionals may be contributing to parents’ fever phobia. As a cross-sectional survey, our study may have been subject to biases from convenience sampling and
Arch Dis Child Month author 2014 Vol 0(or No 0their employer) 2014. Produced by BMJ Publishing Group Ltd (& RCPCH) under licence. 1 Copyright Article
Downloaded from adc.bmj.com on August 29, 2014 - Published by group.bmj.com
PostScript Accepted 10 March 2014
may not be representative of the population as a whole: anxious parents may simply be frequent attenders, or more likely to take part in surveys to voice concerns. However, it is imperative that parent and staff education about fever, aiming to reduce inappropriate hospital attendances for well children and improve home management, is implemented and assessed. Alexandra R Teagle,1 Colin V E Powell2 1
Department of Medicine, Brighton and Sussex University Hospitals NHS Foundation Trust, Brighton, UK 2 Department of General Paediatrics, The Children’s’ Hospital for Wales, Cardiff, UK Correspondence to Dr Colin Powell, Department of
2
General Paediatrics, Children’s Hospital for Wales, Heath Park, Cardiff CF14 4XW, UK; [email protected]
Arch Dis Child 2014;0:1–2. doi:10.1136/archdischild-2013-305853
Contributors ATR conceptualised and designed the study, collected and analysed the data, drafted the initial manuscript, and approved the final manuscript as submitted. CVEP supervised data collection, critically reviewed and revised the manuscript, and approved the final manuscript as submitted.
REFERENCES 1
Competing interests None. Ethics approval
2
Provenance and peer review Not commissioned; externally peer reviewed.
3
To cite Teagle AR, Powell CVE. Arch Dis Child Published Online First: [please include Day Month Year] doi:10.1136/archdischild-2013-305853
4
National Institute for Health and Care Excellence. Feverish illness in children: assessment and initial management in children younger than 5 years. NICE clinical guideline 160, May 2013. Schmitt BD. Fever phobia: misconceptions of parents about fevers. Am J Dis Child 1980;134:176–81. Poirier MP, Collins EP, McGuire E. Fever phobia: a survey of caregivers of children seen in a pediatric emergency department. Clin Pediatr (Phila) 2010;49:530–4. Wood N, Powell C. Healthcare staff views on fever: are we contributing to fever phobia? Welsh Paed J 2011;35:40–3.
Arch Dis Child Month 2014 Vol 0 No 0
Downloaded from adc.bmj.com on August 29, 2014 - Published by group.bmj.com
Is fever phobia driving inappropriate use of antipyretics? Alexandra R Teagle and Colin V E Powell Arch Dis Child published online March 31, 2014
doi: 10.1136/archdischild-2013-305853
Updated information and services can be found at: http://adc.bmj.com/content/early/2014/03/31/archdischild-2013-305853.full.html
These include:
References
This article cites 3 articles, 1 of which can be accessed free at: http://adc.bmj.com/content/early/2014/03/31/archdischild-2013-305853.full.html#ref-list-1
P
