Management of the Child with Fever
Update November 2003
This systematic review was produced from research conducted up to 1997. In 2003 a further search
of research literature was conducted to identify relevant studies carried out in the intervening years,
1998-2003. The literature search followed the original protocol and included additional sources of
research information that had become available since 1997. To assist in identifying relevant studies
as they were published, several current awareness alert services were established in major
databases, such as Ingenta and Science Direct. No new research studies were found that met the
inclusion criteria of the review’s protocol. However, the studies listed below may be useful for
readers with an interest in related areas of research. These articles should be read in conjunction
with the recommendations in the Best Practice Information Sheet developed from the original
systematic review.
Comparison of antipyretic therapy
Mace, S.E. (2000). Preliminary comparison of antipyretic medications in febrile pediatric patients.
Annals of Emergency Medicine 36(4): S28.
Abstract only: A randomised trial involving 224 paediatric emergency department patients
comparing acetaminophen with ibuprophen with a combination of both drugs.
Wong, Anthony, Sibbald, Andres, Ferrero, Fernando, Plager, Mauricio, Santolaya, Maria Elena,
Escobar, Anna Maria, Campos, Sandra, Barragan, Sergio, Gonzalez, Maximiliano De Leon,
Kesselring, Gustavo L.F. (2001). Antipyretic effects of dipyrone versus ibuprofen versus
acetaminophen in children: Results of a multinational, randomized, modified double-blind
study. Clinical Pediatrics 40: 313-324.
628 children between 6 months and 6 years of age attending outpatient emergency clinics of
inpatient paediatric wards were the sample for this double-blind randomised trial comparing the
effectiveness of three antipyretic drugs.
Antipyretics – issues related to administration
Mayoral, Clara F., Marino, Ronald V., Rosenfeld, Warren, Greensher, Joseph (2000). Alternating
antipyretics: Is this an alternative. Pediatrics 105(5): 1009-1012.
A survey of 161 physicians about their management of fever in children, particularly the
temperature at which they initiated the use of antipyretics and how the drugs were administered.
Simon, Harold K., Weinkle, David A. (1997). Over-the-counter medications: Do parents give what
they intend to give? Archives of Pediatrics & Adolescent Medicine 151(7): 654-656.
A survey of 100 caregivers about their use of over-the-counter medicines using a scenario to
determine how much acetaminophen should be administered to their child.
Parental concerns
Crocetti, Michael, Moghebeli, Nooshi, Serwint, Janet (2001). Fever phobia revisited: Have parental
misconceptions about fever changed in 20 years? Pediatrics 107(6): 1241-1246.
A survey of 340 caregivers of children attending hospital-based paediatric clinics to determine their
concerns about fever, how they defined fever and their management of fever.
Van Stuijvenberg, M., de Vos, S., Tjiang, G.C.H., Steyerberg, E.W., Derksen-Lubsen, G., Moll,
H.A. (1999). Parents’ fear regarding fever and febrile seizures. Acta Paediatrica 88: 618-622.
A questionnaire asking 230 parents of children involved in a RCT of ibuprofen to prevent recurrent
febrile seizures about their concern about fever and how that affected their behaviour.
Knowledge and management of fever by parents, nurses, and paediatricians
Al-Eissa, Y.A., Al-Zamil, F.A., Al-Sanie, A.M., Al-Salloum, A.A., Al-Tuwaijri, H.M., Al-Abdali,
N.M., Al-Azzam, S.A. (2000). Home management of fever in children: Rational or ritual?
International Journal of Clinical Practice 54(3): 138-142.
560 randomly selected parents of children in hospital outpatient clinics and emergency departments
were interviewed about their knowledge of fever and its management.
Edwards, Helen E., Courtney, Mary D., Wilson, Jennifer, E., Monaghan, Sarah J., Walsh, Anne M.
(2003). Fever management audit: Australian nurses’ antipyretic usage. Pediatric Nursing
29(1): 31-37.
Edwards, Helen E., Courtney, Mary D., Wilson, Jennifer, E., Monaghan, Sarah J., Walsh, Anne M.
(2001). Fever management practices: What pediatric nurses say. Nursing and Health Sciences
3: 119-130.
Two articles based on an audit of fever management, such as time and timing of recording
temperature and administration of antipyretics and results of a focus group discussion of nurses’
practices in managing fever in a child hospitalised for a febrile medical illness.
McLario, David J., Simon, Harold K., Sullivan, Kevin M., Parmer, Elizabeth M. (1998). Impact of
changes in the Fever protocol on a nursing directed after-hours pediatric telephone advice
service. Ambulatory Child Health 3: 365-371.
A retrospective descriptive study of the impact of a new fever protocol used by a nursing telephone
advice service on referral rate for onsite evaluation.
Meremikwu, M, Oyo-Ita, A. (2003). Physical methods for treating fever in children (Cochrane
Review). In: The Cochrane Library, Issue 2, 2003. Oxford: Update Software.
An updated systematic review (7 RCT/quasi-randomised trials) evaluating the benefits and harms of
physical cooling methods for managing fever in children.
[The studies included in this systematic review were assessed for quality for the systematic review
conducted by the WA Centre for Evidence Based Nursing and Midwifery]
Sarrell, Michael, Cohen, Herman Avner, Kahan, Ernesto (2003). Physicians’, nurses’, and parents’
attitudes to and knowledge about fever in early childhood. Patient Education and Counseling
46(1): 61-65.
2059 questionnaires were completed by physicians, nurses and parents about fever in early
childhood.
Smith, Brendon (1999). Survey of management of fever without source in young children in
Australasian emergency departments. Emergency Medicine 11(3): 150-154.
23 directors of emergency departments were surveyed to describe their management of young
children with fever and to determine the extent to which published guidelines are followed.