Most parents are so concerned about treating and preventing any kind of fever in their children that the American Academy of Pediatrics has had to issue a clinical report titled “Fever and Antipyretic Use in Children”. An antipyretic is something that quells or reduces a fever. The Academy says it has issued the report to help specialists, such as pediatricians and primary care physicians (general practitioners) educate parents and families about fever and fever phobia.

The report appears in the latest issue of the journal Pediatrics.

A fever, also known as pyrexia, is an elevation of the body’s internal temperature to levels deemed to be above normal. Our average normal body temperature is approximately 98.6°F (37°C). Temperatures above 100.4°F (38°C) are usually considered to be febrile (feverish).

Our internal body temperature is determined by our thermoregulatory set-point. This set-point is raised when we respond to, for example, viral or bacterial infections. When this set-point goes up, a fever occurs and the body perceives itself to be colder than it should be (suffering from hypothermia). The body works towards meeting the new, higher set-point and fever symptoms emerge, including feeling cold, accelerated heart rate, stiffness and shivering.

It is natural to be concerned when somebody has a fever. However, they are rarely a reason for panic, unless they have persisted for more than a couple of days, or temperatures have risen severely.

Put simply, a fever is one of our body’s mechanisms that help us fight infection. Although a considerable number of parents give their children medications to reduce a fever, such as ibuprofen or acetaminophen, the report stresses that their main aim should be to make their children feel more comfortable. That is much more important than trying to eradicate the temperature at all costs.

Parents should concentrate on making sure the child is getting plenty of fluids, look out for signs and symptoms of serious illness, observe and regulate their activity, and focus on their well-being.

If the child is sleeping, parents should not wake them up to give them an antipyretic medication. It is important to store antipyretics away safely.

The dosage of any medication should be according to the child’s weight and age. If necessary, an accurate measuring device should be used every time.

Although there is some proof that alternating between acetaminophen and ibuprofen can be more effective in bringing the body temperature down, the AAP wonders how safe this method is for children and whether it makes them more comfortable. This method of treatment, known as combination therapy, has a higher risk of inaccurate dosing, the AAP adds.

The report states that many parents give antipyretics even when the fever is slight, or when the child’s temperature is normal as a preventive measure. There appears to be over-concern to maintain a “normal” body temperature, which may not be the best thing for the child at that time.

The authors wrote:

“There is no evidence that fever itself worsens the course of an illness or that it causes long-term neurologic complications.”

They add that according to current evidence, there is no significant difference in the efficacy and safety of acetaminophen and ibuprofen when caring for healthy children with fever.

The report calls on pediatricians to insist on simplified formulations, instructions and dosing devices, in order to protect patient safety.

“Clinical Report – Fever and Antipyretic Use in Children”
Janice E. Sullivan, MD, Henry C. Farrar, MD, the Section on Clinical Pharmacology and Therapeutics, and Committee on Drugs
PEDIATRICS (doi:10.1542/peds.2010-3852)

Written by Christian Nordqvist