Specially developed for babies and children.

1.4 Management of fever

At the end of this session you will be able to:

1. Evaluate the options available to you to use in the management of fever and identify areas for improvement in your practice setting

In addition you will be able to:

2. Discuss and explain the key arguments for and against treating fever.
3. Implement appropriate non pharmacological measures of fever management
4. Identify the two most common antipyretic drugs

Should fever be treated?

Before considering the best treatment for fever, the concept of whether fever should be treated needs to be considered. There are arguments for and against treating fever. The traditional approach has been to use various measures (cooling, antipyretics) to ‘bring the child’s temperature down’; often resulting from a wish to protect the child from a potential febrile convulsion.

However, the routine use of antipyretics in the treatment of fever is increasingly being questioned. Browne et al (2001) highlight the concern “that the use of antipyretics may prolong viral shedding and, hence, viral illness in children” and they also identify key arguments in the ‘treat/don’t treat’ debate (see Table 3).

Table 3: Arguments for and against treating fever
Arguments for treating fever include:  Arguments against treating fever include:
1. Decreasing discomfort associated with fever often assists with settling an apprehensive home environment.

2. Preventing extreme temperature elevations from causing permanent damage to the CNS.

3. Decreasing, in theory, the likelihood of fever-related seizures in those who have a history of seizures. No study has actually demonstrated that treatment of fever decreases the incidence of febrile seizures. 		 1. The generally recognized view that most fever is short lasting and benign.

2. Situations where adverse drug side effects associated with the use of antipyretics outweigh the benefits of fever reduction.

3. Situations where reducing fever may obscure diagnostic or prognostic signs, as in neutropenic children who have recently received chemotherapy.

4. Recent information suggests that fever may protect the host.

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