Nurses’ management of fever in children: rituals or evidence-based practice?

  • Maureen R. Harrison
Chapter

Abstract

In most instances when children have had febrile convulsions, they are admitted to hospital (Morgan, 1991), and once admitted the patterns of their body temperature and other symptoms will be monitored and managed by medical and nursing staff in order to establish a cause for the convulsion. Febrile seizures are extremely distressing for parents (Addy, 1991; Balslev, 1991; Monsen et al., 1991), and management is often concerned with the prevention of a recurrence, which, if it should happen, is not necessarily harmful to the child (Hunter, 1973; Ellenberg and Nelson, 1980; Neville, 1991; Ross, 1991; Bethune et al., 1993). Management strategies often include pharmacological treatment of the fever using antipyretics such as paracetamol (acetaminophen) or ibuprofen. Among physicians and nurses, the rationale for this procedure appears to be that fever is deemed harmful and should be treated, because antipyretics are thought to provide comfort to a child and prevent febrile convulsions, and finally, because parents often expect to see some treatment administered, usually in the form of medication, for their child (ElRadhi and Carroll, 1994). Despite research findings that support the positive immunological and diagnostic role of fever (Hull, 1991; Kluger, 1995), and that argue against the use of antipyretics, ElRadhi and Carroll (1994) state that the reality in practice appears to be their continued liberal use.

Keywords

Febrile Seizure Febrile Convulsion Febrile Child Endogenous Pyrogen Thermoregulatory Centre 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Abbott P. and Sapsford R. (1998) Research Methods for Nurses and the Caring Professsions ( 2nd edn ), Buckingham, Open University Press.Google Scholar
  2. Addy D. P. (1991) What information and advice should be given to parents? Background paper, Research Unit of the Royal College of Physicians in association with British Paediatric Association.Google Scholar
  3. Agbolosu N. B., Cuevas L. E., Millingan P., Broadhead R. L., Brewster D. and Graham S. M. (1997) ‘Efficacy of tepid sponging versus paracetamol in reducing temperature in febrile children’, Annual Trop. Paediatrics (6AH) 17(3): 283–8.Google Scholar
  4. Anderson E. S., Peterson S. A. and Wailoo M. P. (1990) ‘Factors influencing the body temperature of 3–4 month-old infants at home during the day’, Archives of Disease in Childhood 65: 1308–10.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Atkins E. (1984) ‘Fever: the old and the new’, Journal of Infectious Diseases 149 (3): 339–48.CrossRefPubMedGoogle Scholar
  6. Balslev T. (1991) ‘Parental reactions to a child’s first febrile convulsion’, Acta Paed. Scand. 80: 466–9.CrossRefGoogle Scholar
  7. Bernheim H. A. and Kluger M. J. (1976) ‘Fever: effect of drug-induced antipyresis on survival’, Science 16 July (193): 237–9.CrossRefGoogle Scholar
  8. Bethune P., Gordon K., Dooley J., Camfield C. and Camfield P. (1993) ‘Which child will have a febrile seizure?’ American Journal of Diseases in Children 147: 35–9.Google Scholar
  9. Bonadio W. A., Bellomo T., Brady W. and Smith D. (1993) ‘Correlating changes in body temperature with infectious outcome in febrile children who receive acetaminophen’, Clinical Pediatrics 32 (6): 343–6.CrossRefPubMedGoogle Scholar
  10. Bowman W. C. and Rand M. J. (1980) Textbook of Pharmacology, Oxford, Blackwell.Google Scholar
  11. Carmichael L. E., Barnes F. D. and Percy D. H. (1969) ‘Temperature as a factor in resistance in young puppies’, Journal of Infectious Disease 120: 669–78.CrossRefGoogle Scholar
  12. Dinarello C. A., Bernheim H. A., Duff G. S. et al. (1984) ‘Mechanisms of fever induced by recombinant human interferon’, Journal of Clinical Investigation 94: 906–31.CrossRefGoogle Scholar
  13. Ellenburg J. H. and Nelson K. B. (1980) ‘Sample selection and the natural history of disease’, Journal of American Medical Association 243 (13): 1337–40.CrossRefGoogle Scholar
  14. El-Radhi A. S. and Banajeh S. (1989) ‘Effect of fever on reoccurence rate of febrile convulsions’, Archives of Disease in Childhood 64: 89–90.CrossRefGoogle Scholar
  15. El-Radhi A. S. and Carroll J. E. (1994) Fever in Paediatric Practice, Oxford, Blackwell.Google Scholar
  16. Eskerud J. R., Andrew M., Stromnes B. et al. (1993) ‘Pharmacy personnel and fever: a study on perception, selfcare and information to customers. General practitioners and fever: a study on perception, self care and advice to patients’, Pharmacy World and Science 15 (4): 156–64.CrossRefPubMedGoogle Scholar
  17. Goodman A., Gilman A. and Goodman L. S. (1980) The Pharmacological Basis of Therapeutics ( 6th edn ), New York, Macmillan.Google Scholar
  18. Guberman D. (1990) ‘Use of acetaminophen in the community’, Harefuah, 118 (1): 17–19.PubMedGoogle Scholar
  19. Haahr S. and Mogensen S. (1977) ‘Function of fever’, Lancet 2: 613.CrossRefPubMedGoogle Scholar
  20. Hanson D. F., Murphy P. A., Silicano R. and Shin H. S. (1983) ‘The effect of temperature on the activation of thymocytes by interleukins I and II’, Journal of Immunology 130: 216–21.Google Scholar
  21. Heron I., and Berg K. (1978) ‘The actions of interferons are potentiated at elevated temperature’, Nature 274: 508–510.CrossRefPubMedGoogle Scholar
  22. Hull D. (1991) How important is it to control fever? How is it best controlled? Does control of fever affect febrile convulsions? Background paper, Research Unit of the Royal College of Physicians in association with the British Paediatric Association.Google Scholar
  23. Hunter J. (1973) ‘Study of antipyretic therapy in current use’, Archives of Disease in Childhood 48: 313–15.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Ipp M. and Jaffe D. (1993) ‘Physician’s attitudes toward the diagnosis and management of fever in children 3 months to 2 years of age’, Clinical Pediatrics 32 (2): 66–70.CrossRefPubMedGoogle Scholar
  25. Kinmonth A. L., Fulton H. and Campbell M. J. (1992) ‘Management of feverish children at home’, British Medical Journal 305 (6682): 1134–6.CrossRefPubMedPubMedCentralGoogle Scholar
  26. Kluger M. J. (1991) ‘Fever: role of endogenous pyrogens and cryogens’, Physiology Reviews 71: 93–127.Google Scholar
  27. Kluger M. J. (1995) ‘The mechanism of fever’. In David T. J. (ed.) Recent Advances in Paediatrics London, Longman Group.Google Scholar
  28. Knudsen F. U. (1988) ‘Optimum management of febrile seizures in childhood’, Drugs 36: 111–120.CrossRefPubMedGoogle Scholar
  29. Kramer M. S., Naimark L. Leduc D. J. et al. (1985) Parental fever phobia and its correlates’, Paediatrics 75: 1110–13.Google Scholar
  30. Kramer M. S., Naimark L. E., Roberts-Brauer R., McDougall A. and Leduc D. G. (1991) ‘Risks and benefits of paracetamol antipyresis in young children with fever of presumed viral origin’, Lancet 337 (8741): 591–4.CrossRefPubMedGoogle Scholar
  31. Lewis H. M., Parry J. V., Parry R. et al. (1979) ‘Role of viruses in febrile convulsions’, Archives of Disease in Childhood 54: 869–76.CrossRefPubMedPubMedCentralGoogle Scholar
  32. McCance K. L. and Huether S. E. (1994) Pathophysiology: The Biologic Basis for Disease in Adults and Children, St Louis, Mosby Year Book.Google Scholar
  33. Monsen R. F., Graham W. M. and Snell G. F. (1991) ‘Febrile seizures: caring for the patients and their parents’, Post Graduate Medicine 90 (2): 217–23.CrossRefGoogle Scholar
  34. Morgan D. R. (1991) How are febrile convulsions best managed in general practice? Background paper, Research Unit of Royal College of Physicians in association with British Paediatric Association.Google Scholar
  35. Morley C. J., Hewson P. H., Thornton A. J. and Cole T. J. (1992) ‘Axillary and rectal temperature measurements in infants’, Archives of Disease in Childhood 67: 122–5.Google Scholar
  36. Needleman P. and Isakson P. C. (1998) ‘Selective inhibition of cyclo-oxygenase 2’, Science and Medicine Jan./Feb.: 26–35.Google Scholar
  37. Neville B. (1991) What do we mean by febrile convulsions? Background paper, Research Unit of Royal College of Physicians in association with British Paediatric Association.Google Scholar
  38. Ross E. M. (1991) What is the prognosis following a febrile convulsion? Background paper, Research Unit of Royal College of Physicians in association with British Paediatric Association.Google Scholar
  39. Rowsey P. J. (1997) ‘Pathophysiology of fever. 2: Relooking at cooling interventions’, Dimensions of Critical Care Nursing 16 (5): 251–6.CrossRefPubMedGoogle Scholar
  40. Rylance G. W. (1991) What do we know about the drugs which may be used in children with febrile convulsions? What are the potential toxic effects of the drugs? Background paper, Research Unit of the Royal College of Physicians in association with the British Paediatric Association.Google Scholar
  41. Sanz E. J., Bush P. J. and Garcia M. (1996) ‘Medicines at home: the contents of medicine cabinets in eight countries’. In Bush P., Trakas D., Sanz E. et al. (eds) Children, Medicines and Culture, New York, Haworth Press.Google Scholar
  42. Schmit B. D. (1985) ‘Fever phobia: misconception of parents about fevers’, American Journal of Disease in Children.Google Scholar
  43. Schnaiderman D., Lahat E., Sheefer T. and Aladjem M. (1993) ‘Antipyretic effectiveness of acetaminophen in febrile seizures: ongoing prophylaxis versus sporadic usage’, European Journal of Pediatrics 152: 747–9.CrossRefPubMedGoogle Scholar
  44. Smith C. M. and Reynard A. M. (1995) Essentials of Pharmacology. Philadelphia, W.B. Saunders, pp. 147–63.Google Scholar
  45. Uhari M., Rantala H., Vainionpaa L. and Kurttila R. (1995) ‘Effect of acetaminophen and of low intermittent doses of diazepam on prevention of recurrences of febrile seizures’, Journal of Pediatrics 126 (6): 991–5.CrossRefPubMedGoogle Scholar
  46. UKCC (1992) Standards for the Administration of Medicines, London, UKCC.Google Scholar
  47. Walson P. D., Galletta G., Chomilo F., Braden N. J., Sawyer L. A. and Scheinbaum M. L. (1992) ‘Comparison of multidose ibuprofen and acetaminophen therapy in febrile children’, American Journal of Diseases of Children, 146 (5): 626–32.PubMedGoogle Scholar
  48. Weinberg E. D. (1978) ‘Iron and infection’, Microbiology Reviews, 42: 45–66.Google Scholar
  49. Wilson J. T., Brown D., Bocchini J. A. and Kearns G. L. (1982) ‘Efficacy, disposition and pharmacodynamics of asprin, acetaminophen, and choline salicylate in young febrile children’, Therapeutic Drug Monitoring 4: 147–180.CrossRefPubMedGoogle Scholar
  50. Wilson J. T., Brown, R. D., Kearns G. L. et al. (1991) ‘Single-dose, placebo-controlled comparative study of ibuprofen and acetaminophen antipyresis in children’, Journal of Pediatrics 119 (5): 803–11.CrossRefPubMedGoogle Scholar

Copyright information

© The Editor(s) 2000

Authors and Affiliations

  • Maureen R. Harrison

There are no affiliations available

Personalised recommendations