Fever phobia: The impact of time and mortality – A systematic review and meta-analysis

Determination of the relationship between parents' health literacy and fever management of their children: A cross-sectional study

AIMS

The research was conducted to determine the practices of parents regarding the fever management of their children and reveal the relationship between their health literacy (HL) and fever management of their children.

DESIGN

Cross-sectional study was used.

METHODS

This study was carried out with 242 parents. The data were collected using the Parent Descriptive Information Form, Turkish HL Scale-32 and Parents' Fever Management Scale between September 2021 and September 2022. The data were evaluated with the SPSS program, using percentages, averages, Pearson's correlation and regression analysis.

RESULTS

The mean age of the parents was 31.87 ± 6.59. The parents' mean Parents' Fever Management Scale score was 36.22. It means that parents had high fever management practice. Their mean Turkish HL Scale-32 total score was 34.43. 51.6% of the parents had a problematic or insufficient HL level. In the cases of fever, 61.2% of the parents stated that they took off the child's clothes, 69.0% measured temperature from the armpit, and 55.4% gave antipyretics according to the doctor's prescription. There is a statistically significant positive correlation between the Parents' Fever Management Scale and Turkish HL Scale-32. It is observed that 8.2% of the change in parents' fever management is explained by HL.

CONCLUSION

The study found that with an increase in parents' HL, fever management of their children also increased.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Emerging evidence showed that developing parents' HL knowledge and skills could be an option/approach in fever management. It should be a basic nursing skill that to provide HL support to parents.

REPORTING METHOD

This study adhered to the relevant cross-sectional STROBE (the Strengthening the Reporting of Observational Studies in Epidemiology) guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Retrospective Analysis of Fever in Pediatric Age: Our Experience over the Last 5 Years

BACKGROUND

Fever is one of the most frequent symptoms highlighted during medical assistance. Due to this great impact, our study has the purpose of analyzing the demographic and laboratory characteristics of patients hospitalized in our center and identifying predictive markers to make the differential diagnosis between infectious and non-infectious fever.

METHODS

Our population included 220 children, collected from January 2017 to August 2022, hospitalized for continuous fever (4 days or more in duration with at least one temperature peak ≥37.5 °C) and excluded cases of discharge against medical advice and/or transfer to other operating units. Demographic (mean age at the time of admission, frequency of hospitalization, and mean days of hospitalization), laboratory, and instrumental variables were analyzed in order to find correlation with fever etiology.

RESULTS

Older age at the time of hospitalization, family history of periodic fever, fever lasting more than 8 days, and longer hospitalization are strongly associated with non-infectious fever, together with anemia, high platelet count, high CRP and ferritin, and hyponatremia at the time of admission. Paracetamol is the preferred antipyretic treatment. Echocardiogram has shown anomalies in patients with infectious fever, while ECG anomalies were detected in non-infectious fever.

CONCLUSIONS

Our data underline the importance of predictive markers, such as clinical and laboratory parameters, to differentiate infectious from non-infectious fevers, but further studies are necessary.

Fever education for caregivers in the emergency room (The FEVER study)-an interventional trial

BACKGROUND

Despite the vast majority of fevers representing benign self-limiting illnesses, caregiver anxiety regarding fever is high. Empowering caregivers with knowledge to safely and appropriately manage fever at home has the potential to reduce demands upon healthcare services.

AIM

To improve caregiver knowledge about fever and its management in children via an educational intervention.

METHODS

Caregivers of children over 6 months presenting with fever to a Paediatric Emergency Department were recruited. A pre-intervention survey was completed to ascertain caregiver knowledge about fever and its management. The intervention of (i) an infographic about fever, with (ii) a short video on fever was viewed. A post-intervention survey re-assessed knowledge. The primary outcome was the correct definition of fever as a temperature ≥38 °C.

RESULTS

Caregivers (n = 51) who correctly defined fever increased from 41% (n = 21) pre-intervention to 94% (n = 48) post-intervention. There was a reduction in common misconceptions about fever, including a higher fever representing a more serious infection (76% vs. 8%). Caregivers reported they were less likely to seek emergency healthcare due to the height and nature of the fever alone.

CONCLUSIONS

A simple brief educational intervention can rapidly increase caregiver knowledge about fever in children. There is a continuing need for clear, easily-accessible information for caregivers on this topic.

IMPACT

Parental knowledge about fever and how to manage it in their children is low. A simple brief educational intervention can significantly increase caregiver knowledge about fever. A combined written and audiovisual approach is effective and well-received by parents. Educating caregivers has the potential to improve the management of childhood fever at home and to reduce the burden on healthcare services, as well as reduce unpleasant hospital visits for children and their caregivers.

Parental knowledge, attitudes, and practices towards childhood fever among South-East and East Asian parents: A literature review

AIM

The aim of this literature review was to identify, summarize, and critically appraise available empirical articles on the knowledge, attitudes, and practices towards childhood fever management among South-East and East Asian parents.

DESIGN

A literature review following PRISMA.

METHODS

Articles were limited to those available in the English language. Articles had to be empirical studies that used a qualitative or quantitative research design with full-text available; focus on parental knowledge, attitudes, and practices towards fever; and be published in South-East and East Asia. Searches were conducted with CINAHL, PubMed and Scopus from inception to June 2022, and eleven articles were included after removing duplicates and excluding irrelevant articles.

RESULTS

Narrative synthesis was conducted according to four themes: source of fever information, knowledge level, attitudes, and practices towards childhood fever. Parents showed different fever knowledge needs and various information-seeking behaviors. A low level of fever knowledge was revealed in terms of temperature, fever causes, potential harms and influencing factors. South-East and East Asian parents mainly reported anxiety, concerns and fever phobia. Fever assessment methods and fever management strategies varied based on parents' cultural background and beliefs.

CONCLUSIONS

The findings of this review highlight that inadequacy of fever knowledge and negative attitudes towards childhood fever exist in South-East and East Asian parents. Parents have diverse cultural practices during their children's febrile episodes. However, some of them conflict with current medical guidelines, as they prioritize fever and body temperature reduction. This raises questions about their effectiveness and safety. Although some of them are medically discouraged, there are others that have been proven beneficial for the symptomatic relief of childhood fever. The results indicate an urgent need to develop a cultural-sensitive educational intervention for childhood fever management among South-East and East Asian parents. Unified educational interventions are needed to address parental concerns and fever-related knowledge needs.

Childhood fever and medical students: A multicentre, educational intervention

AIM

Misconceptions and non-evidence-based practices toward childhood fever are reported worldwide. Medical students might be ideal candidates to introduce long-lasting changes in clinical practice. However, no study has gauged the effectiveness of an educational intervention to improve fever management in this population. We conducted an educational, interventional study on childhood fever among final-year medical students.

METHODS

We conducted a prospective, multicentre interventional study employing a pre/post-test design. Participants from three Italian Universities filled in a questionnaire just before the intervention (T0), immediately after (T1) and 6 months later (T2) in 2022. The intervention was a two-hour lecture focused on the pathophysiology of fever, recommendations for its treatment and risks associated with improper management.

RESULTS

188 final-year medical students (median age of 26 years, 67% females) were enrolled. Relevant improvements in the criterion for treating fever and conceptions about the beneficial effects of fever were observed at T1 and T2. Similar data were found for the reduction of physical methods advice to decrease body temperature and concerns for brain damage from fever.

CONCLUSION

This study shows for the first time that an educational intervention is effective in changing students' conceptions and attitudes toward fever both in the short and medium term.

Approach to fever in children among final-year nursing students: a multicenter survey

BACKGROUND

Unfounded concerns regarding fever are increasingly observed among nurses worldwide. However, no study has so far explored the preferred approach towards pediatric fever among nursing students. Therefore, we aimed to investigate the attitude towards pediatric fever among final-year nursing students.

METHODS

Between February and June 2022, final-year nursing students of 5 Italian university hospitals were asked to answer an online survey on their approach to fever in children. Both quantitative and qualitative methods were utilized. Multiple regression models were employed to explore the existence of moderators on fever conceptions.

RESULTS

The survey was filled in by 121 nursing students (response rate 50%). Although most students (98%) do not consider discomfort to treat fever in children, only a minority would administer a second dose of the same antipyretic in nonresponsive cases (5.8%) or would alternate antipyretic drugs (13%). Most students would use physical methods to decrease fever (84%) and do not think that fever has mainly beneficial effects in children (72%). The own know-how adequacy on fever was inversely associated (OR 0.33, 95% CI 0.13-0.81) with the beliefs that high fever might lead to brain damage. No further predictive variable was significantly associated with the concern that fever might be associated with brain damage, the advice of physical methods use, and the assumption that fever has mostly positive effects.

DISCUSSION

This study shows for the first time that misconceptions and inappropriate attitudes towards fever in children are common among final-year nursing students. Nursing students could potentially be ideal candidates for improving fever management within clinical practice and amongst caregivers.

A Cross Sectional Study to Identify Traumatic Stress, Medical Phobia and Non-Adherence to Medical Care among Very Young Pediatric Patients

After a traumatic medical event, such as surgery or hospitalization, a child may develop a phobia of medical care, sometimes preventing future medical adherence and impairing recovery. This study examined the correlation of Pediatric Medical Traumatic Stress (PMTS) on the development of Medical Phobia (MP) and subsequent treatment adherence. We enrolled 152 parents of children aged 1-6 hospitalized in a surgical ward. During hospitalization, parents completed questionnaires that identified post-traumatic stress symptoms. Four months post hospitalization, parents completed questionnaires on post-traumatic stress, medical phobia, psychosocial variables and medical adherence. We found a positive correlation between PMTS and MP and low adherence to medical treatment. In addition, MP mediated the relationship between PMTS severity and adherence, indicating that PMTS severity is associated with stronger medical phobia, and lower pediatric adherence to medical treatment. Our findings suggest that medical phobia serves as an essential component of PMTS. It is important to add medical phobia to medical stress syndrome definition. In addition, as MP and PMTS are involved in the rehabilitation and recovery process and subsequent success, it is an important aspect of treatment adherence.

Perception, knowledge and attitude towards childhood fever: A survey among final-year medical students

AIMS

Undue concerns about the consequences of fever and its inappropriate management have been documented worldwide among physicians. However, no data exist on medical students. We investigated the perception, knowledge and attitude towards childhood fever among final-year medical students.

METHODS

Between June and September 2021, final-year medical students of six Italian universities were invited to complete an online survey on their conceptions and attitude towards pharmacological and non-pharmacological management of childhood fever. History of relevant personal or second-hand experience with childhood fever was also addressed. Both quantitative and qualitative approaches were used.

RESULTS

Of 1095 (69%) final-year medical students, 756 completed the survey. Many students believe that high fever might cause brain damage, would recommend physical methods and alternate two drugs for fever. Most students do not think that fever has mainly beneficial effects. In Northern Italy, students are less likely to believe that fever might lead to brain damage (OR 0.55, 95% CI 0.33-0.94), and in Southern Italy students are more likely to advise physical methods (OR 1.77, 95% CI 1.22-2.57) and less likely to believe that fever has mainly beneficial effects (OR 0.55, 95% CI 0.39-0.77). History of a relevant personal episode of fever during childhood was not associated with these outcomes.

CONCLUSIONS

Misconceptions about fever are common among final-year medical students in Italy. Cultural factors rather than individually learned traits might underlie these beliefs. Medical students are a promising target for educational interventions to improve childhood fever management.

Determining the fever-related knowledge and practices of mothers with children aged 1-5 years presenting to a child emergency service with fever complaints in Turkiye

PURPOSE

This study aimed to evaluate and determine the knowledge and practices of mothers with children aged between 1 and 5 years presenting to a pediatric emergency service with fever complaints regarding fever management.

DESIGN AND METHODS

This study was descriptive and correlational study was conducted between March and May 2019 with mothers over the age of 18 who brought their children aged 1-5 years to the XX State Hospital Pediatric Emergency Department with fever complaints. To evaluate the descriptive characteristics of the mothers and their practices when their children had a fever, data were collected with a questionnaire form consisting of 36 open-ended questions and the Parents' Fever Management Scale-Turkish Version (PFMS-TR). The data were analyzed using the SPSS 21 software with frequency, percentage, mean, standard deviation, min-max values, chi-squared, Cronbach's alpha, ANOVA, t-test, Kruskal- Wallis test, post hoc analysis with Bonferroni correction and correlation analysis, where p < 0.05, was considered statistically significant.

RESULTS

Of the mothers included in the study, 36.9% (n = 118) were between the ages of 33 and 39, 33.4% (n = 107) were graduates of higher education and 57.2% (n = 183) were homemakers. The mean number of people living at the homes of the participants was 4.26 ± 1.24 (min = 3, max = 8), the mean number of their children was 2.0 ±,97 (min = 1, max = 6), and the mean age of their children was 2.90 ± 1. 37 (min = 1, max = 5). The most common practices of the mothers when their children had fever were taking off their clothes and giving them antipyretic drugs. Moreover, the inappropriate practices of the mothers included rubbing the child with a vinegar and water mixture (11.9%) and cold application (8%). While 55.9% of the mothers were worried that the child would suffer post-fever convulsions 25.9% of them were worried that the child would suffer brain damage. A significant relationship was found between the mean scores of the mothers on PFMS-TR and their educational and economic statuses (p < 0.05).

CONCLUSIONS

Fears of fever are common in mothers, but their knowledge and practices about fever are inaccurate / incomplete.

PRACTICE IMPLICATIONS

Parents should be informed about fever with up-to-date information by nurses, and the appropriate attitude should be established on this issue. Efficient educational activities can reduce fears of mothers and prevent ill-advised practices.

Parental Confidence in Relation to Antipyretic Use, Warning Signs, Symptoms and Well-Being in Fever Management-Results from an App-Based Registry

Parents' confidence regarding their children's fever is a key factor in its management and there is still unnecessary anxiety and associated antipyretic overuse. The FeverApp application collects naturalistic real-time data on febrile infections and educates parents on fever management. Logistic regression examined the associations between (1) parental confidence and (2) antipyretics use with fever relevant parameters. First entry data of 3721 children (mean age 21 months; SD 22.97) was assessed. A total of 58.0% of parents felt confident upon first fever documentation. Warning signs [OR = 0.49, 95% CI: 0.40-0.61], dehydration [OR = 0.65, 95% CI: 0.52-0.81], fever [OR = 0.67, 95% CI: 0.57-0.80] and having a female child [OR = 0.77, 95% CI: 0.66-0.90] had the highest negative association with parental confidence. Antipyretics were used initially in 14.7% of children. Fever had the highest positive [OR = 2.58, 95% CI: 1.89-3.50] and well-being the highest negative association with antipyretic use [OR = 0.37, 95% CI: 0.22-0.63). In the first entry data, parental confidence was related to children's health condition in a reasonable medical manner. The use of antipyretics was mostly associated with febrile temperature, but also low well-being. Thus, associations were partly in accordance with recent guidelines.

Fever among preschool-aged children: a cross-sectional study assessing Lebanese parents' knowledge, attitudes and practices regarding paediatric fever assessment and management

OBJECTIVES

This study investigated parental knowledge, attitudes and practices towards fever in preschool children to help address gaps in public health and provide information with the aim of supporting clinical reports for parental education.

DESIGN

A cross-sectional study design was used to explore parental experiences with fever.

SETTING

Participants were recruited randomly from schools all over Lebanon targeting the preschool divisions.

PARTICIPANTS

Parents of children aged 5 years or less.

INTERVENTIONS

An electronic self-administered questionnaire was sent to the parents through the schools' emails and e-learning mobile applications.

PRIMARY AND SECONDARY OUTCOMES

The primary outcome measure was to assess parental knowledge about the precise definition of fever, correct use of medications and to evaluate the impact of sociodemographic factors on this knowledge. The secondary outcome measures were to assess parental attitudes and practices of fever management, sources of information and reasons to seek primary medical attention.

RESULTS

A total of 733 parents were included in the study. Only 44% identified fever correctly according to the recognised definition by international guidelines. A significant association between parents' knowledge of antibiotics and years of parenting experience was found (adjusted OR, ORa=4.23, 95% CI 1.41 to 12.68, p=0.01). Other sociodemographic factors that were significantly associated with parents' knowledge of antibiotics were age (ORa=3.42, 95% CI 1.09 to 10.73, p=0.036) and education level (ORa=7.99, 95% CI 3.71 to 17.23, p<0.001). Greater than 75% usually give their children antipyretics without consulting a doctor. Approximately one-quarter of parents (26.3%) consulted different doctors at the same time, of which more than half (58.4%) had received different medical information.

CONCLUSIONS

This research determines deficiencies in parents' knowledge of fever with some malpractices in its management particularly regarding antipyretic use. It provides insight for healthcare providers to empower parental experiences by offering the necessary information to enhance general outcomes of febrile sickness.

Recent advances in wearable medical diagnostic sensors and new therapeutic dosage forms for fever in children

Fever in children is one of the most common symptoms of pediatric diseases and the most common complaint in pediatric clinics, especially in the emergency department. Diseases such as pneumonia, sepsis, and meningitis are leading causes of death in children, and the early manifestations of these diseases are accompanied by fever symptoms. Accurate diagnosis and real-time monitoring of the status of febrile children, rapid and effective identification of the cause, and treatment can have a positive impact on relieving their symptoms and improving their quality of life. In recent years, wearable diagnostic sensors have attracted special attention for their high flexibility, real-time monitoring, and sensitivity. Temperature sensors and heart rate sensors have provided new advances in detecting children's body temperature and heart rate. Furthermore, some novel formulations have also received wide attention for addressing bottlenecks in medication administration for febrile children, such as difficulty in swallowing and inaccurate dosing. In this context, the present review provides recent advances of novel wearable medical sensor devices for diagnosing fever. Moreover, the application progress of innovative dosage forms of classical antipyretic drugs for children is presented. Finally, challenges and prospects of wearable sensor-based diagnostics and novel agent-based treatment of fever in children are discussed in brief.

Efficacy of Scenario Simulation-Based Education in Relieving Parental Anxiety about Fever in Children

PURPOSE

This study was designed to evaluate the short- and long-term effects of a scenario simulation-based education intervention on parental anxiety about fever in their children.

DESIGN AND METHODS

This experimental research was conducted using a two-group pretest-posttest design. One hundred and sixty parents of 3-month to 5-year-old children enrolled in preschools and kindergartens with childcare services were recruited as participants using cluster random sampling. The participants were divided randomly into an experimental group (80) and a control group (80). The former participated in a scenario simulation-based education intervention and received a fever education booklet. The latter received the booklet only. Data were collected using the Children's Fever Anxiety Inventory at three time points: before the intervention (pretest, T1) and at six-month (T2) and 12-month (T3) posttests.

RESULTS

Significant intergroup differences in fever anxiety were found at both T2 and T3 (p < .001). For both groups, the scores at T2 and T3 were significantly lower than at T1 (p < .001) and the difference between T2 and T3 did not attain statistical significance (p > .05). Although both groups experienced reduced fever anxiety over time, this reduction was significantly greater in the experimental group than in the control group (p < .001).

CONCLUSION

Simulation-based education may be used in conjunction with the traditional fever education booklet to further reduce parent fever anxiety over time.

PRACTICE IMPLICATIONS

This simulation-based education approach significantly and positively impacts parental anxiety about fever in their children. Furthermore, the approach may be generalizable to other childhood healthcare settings.

Symptomatic fever management in children: A systematic review of national and international guidelines

INTRODUCTION

Divergent attitudes towards fever have led to a high level of inconsistency in approaches to its management. In an attempt to overcome this, clinical practice guidelines (CPGs) for the symptomatic management of fever in children have been produced by several healthcare organizations. To date, a comprehensive assessment of the evidence level of the recommendations made in these CPGs has not been carried out.

METHODS

Searches were conducted on Pubmed, google scholar, pediatric society websites and guideline databases to locate CPGs from each country (with date coverage from January 1995 to September 2020). Rather than assessing overall guideline quality, the level of evidence for each recommendation was evaluated according to criteria of the Oxford Centre for Evidence-Based Medicine (OCEBM). A GRADE assessment was undertaken to assess the body of evidence related to a single question: the threshold for initiating antipyresis. Methods and results are reported according to the PRISMA statement.

RESULTS

74 guidelines were retrieved. Recommendations for antipyretic threshold, type and dose; ambient temperature; dress/covering; activity; fluids; nutrition; proctoclysis; external applications; complementary/herbal recommendations; media; and age-related treatment differences all varied widely. OCEBM evidence levels for most recommendations were low (Level 3-4) or indeterminable. The GRADE assessment revealed a very low level of evidence for a threshold for antipyresis.

CONCLUSION

There is no recommendation on which all guidelines agree, and many are inconsistent with the evidence-this is true even for recent guidelines. The threshold question is of fundamental importance and has not yet been answered. Guidelines for the most frequent intervention (antipyresis) remain problematic.

Randomised comparative trial of the efficacy of paracetamol syrup and dispersible tablets for the treatment of fever in children

Objective

Fever is the most common reason for the presentation of children in the outpatient department. Paracetamol is marketed in different formulations for ease of administration to the paediatric population. These include syrups, dispersible tablets and rectal inserts. Dispersible tablets disintegrate rapidly in liquid and are subsequently taken orally, providing another oral formulation. We determined if there is a difference in the antipyretic efficacy of the syrup and the dispersible formulation of paracetamol, thereby prompting the development of the latter (another oral formulation) for use in children.

Methods

A randomised, controlled, double-blind intervention of a single dose of both formulations was given to febrile children, and their temperatures were documented twice in 30-minute intervals. Temperature changes were compared statistically.

Results

The mean temperatures at recruitment were 38.2 ± 0.5°C and 38.3 ± 0.6°C for the dispersible and syrup group, respectively. There was no significant difference between the temperature changes at T2 (30 minutes) and T3 (60 minutes) between the two study arms. However, the temperature was significantly different at T1 (baseline), T2 and T3 within the dispersible and syrup groups.

Conclusion

The decreasing trend in temperature was similar in both groups. Both preparations produced statistically similar antipyretic effects with no reported adverse drug reaction.

Health Beliefs Regarding Medicine Use of Mothers Whose Children Are Hospitalized in a University Hospital and Knowledge and Practices of Mothers Towards Rational Use of Medicines in Their Children

Aim: This study was carried out to determine the health beliefs of mothers with children hospitalized at a university hospital regarding medicine use and their knowledge and practices towards rational use of medicines in the children. Methods: This is a descriptive and cross-sectional study. The study was conducted between 15 July and 15 October 2018 at the Karabük University Research and Training Hospital with 260 mothers. A Participant Information Form and the Drug Use Health Beliefs Scale were used as the data collection tools. Results: It was determined that only 10.8% (n=28) of the mothers had knowledge about rational use of medicines. The mothers’ Drug Use Health Beliefs Scale total mean score was 150.91 ± 15.13. 93.5% (n=243) of the mothers used antipyretics, whereas only 17.7% (n=43) of them used antipyretics recommended by a doctor. The mothers who read the package inserts of medicine had a significantly higher mean scale score than those who did not. Conclusion: The mothers had insufficient knowledge on rational use of medicines, but their health beliefs related to prescription medicine use were high. However, the mothers used antipyretic, analgesic, antibiotic and cough medicines in their children without consulting a doctor, whereas the majority of them used particularly antipyretics without a doctor’s recommendation. Keywords: rational use of medicines, Drug Use Health Beliefs Scale, children, mothers

Second opinions, multiple physician appointments, and overlapping prescriptions in the paediatric population: A systematic literature review

OBJECTIVES

Doctor shopping, double doctoring, and overlapping prescriptions are often used as synonyms for multiple physician appointments in the same disease episode. Such behaviours translate into poor patient satisfaction and patient-doctor communication as well as abuse or misuse of drugs, increasing health care costs and resulting in negative health consequences. This systematic review of the literature was conducted to identify factors that drive doctor-shopping behaviour in children's caregivers.

METHODS

The search was conducted in PubMed and grey literature and was based on the following search terms: included doctor or physician shopping, drug seeking, double doctoring, children, and combinations of those. Overall, 500 records were identified, of which 11 were selected for qualitative synthesis. Data extracted considered definitions of doctor shopping, co-morbidities, and target population characteristics.

RESULTS

Definitions of doctor shopping were inconsistent. The frequency of doctor shopping was high for acute illnesses and ranged from 53% in children with a fever in Hong Kong to 18% at an emergency department in Canada. The incidence of this phenomenon was low when taking into account addictive drugs and was rated at 0.02% to 0.3% in the full paediatric population. This phenomenon was more prevalent in children younger than 1 year, in children with attention-deficit hyperactivity disorder (ADHD) and co-morbid psychiatric conditions, and in those whose caregivers themselves had psychiatric conditions. It was more frequent in cases with an acute disease (eg, fever, gastroenteritis, and urinary tract infection) than a chronic disease (eg, asthma).

CONCLUSIONS

The knowledge about doctor shopping by children's caregivers is limited, despite that this is a frequent behaviour. There is a need for further research covering a broader range of diseases. The causes and consequences of doctor shopping should be sought as well to investigate its relation to health care regulations and possibility to reduce unnecessary medical resource utilization.

Parents' experiences and information needs related to childhood fever: A systematic review

OBJECTIVE

To synthesize current evidence about experiences and information needs of parents/caregivers managing pediatric fever.

METHODS

We used systematic review methodology with an a priori protocol. We searched Medline, Embase, PsycINFO, CINAHL and ProQuest Dissertations and Theses Global, from 2000 to May 2018.

RESULTS

We included thirty-six studies (n = 29 quantitative, n = 7 qualitative; 15,727 participants). Quantitative data contained four themes; 1) caregivers seek information about pediatric fever, 2) low knowledge is coupled with misconceptions and anxiety, 3) fever assessment and management practices vary, 4) demographic factors (e.g., ethnicity, age, socioeconomic status, education) influence information needs and health practices. Qualitative data contained three themes; 1) tension between logic and emotion, 2) responsibility contrasted with sense of vulnerability, 3) seeking support and information to build confidence.

CONCLUSION

Parents often overestimate the risks associated with pediatric fever and struggle to make decisions during a child's febrile illness - leading to caregiving actions that may not reflect current clinical recommendations. Parents seek knowledge about how to care for a febrile child at home and what indicators should prompt them to seek medical attention.

PRACTICE IMPLICATIONS

In addition to providing clear, reliable information, interventions that address educational, pragmatic, and emotional domains may be effective in supporting parents.

Fading confidence: A qualitative exploration of parents' experiences caring for a febrile child

AIMS AND OBJECTIVES

To explore parents' experiences with paediatric fever to understand their needs for information and support.

BACKGROUND

Paediatric fever is a normal part of childhood, and multiple episodes of fever are a common occurrence between infancy and adulthood. Despite this expectation, paediatric fever often sparks fear and anxiety amongst parents. Existing research has primarily focused on measuring parental deficits, so a more in-depth exploration is helpful to understand the complexities of caring for a febrile child.

DESIGN

Qualitative descriptive study.

METHODS

Purposive sampling of N = 15 parents from a paediatric emergency department presenting with a febrile child. Semi-structured interviews were conducted in-person or via telephone. Thematic analysis was used to understand the data in the light of our research question. Reporting follows the consolidated criteria for reporting qualitative research checklist.

RESULTS

We found themes of (a) parental confidence through caregiving tasks, (b) emergent feelings of inadequacy, (i) referrals and limitations of community practice, (c) information needs and (d) information sources. Whereas parents were initially confident accessing information, providing care, making decisions and managing symptoms, new signs/symptoms sparked a change in parents' emotions, coping and behaviour. Parents routinely search for information about paediatric fever and value reliable, accessible resources.

CONCLUSIONS

Our findings highlight parents' strengths assessing fever and effectively managing symptoms. We are encouraged by the potential for these results to inform the development of empowering resources to help parents make child health decisions during paediatric fever.

RELEVANCE TO CLINICAL PRACTICE

Findings provide an evidence base for researchers, clinicians and policymakers to improve care for paediatric patients and families. Parents want clear, reliable and accessible information about decision points associated with paediatric fever. Resources with an empowerment focus may help parents maintain a sense of control when caring for a febrile child.

Randomised controlled trial of an intervention to improve parental knowledge and management practices of fever

BACKGROUND

We know that parents require resources which can assist them to improve fever knowledge and management practices. The purpose of this study, using an RCT, was to examine the effectiveness of an information leaflet at increasing parental knowledge of fever, specifically temperature definition.

METHODS

A prospective, multi-centre, randomised, two-parallel arm, controlled trial with blinded outcome ascertainment was conducted. Parents presenting at purposively selected healthcare facilities who had a child aged ≤5 years of age were invited to participate. An information leaflet for use in the trial was designed based on previous studies with parents. Parents in the intervention arm read an information leaflet on fever and management of fever in children, completed a short questionnaire at Time 1 (T1) and again 2 weeks after randomisation at Time 2 (T2). Parents in the control arm did not receive the fever information leaflet but completed the same questionnaire as the intervention arm at T1 and againat T2. The primary outcome was the correct definition of fever (higher than ≥38 °C).

RESULTS

A total of 100 parents participated in the study at T1. A greater proportion of the intervention group (76%) than the control group (28%) selected the correct temperature (≥38 °C) at T1. 76% of the intervention arm correctly identified "higher than ≥38°C" as the temperature at which a fever is said to be present compared to 28% of the control arm. After 2 weeks, there was an increase of 6% of parents in the intervention arm (increase to 82.4%) who gave the correct temperature compared to just a 2.8% increase in the control arm (increase to 30.8%). Univariate logistic regression showed that parents in the intervention arm were significantly more likely to give the correct answer at both time-points (T1: OR 8.1; CI 95% 3.3-19.9: p < 0.01; T2: OR 10.5; CI 95% 3.4-32.0: p < 0.01).

CONCLUSIONS

Our RCT of this simple educational intervention has been shown to improve parental understanding of fever knowledge and correct management strategies. Education interventions providing simple, clear information is a key step to decreasing parental mismanagement of fever and febrile illness in children.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02903342, September 16, 2016, Retrospectively registered.

Emergency department presentations of febrile children to an Australian public hospital

AIM

We investigated the presentations of children with unspecified fever to an Australian emergency department (ED): (i) to determine the proportion of these presentations that could be classified as potentially avoidable and (ii) to identify factors associated with an increased risk of hospital admission.

METHODS

This study retrospectively identified and described children aged <6 years who presented to the Royal Hobart Hospital (Tasmania, Australia) ED with unspecified fever (ICD-10-AM code R50.9) between January 2013 and December 2015, using data from the ED information system and digital medical records. The Australian Institute of Health and Welfare method was used to estimate the number of potentially avoidable general practitioner-type presentations. Predictors of hospital admission were determined using multivariate logistic regression.

RESULTS

A total of 459 patients aged <6 years presented to the ED with a primary diagnosis description of unspecified fever. Of these, 30.7% were classed as potentially avoidable general practitioner-type presentations. Overall, 26.1% of presentations resulted in admission to hospital. Administration of intravenous fluids in the ED and a longer treat time were identified as significant predictors of a child with non-specific fever being admitted to hospital. Older age, administration of antipyretics in the ED and presentations triaged as semi-urgent and non-urgent significantly reduced the probability of admission.

CONCLUSIONS

To our knowledge, this is the first Australian study that has assessed the impact of unspecified childhood fever on an Australian ED. Further investigation of presentations classified as potentially avoidable is warranted to investigate whether these could be managed in the primary care setting.

Recognition and management of febrile convulsions in children

Febrile convulsions (FCs) are characterised by convulsions associated with fever in children aged between 6 months and 6 years. FCs are relatively common and affect 3-4% of children in western countries. This is the most common seizure disorder seen in children. The cause of febrile illness in FC is usually benign and most frequently due to acute viral infection. Convulsions secondary to an intracranial infection (e.g. meningitis, encephalitis) or from acute electrolyte imbalance should not be labelled as FCs. The diagnosis is based mainly on clinical history, and further investigations are generally unnecessary; management is largely symptomatic. Prolonged FC may need anticonvulsant medication to stop the seizure. Referral to paediatric neurologists may be considered in cases of complex or recurrent FC or in children where there is a pre-existing neurological disorder. One third of children with a first FC will develop a further FC during subsequent febrile illness; the likelihood increases in presence of other risk factors. This article outlines the presentation, management, investigations and prognosis for FC, and highlights how nurses in different clinical settings can provide education, support and counselling to help families return to normality after the event. An illustrative case study is also included to highlight the challenges faced by health professionals while managing children with this condition.

Symptomatic Management of Febrile Illnesses in Children: A Systematic Review and Meta-Analysis of Parents' Knowledge and Behaviors and Their Evolution Over Time

Recommendations to guide parents' symptomatic management of febrile illnesses in children have been published in many countries. The lack of systematic appraisal of parents' knowledge and behaviors and their evolution over time precludes an analysis of their impact and identification of targets for future educational messages. We systematically searched for studies published between 1980 and 2016 that reported a quantitative evaluation of knowledge and behaviors of >50 parents for managing fever in children. We used MEDLINE and tracked related articles, citations and co-authors personal files. Study selection and data extraction were independently performed by two reviewers. For each item of knowledge and behaviors, we calculated mean frequencies during the first and last quinquennials of the studied period and assessed temporal trends with inverse-variance weighted linear regression of frequencies over years. We observed substantial methodological heterogeneity among the 62 included articles (64 primary studies, 36,791 participants, 30 countries) that met inclusion criteria. Statistically significant changes over time were found in the use of rectal (98 to 4%) and axillary temperature measurement (1-19%), encouraging fluid intake (19-62%), and use of acetylsalicylic acid (60 to 1%). No statistically significant change was observed for the accurate definition of fever (38-55%), or the use of acetaminophen (91-92%) or ibuprofen (20-43%). Parents' knowledge and behaviors have changed over time but continue to show poor concordance with recommendations. Our study identified future targets for educational messages, including basic ones such as the definition of fever.

Análisis de los cuidados y los conocimientos parentales sobre la fiebre en la infancia

Objetivo

Describir los conocimientos y los cuidados parentales de la fiebre en niños menores de 2 años y relacionarlos con características sociodemográficas.

Diseño

Estudio descriptivo transversal de correlación multicéntrico.

Emplazamiento

Realizado en 5 equipos de atención primaria de Barcelona.

Participantes

Padres, madres o tutores legales de niños menores de 2 años que acuden para la administración de una vacuna incluida en el calendario sistemático. Participaron un total de 311 sujetos.

Mediciones principales

Las variables principales son 9 ítems de conocimientos y 8 de cuidados o manejo de la fiebre obtenidos con la adaptación del cuestionario de Chiappini et al. (2012).

Resultados

El 69,8% tienen un manejo/cuidado correcto de la fiebre. Un 3,9% acertaron todos los ítems de conocimientos. La puntuación de conocimientos es menor en personas sin estudios (p = 0,03), mayor en europeos y sudamericanos y menor en Asia y África (p < 0,001). El 100% de los pacientes crónicos tuvieron todos los ítems de cuidado/manejo correctos (p = 0,03). Se observa que la correlación entre las puntuaciones de conocimiento y manejo es positiva (rho = 0,15, p = 0,008).

Conclusiones

Se observan unos cuidados correctos de la fiebre a pesar de la falta de conocimientos. Una buena estrategia para fomentar el adecuado manejo del niño febril es dar información actualizada y adaptada a los padres, incidiendo en los grupos étnicos que parecen tener creencias inexactas sobre la fiebre.

La fiebre en el niño: una mirada reflexiva a las prácticas de cuidado

Objetivo: Realizar un análisis crítico-reflexivo de las prácticas rutinarias de los profesionales de enfermería y de los cuidadores familiares en el cuidado del niño con fiebre, a fin de incentivar un cuidado basado en evidencia científica que asegure el bienestar infantil.Síntesis de contenido: Se realizó una revisión bibliográfica de artículos científicos publicados entre los años 2007 y 2017, en las bases de datos ebscohost, ScienceDirect, medline, PubMed, cinahl, Web of Science y cuiden®, para lo cual se utilizaron los descriptores y sus combinaciones en español, portugués e inglés Fiebre; Cuidadores; Niño. Se elaboró un compendio de 45 artículos seleccionados y analizados que contenía las prácticas de cuidado con convergencias, divergencias y complementariedades.Los resultados se agruparon en los siguientes cinco temas: Concepción histórica de la fiebre; La fiebrefobia:una concepción en las actuales prácticas de cuidado; El baño de esponja:una práctica ancestral controvertida; El uso de antipiréticos: una rutina en contravía de la salud y la vidade los niños; La fiebre: en busca de una mirada desde su beneficio.Conclusiones: La concepción de la fiebre infantil centrada en el miedo y en el daño permanece. Las acciones de cuidado más comunes, como el baño de esponja y el uso/abuso de antipiréticos, son cuestionadas desde la evidencia científica, demostrando los efectos deletéreos que producen en la salud del niño. El cuidado del niño, después de una evaluación individualizada, deberá enfocarse en el confort, en un ambiente fresco y tranquilo y en el aumento de la ingesta de líquidos para evitar la deshidratación u otras complicaciones.

Parental knowledge, attitudes and beliefs on fever: a cross-sectional study in Ireland

OBJECTIVES

Fever is a common symptom of mostly benign illness in young children, yet concerning for parents. The aim of this study was to describe parental knowledge, attitudes and beliefs regarding fever in children aged ≤5 years of age.

DESIGN

A cross-sectional study using a previously validated questionnaire. Results were analysed using descriptive statistics and multivariable logistic regression.

SETTING

Purposively selected primary schools (n=8) in Cork, Ireland, using a paper-based questionnaire. Data were collected from a cross-sectional internet-based questionnaire with a convenience sample of parents via websites and web pages (n=10) previously identified in an interview study.

PARTICIPANTS

Parents with at least one child aged ≤5 years were invited to participate in the study.

MAIN OUTCOME MEASURES

Parental knowledge, attitudes and beliefs when managing fever in children.

RESULTS

One thousand one hundred and four parents contributed to this research (121 parents from schools and 983 parents through an online questionnaire). Almost two-thirds of parents (63.1%) identified temperatures at which they define fever that were either below or above the recognised definition of temperature (38°C). Nearly two of every three parents (64.6%) alternate between two fever-reducing medications when managing a child's fever. Among parents, years of parenting experience, age, sex, educational status or marital status did not predict being able to correctly identify a fever, neither did they predict if the parent alternated between fever-reducing medications.

CONCLUSIONS

Parental knowledge of fever and fever management was found to be deficient which concurs with existing literature. Parental experience and other sociodemographic factors were generally not helpful in identifying parents with high or low levels of knowledge. Resources to help parents when managing a febrile illness need to be introduced to help all parents provide effective care.

Childhood fever in well-child clinics: a focus group study among doctors and nurses

Background

Fever is common in children aged 0-4 years old and often leads to parental worries and in turn, high use of healthcare services. Educating parents may have beneficial effects on their sense of coping and fever management. Most parents receive information when their child is ill but it might be more desirable to educate parents in the setting of well-child clinics prior to their child becoming ill, in order to prepare parents for future illness management. This study aims to explore experiences of well-child clinic professionals when dealing with childhood fever and current practices of fever information provision to identify starting points for future interventions.

Methods

We held four focus group discussions based on naturalistic enquiry among 22 well-child clinic professionals. Data was analysed using the constant comparative technique.

Results

Well-child clinic professionals regularly received questions from parents about childhood fever and felt that parental worries were the major driving factor behind these contacts. These worries were assumed to be driven by: (1) lack of knowledge (2) experiences with fever (3) educational level and size social network (4) inconsistencies in paracetamol administration advice among healthcare professionals. Well-child clinic professionals perceive current information provision as limited and stated a need for improvement. For example, information should be consistent, easy to find and understand.

Conclusions

Fever-related questions are common in well-child care and professionals perceive that most of the workload is driven by parental worries. The focus group discussions revealed a desire to optimise the current limited information provision for childhood fever. Future interventions aimed at improving information provision for fever in well-child clinics should consider parental level of knowledge, experience, educational level and social network and inconsistencies among healthcare providers. Future fever information provision should focus on improving fever management and practical skills.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1488-1) contains supplementary material, which is available to authorized users.