A Survey About Fever Knowledge, Attitudes, and Practices Among Parents

The information seeking behaviors of caregivers in the management of childhood fever - A systematic literature review

INTRODUCTION

Parents' and caregivers' non-evidence-based childhood fever management 'fever phobic' practices have remained relatively stable over more than 34 years despite successful educational interventions. This systematic review aimed to assess the information seeking behavior of caregivers managing fever in their children, as well as to compile the fever management practices undertaken by caregivers by investigating underlying factors influencing them.

METHODS

The electronic databases Pubmed, CINAHL, Medline, and International Pharmaceutical Abstracts were searched using key terms including, fever, child, caregiver, and management. Studies were included if they were written in English, published between January 1980 and January 2021, explored generalized childhood fever management practices of caregivers, and factors which influence fever management. Data extracted included study year and design, location, dimensions of fever management explored (i.e., knowledge, beliefs, detection, and/or treatment of fever), factors influencing management, and information sources used by caregivers.

RESULTS

In total, 36 studies were eligible for inclusion in the study. Twenty-nine of the studies were designed as a cross-sectional survey, six studies were interviews and the remainder were pre-post studies. The review of studies found that parents and caregivers sourced childhood fever management information most commonly from friends and family or their own personal experiences, however, participants most commonly sourced doctors/general practitioners as their first line of information when required. Over the years, trends showed that doctors as well as the internet were more frequently being used as a first line source of information by caregivers.

CONCLUSIONS

Despite decades of research, education and development of evidence-based guidelines caregivers continue to exhibit 'fever phobia' when caring for febrile children. This is demonstrated by their continued use of non-evidence-based methods and increasing reliance on, and incorrect use of antipyretics, alternating antipyretics if fever is not sufficiently reduced or returns. There is an increasing need for the development of easy to access digital resources for caregiver as internet use is rising which mirrors best practice taught to professionals.

Advising parents when their child has a fever: a phenomenographic analysis of nurses' perceptions when working at a telephone helpline, at primary care or at a paediatric emergency department in Sweden

OBJECTIVES

To describe nurses' perceptions of advising parents when their child has a fever.

DESIGN/METHOD

Inductive, descriptive study with a qualitative, phenomenographic approach.

PARTICIPANTS AND SETTING

A purposive sampling was used. To be included, the 24 online interviewed nurses had to have experience advising parents of febrile children between birth and 5 years of age. They were recruited from three different parts of the healthcare system from four regions in the south of Sweden.

RESULTS

The nurses described advising parents when their child has a fever as four different kinds of balancing acts: balancing between the parents' story and objective assessment, balancing between listening and teaching, balancing between self-confidence and trust in the expert, and balancing between independence and having someone by one's side.

CONCLUSIONS

Giving advice to parents when their child has a fever is a process where the nurse needs to listen, assess and give advice based on the situation. This requires a correct assessment that depends on the parents' story. Creating a trusting relationship is perceived as necessary for parents to assimilate the advice that is provided. What dominates are the nurses' perceptions of the inner qualities required to achieve a balance in the process, for example, the importance of experience and security in their professional role, while it is also necessary to get support from colleagues.

Knowledge, attitudes, and practices toward over-the-counter antipyretics among fever patients: a cross-sectional study in the context of a policy change KAP of OTC antipyretics

Background

On January 8, 2023, a change in the control policy for COVID-19 was implemented in China, whereby patient self-management of fever typically entails the utilization of over-the-counter fever-reducing medications.

Objective

This study aimed to investigate the knowledge, attitudes, and practices (KAP) toward over-the-counter (OTC) antipyretics among fever patients.

Methods

This cross-sectional study was conducted between October 2022 and February 2023 at author's hospital in Wuhan, China, among fever patients on OTC antipyretics, using a self-administered questionnaire.

Results

A total of 481 valid questionnaires were collected, with the age of 36.05 ± 12.10 years, including 240 (49.90%) males, and 209 (43.45%) collected before policy change. The knowledge, attitudes, precautions for medication administration and decision-making practices scores were 6.86 ± 3.30 (possible range: 0-12), 16.67 ± 2.46 (possible range: 7-35), 29.98 ± 5.41 (possible range: 7-35) and 27.87 ± 1.28 (possible range: 8-40), respectively. The multivariable logistic regression analysis showed that knowledge (OR = 0.83, 95%CI: 0.81-0.92, p < 0.001) was independently associated with positive attitude. Knowledge (OR = 1.41, 95%CI: 1.28-1.56, p < 0.001), attitude (OR = 0.87, 95%CI: 0.79-0.95, p = 0.004), suburban (OR = 0.45, 95%CI: 0.23-0.88, p = 0.019) were independently associated with proactive precautions for medication administration practices. Knowledge (OR = 1.14, 95%CI: 1.07-1.22, p < 0.001), attitude (OR = 0.90, 95%CI: 0.82-0.98, p = 0.018), responding after policy change, 2023 (OR = 1.70, 95%CI: 1.10-2.63, p = 0.016) were independently associated with proactive decision making practices.

Conclusion

Fever patients had moderate knowledge, negative attitude, proactive precautions for medication administration practices, moderate decision-making practices. After the policy change, there was a significant increase in knowledge regarding medication administration precautions and decision-making.

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.

Associations between maternal reports of periconceptional fever from miscellaneous causes and structural birth defects

BACKGROUND

Associations between birth defects and fevers attributed to colds, influenza, and urinary tract infections (UTIs) have been observed in previous studies. Our aim was to study associations between birth defects and fevers attributed to other causes.

METHODS

We analyzed data from 34,862 participants in the National Birth Defects Prevention Study, a multistate case-control study of major structural birth defects. Using multivariable logistic regression, we assessed the association between maternal report of fever during early pregnancy due to causes other than colds, influenza, or UTI and 36 categories of birth defects.

RESULTS

Maternal reports of fever due to other causes were associated with significantly elevated odds ratios ranging from 1.93 to 10.60 for 8 of 36 birth defects, primarily involving the spine, limbs, and heart (spina bifida, intestinal atresia, intercalary limb deficiency, transverse limb deficiency, congenital heart defect with heterotaxy, tetralogy of Fallot, pulmonary atresia and atrial septal defect, not otherwise specified).

CONCLUSION

Our data suggests fever itself or other physiologic changes associated with many infections are associated with some birth defects. Women who are pregnant or planning to become pregnant may want to consider speaking with their healthcare provider about the best ways to avoid infections that may cause fever and for guidance on how to treat fevers during pregnancy.

Exploring Latino Perspectives in Childhood Fever: Beliefs, Practices, and Needs

INTRODUCTION

Latino parents have significant knowledge gaps and misconceptions about fever. In this study, we explored Latino beliefs and practices around fever and its impact on their care decisions.

METHODS

A qualitative-focused ethnography was conducted with 21 Latino parents. Semi-structured interviews were completed, and inductive thematic analysis was used to identify themes and subthemes.

RESULTS

Three major themes emerged: (a) the meaning of fever; (b) seeking guidance; and (c) navigating fever. Subthemes included: a sign of folk illness, a sign of infection, trust in health care providers, watchful waiting, and barriers and needs.

DISCUSSION

Latino parents have significant knowledge gaps about the role of fever in illness. They engage multiple systems of care but rarely share their fears with health care providers. Culturally-sensitive interventions incorporating traditional and biomedical approaches are needed. Findings can help inform future interventions targeting knowledge gaps in this population.

Paracetamol and Ibuprofen in the Treatment of Fever and Acute Mild-Moderate Pain in Children: Italian Experts' Consensus Statements

Fever and pain are challenging symptoms in children and adolescents and are common reasons for consultations in primary care and hospital. Paracetamol and ibuprofen are currently the only recommended drugs for treating fever in Italy, but the therapeutic approaches are discrepant in the different settings. In Italy, paracetamol and ibuprofen are the most prescribed analgesics for acute mild–moderate pain in children; however, their use is often inappropriate in that fever is over-treated and pain is under-treated. An Italian board of experts analyzed the motivations for the misalignment between daily practice and guidelines of fever and acute mild–moderate pain management of the territory and hospitals. The expert opinion consensus process underscored the appropriate use of paracetamol and ibuprofen according to clinical scenarios, patients’ profiles, and the safety features of the drugs. Although patients’ profiles can indicate different benefits from paracetamol or ibuprofen, critical issues of fever and acute mild–moderate pain management persist in primary care and hospitals. These expert opinion consensus statements can be an across-the-board tool to harmonize the routine practice between the territory and hospitals, especially under special conditions (at-risk for dehydration, coagulation disorder patients, etc.). It can also promote educational activity about fever and acute mild–moderate pain management to enhance the milestones already achieved by Italian pediatricians.

Development and Implementation of a Pediatric Nursing-Clinical Decision Support System for Hyperthermia: A Pre- and Post-test

This article describes the development process and application of the Pediatric Nursing-Clinical Decision Support System for Hyperthermia. Firstly, we formed the Pediatric Nursing-Knowledge Base for Hyperthermia, which combines publicly available clinical practice guidelines and nursing routines of hyperthermia management. Then, following the nursing process framework, the system was developed using clinical decision support technology. Finally, a pre- and post-test were adopted to examine the effectiveness, usability, and feasibility before (1st to 31st of August 2018) and after (1st to 31st of December 2019) using the system. Its effectiveness was examined by analysis of nursing records' quality, including completeness of nursing assessment, timeliness of nursing diagnosis, individualization of nursing interventions, and timeliness of nursing evaluation. Its usability and feasibility were assessed using the Clinical Nursing Information System Effectiveness Evaluation Scale. There was a significant difference between the two groups in effectiveness, usability, and feasibility. Although the system was developed specifically for our hospital workflow and processes, the Pediatric Nursing-Knowledge Base for Hyperthermia and workflow for hyperthermia management in this study can be used as a reference to other hospitals.

Molecular and cellular cues governing nanomaterial-mucosae interactions: from nanomedicine to nanotoxicology

Mucosal tissues constitute the largest interface between the body and the surrounding environment and they regulate the access of molecules, supramolecular structures, particulate matter, and pathogens into it. All mucosae are characterized by an outer mucus layer that protects the underlying cells from physicochemical, biological and mechanical insults, a mono-layered or stratified epithelium that forms tight junctions and controls the selective transport of solutes across it and associated lymphoid tissues that play a sentinel role. Mucus is a gel-like material comprised mainly of the glycoprotein mucin and water and it displays both hydrophilic and hydrophobic domains, a net negative charge, and high porosity and pore interconnectivity, providing an efficient barrier for the absorption of therapeutic agents. To prolong the residence time, absorption and bioavailability of a broad spectrum of active compounds upon mucosal administration, mucus-penetrating and mucoadhesive particles have been designed by tuning the chemical composition, the size, the density, and the surface properties. The benefits of utilizing nanomaterials that interact intimately with mucosae by different mechanisms in the nanomedicine field have been extensively reported. To ensure the safety of these nanosystems, their compatibility is evaluated in vitro and in vivo in preclinical and clinical trials. Conversely, there is a growing concern about the toxicity of nanomaterials dispersed in air and water effluents that unintentionally come into contact with the airways and the gastrointestinal tract. Thus, deep understanding of the key nanomaterial properties that govern the interplay with mucus and tissues is crucial for the rational design of more efficient drug delivery nanosystems (nanomedicine) and to anticipate the fate and side-effects of nanoparticulate matter upon acute or chronic exposure (nanotoxicology). This review initially overviews the complex structural features of mucosal tissues, including the structure of mucus, the epithelial barrier, the mucosal-associated lymphatic tissues and microbiota. Then, the most relevant investigations attempting to identify and validate the key particle features that govern nanomaterial-mucosa interactions and that are relevant in both nanomedicine and nanotoxicology are discussed in a holistic manner. Finally, the most popular experimental techniques and the incipient use of mathematical and computational models to characterize these interactions are described.