Fever is one of the most common reasons that parents seek medical attention for their children. Parental concerns arise in part because of the belief that fever is a disease rather than a symptom or sign of illness. Twenty years ago, Barton Schmitt, MD, found that parents had numerous misconceptions about fever. These unrealistic concerns were termed “fever phobia.” More recent concerns for occult bacteremia in febrile children have led to more aggressive laboratory testing and treatment. Our objectives for this study were to explore current parental attitudes toward fever, to compare these attitudes with those described by Schmitt in 1980, and to determine whether recent, more aggressive laboratory testing and presumptive treatment for occult bacteremia is associated with increased parental concern regarding fever.
Between June and September 1999, a single research assistant administered a cross-sectional 29-item questionnaire to caregivers whose children were enrolled in 2 urban hospital-based pediatric clinics in Baltimore, Maryland. The questionnaire was administered before either health maintenance or acute care visits at both sites. Portions of the questionnaire were modeled after Schmitt's and elicited information about definition of fever, concerns about fever, and fever management. Additional information included home fever reduction techniques, frequency of temperature monitoring, and parental recall of past laboratory workup and treatment that these children had received during health care visits for fever.
A total of 340 caregivers were interviewed. Fifty-six percent of caregivers were very worried about the potential harm of fever in their children, 44% considered a temperature of 38.9°C (102°F) to be a “high” fever, and 7% thought that a temperature could rise to ≥43.4°C (≥110°F) if left untreated. Ninety-one percent of caregivers believed that a fever could cause harmful effects; 21% listed brain damage, and 14% listed death. Strikingly, 52% of caregivers said that they would check their child's temperature ≤1 hour when their child had a fever, 25% gave antipyretics for temperatures <37.8°C (<100°F), and 85% would awaken their child to give antipyretics. Fourteen percent of caregivers gave acetaminophen, and 44% gave ibuprofen at too frequent dosing intervals. Of the 73% of caregivers who said that they sponged their child to treat a fever, 24% sponged at temperatures ≤37.8°C (≤100°F); 18% used alcohol. Forty-six percent of caregivers listed doctors as their primary resource for information about fever. Caregivers who stated that they were very worried about fever were more likely in the past to have had a child who was evaluated for a fever, to have had blood work performed on their child during a febrile illness, and to have perceived their doctors to be very worried about fever. Compared with 20 years ago, more caregivers listed seizure as a potential harm of fever, woke their children and checked temperatures more often during febrile illnesses, and gave antipyretics or initiated sponging more frequently for possible normal temperatures.
Fever phobia persists. Pediatric health care providers have a unique opportunity to make an impact on parental understanding of fever and its role in illness. Future studies are needed to evaluate educational interventions and to identify the types of medical care practices that foster fever phobia.fever, fever phobia, child, children, antipyretics, sponging, health care practices.
Comments
Fever Phobia indeed
In searching for literature, to upgrade our knowledge base,I came across this article,just about the time I ended a call from a doctor concerned about his child's fever of 103F, with puffy eyes and a slight rhinorrhea. Child did not show toxic signs. The father was aggresively treating the fever with alternating doses of Tylenol and Motrin. He wanted to administer an antibiotic. Duration of sx < 30 hrs. Most of the fever phobia seems to be fostered by the medical community itself. Seems often times no explanation to the pt or pt's caregivers about the cause and purpose of fevers is given during a visit. It seems that there may be a lack of understanding about cause and effect of fevers amongst medical providers as well. We, as triage nurses, spend a lot of time educating pts and caregivers about fevers. I am often perplexed about the lack of knowledge amongst doctors and nurses regarding the need to support the body during illness ,in its effort to heal. Ellen Sweeney,RN
Response to Dr. Bratt's letter
Thanks to Dr. Bratt for his letter. Unfortunately, we do not know from this study what impact physician-directed or parent-directed practices have on fever phobia. Until we have the ability to easily detect children with a serious bacterial illness I suspect that a certain amount of laboratory testing will continue on children with fever and no source. The good news is that with the success of the HiB vaccine and the potential for the conjugate pneumococcal vaccine we may see a drastic decline in overall bacteremia and its sequella. Even if all of these things happen children will develop fever. Therefore, pediatric providers need to continue to educate their families on the proper management of fever and dispel the myths about the damaging effects of fever. Until this behavior is pervasive fever phobia will persist.
Michael Crocetti, MD.
Seems to me that this statement taken from your article, "Caregivers who stated that they were very worried about fever were more likely in the past to have had a child who was evaluated for a fever, to have had blood work performed on their child during a febrile illness, and to have perceived their doctors to be very worried about fever", goes to the heart of the matter. How can we expect parents not to worry about fever when we ourselves cannot agree about what to do when a child has fever?
The Biggest Culprit of All
Probably the greatest single cause of parental "fever phobia" is advertisements, especially on TV. These commercials make all kinds of vague and obscure statements meant to mislead the public.
For example, they will things like "for your peace of mind..." or "because you care enough..." or similar other meaningless things. The obvious unstated goal of these statements is to make parents think that anti-pyretics will save their children's lives. Therefore, if you are a good parent who deeply loves their children, you almost can't help but to have "fever phobia".
Lastly, I don't mean to let doctors off the hook and blame everything on television. Pediatricians need to communicate better to their patients about the real risks and benefits of fever. When doctors just tell parents to give anti-pyretics when the fever goes above a certain level, say 101F, then many parents automatically assume that this is a "dangerous" fever and that the drugs will help prevent harm.
In reality, the main purpose of anti-pyretics are really to provide a little comfort. If doctors were more clear to their patients about this, there would be a lot less "fever phobia" around.