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Educating caregivers about fever – what and why?

1,2 ✉
Damian Roland

© The Author(s) 2024

Pediatric Research (2024) 96:33–34; https://doi.org/10.1038/s41390-024-03134-2

Fever is a ubiquitous cause of presentation to Primary Care,

Emergency Departments and Acute Paediatric services all over the Table 1. Parental reported harmful effects of fever.
world. Fever is a primary indicator of infection and infection is Outcome of Schmitt (n = 81) Crocetti (n = 341)
a leading cause of death and morbidity in children. Why then is Concern 1980 [3] 2001 [4]
there a concept of fever phobia and such concern about the Brain Damage 45% 21%
negative effects it has on health seeking behaviour? And why is so
much energy used on improving parental education in how to Seizure 15% 32%
manage the child with a fever? Delirium 12% 1%
There are two related underlying principles here; the first that Death 8% 14%
1234567890();,:

fever in children is common but the negative consequences of No response 6% 9%

fever are rare. Numbers vary depending either on economic status
of the country, access to healthcare services and incidence of Coma 4% 2%
serious illness but infants may have an annual incidence of 5–7 Dehydration 4% 4%
episodes of fever. General Practitioners or Family Doctors being Blindness 3% 1%
consulted around 3.7 times per year specifically about fever.1 Really Sick 1% 2%
Fever episodes will largely be secondary to viral illnesses which
are self-limiting in nature and have no long term consequence for Other 14%
the child. In fact there is evidence fever is a positive attribute and
mortality, in admitted adult patients, is increased by regular know what the appropriate cut off is to be concerned about? This
prescription of antipyretics to reduce it.2 knowledge doesn’t form part of a curriculum during primary or
The second is concern about fever is disproportionate to its secondary school education and is probably only given to
outcome. Schmitt3 in 1980 highlighted the extreme reaction to fever parents by midwives and health visitors at the birth of the child,
some parents have. 20 years on work by Crosetti4 demonstrated a time period when information is easily forgotten. This latter
little had changed. (Table 1). There hasn’t been a formal replication fact is relevant to Lynch et al.’s study as they acknowledge the
of this work in the 2020 s but there is no reason to believe, given that subsequent recall of this information was not measured. How
fever remains the most common reason that children attend long a parent or carer may retain a given number is not clear.
Emergency Departments, that this has changed. Also, while to the study teams’ credit they produced information
Lynch et al.’s recent publication5 in Paediatric Research also in both written and audiovisual formats (an important factor
evidenced the need for continued education. Their very practical in safety netting6), how families would access this information
(and importantly reproducible) education programme demon- again and which resources they would turn to isn’t clear. Access
strated only 41% of caregivers attending a Children’s Emergency to information in the future depends on not losing the leaflet
Department could define what constituted a significant temperature you have been given or, if via the internet, the website address
(38 °C or 100.40F) in a child correctly. Their intervention of written not changing. Access is also dependant on not being subject to
and video material appeared successful with correct answers in 94% digital poverty or that the language the health information is
of the 48 caregivers in the post-intervention group. It also improved written in is your first language.
a number of secondary objectives such as myth-busting the need for One question that also hasn’t been answered is how much fever
tepid sponging and that antipyretics are always needed regardless education drives fever phobia itself. An adage in paediatrics is
of the child’s level of distress. “treat the child, not the fever”. Do families, apart from those in high
Those reading this paper may be struck by the low number of risk groups such as neonates and the immunosuppressed, even
caregivers appreciating what defines a fever in a medical context. need to own a thermometer at all? Does the ‘act’ of educating
However this may well be a little paternalistic. What constitutes a about a temperature boundary just re-inforce that there is such a
fever is subject to debate. In fact, even in the United Kingdom’s boundary to be concerned about? Ultimately is the positive
National Institute for Health and Social Care excellence (NICE) information (i.e. not needing to tepid sponge and the risk of
guidance on management of the Feverish Child, a specific serious illness being very low) negated by the fact that we as
temperature is only mentioned in the context of a risk assessment paediatricians still require to know when a child definitely has
for a less than six month old infant. Why would parents and carers a fever or not? If we think it’s important, why shouldn’t the

1
SAPPHIRE Group, Population Health Sciences, Leicester University, Leicester, UK. 2Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children’s Emergency
Department, Leicester Royal Infirmary, Leicester, UK. ✉email: [email protected]

Received: 28 January 2024 Accepted: 17 February 2024

Published online: 14 March 2024
 D. Roland
34
caregivers? And so when they do have a confirmed fever they are COMPETING INTERESTS
going to worry about it; regardless of how much reassurance they Prof. Roland is member of the Paediatric Emergency Research United Kingdom and
have been given that it’s probably not that important in the well Ireland (PERUKI) network with Prof. Barrett.
appearing child. Lynch et al. have shown how it is possible to
rapidly improve caregiver knowledge. The paediatric community
now have to determine what that knowledge should be. ADDITIONAL INFORMATION
Correspondence and requests for materials should be addressed to Damian Roland.

REFERENCES Reprints and permission information is available at http://www.nature.com/

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material in this article are included in the article’s Creative Commons licence, unless
https://doi.org/10.1038/s41390-024-03047-0.
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FUNDING
No funding was received for the production of this paper. © The Author(s) 2024

Pediatric Research (2024) 96:33 – 34