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Fever is a common medical complaint in children; 20–40% of parents report feverish illness each year.1 In 1980, Schmitt used the term ‘fever phobia’ to describe parents’ misconceptions and anxiety about fever.2 We conducted a single-centre cross-sectional study at the Children's Assessment Unit (CAU) of the Children's Hospital for Wales, Cardiff. Over 3 weeks, a self-administered anonymous 23-item written semistructured questionnaire regarding beliefs, concerns and management of fever was distributed to a convenience sample of 78 parents/caregivers of children aged 0–10 years, attending with acute medical problems. This questionnaire had been validated in emergency department setting.3
We found that parents held strong beliefs about fever and had low thresholds for seeking medical advice or treating fever (figure 1). The risk of dehydration caused the most concern (78.2%; 95% CI 69.0% to 87.4%), with 87.2% of parents (95% CI 79.8% to 94.6%) appropriately giving their child more fluid during a febrile episode;1 65.4% of parents were concerned about seizures (95% CI 54.9% to 75.9%), and 29.5% (95% CI 19.4% to 39.6%) worried about brain damage, coma and/or death. Antipyretics such as paracetamol and ibuprofen were the most popular treatment used (94.9%; 95% CI 90.0% to 99.8%). Both drugs are advocated for childhood fever, but their concurrent or alternating use is not recommended.1 Despite this, combined use was common (51.3%), as were other non-evidence-based practices, such as cold-sponging and tepid-sponging (33.3% and 30.8%, respectively). Parents admitted using paracetamol and ibuprofen more frequently than recommended with 6.4% (95% CI 1.0% to 11.8%) and 42.3% (95% CI 31.3% to 53.3%), respectively, giving their child more than the recommended 4-hourly or 6-hourly, placing their children at risk of toxicity. Parents who had attended hospital previously with a febrile child (25.6%) answered ‘brain damage’, ‘coma’ and ‘death’ as consequences of fever more frequently than those who had not (40.0%; 95% CI 18.5% to 61.5% vs 25.9%; 95% CI 14.7% to 37.1%). These parents also used paracetamol and ibuprofen together more frequently (60.0%; 95% CI 38.5% to 81.5% vs 48.3%; 95% CI 35.4% to 61.2%). These findings suggest fever-related anxiety among this group may be associated with inappropriate management.
Medical staff are the most popular source of information and advice about fever, in our study (figure 2) (76.9%; 95% CI 67.6% to 86.2%) and others, and thus have a vital responsibility to reassure and educate parents about fever; the fact that parents remain anxious despite previous attendance suggests opportunities to address the fever phobia demonstrated here are being missed. Previous work from the Children's Hospital for Wales4 highlighting staff misconceptions, particularly regarding consequences and management of fever, suggests that health professionals may be contributing to parents’ fever phobia. As a cross-sectional survey, our study may have been subject to biases from convenience sampling and may not be representative of the population as a whole: anxious parents may simply be frequent attenders, or more likely to take part in surveys to voice concerns. However, it is imperative that parent and staff education about fever, aiming to reduce inappropriate hospital attendances for well children and improve home management, is implemented and assessed.
Footnotes
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Contributors ATR conceptualised and designed the study, collected and analysed the data, drafted the initial manuscript, and approved the final manuscript as submitted. CVEP supervised data collection, critically reviewed and revised the manuscript, and approved the final manuscript as submitted.
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Competing interests None.
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Ethics approval
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Provenance and peer review Not commissioned; externally peer reviewed.