PHYSICIANS' APPREHENSIONS IN MANAGING A FEBRILE CHILD
Abstract
Â
 Objectives: Fever in children under the age of 5 years can be a diagnostic challenge for pediatricians and primary care physicians since it is often complicated to recognize the rationale. In this study, we intend to ascertain their understanding, attitudes and misapprehensions concerning fever in children.
Methods: This transversal study was conducted from March to August 2014 by adopting a pre-validated questionnaire. The study population comprised of physicians working in different public and private sector hospitals and clinics of Karachi. Descriptive statistics was employed to acquire the response of respondents to questionnaire items. Kruskal-Wallis H test was executed to evaluate the association of gender, position, experience and institution of physicians with their responses.
Results: The response rate for filling the questionnaire was 71%. More than 97% considered fever risky for a child, 92.25% considered that neurological disorders, seizures and fatality are problems associated with fever. More than 95% opined that when the fever increases then the possibility of febrile convulsions increases. High fever was considered as a sign of severe bacterial infection by majority (90.14%) of participants. Many (79%) opined that the body temperature of above 38°C must absolutely be treated in spite of the causal pathology. Majority of the physicians recommended physical methods such as baths (90.14%), cold application, (82.39%) and rubbing the body with alcohol (28.87%) to be utilized in reducing fever.
Conclusion: The study revealed that there were misapprehensions about fever and its associated problems. This demands the execution of educational intervention employing international guiding principles concerning the appropriate management of the febrile child.
Keywords: Fever, Physicians, Febrile child, Pakistan.
Downloads
References
Group WB. World Development Indicators 2012. Washington, DC: World Bank Publications; 2012.
Khan MS, Hussain I, Kazmi NR, Majid A, Javaid A. Morbidity and mortality in children in rural community of district Peshawar. Gomal J Med Sci 2004;7(1):31-4.
Walsh A, Edwards H, Fraser J. Influences on parents’ fever management: Beliefs, experiences and information sources. J Clin Nurs 2007;16(12):2331-40.
Chiappini E, Parretti A, Becherucci P, Pierattelli M, Bonsignori F, Galli L, et al. Parental and medical knowledge and management of fever in Italian pre-school children. BMC Pediatr 2012;12:97.
Demir F, Sekreter O. Knowledge, attitudes and misconceptions of primary care physicians regarding fever in children: A cross sectional study. Ital J Pediatr 2012;38:40.
Karwowska A, Nijssen-Jordan C, Johnson D, Davies HD. Parental and health care provider understanding of childhood fever: A Canadian perspective. CJEM 2002;4(6):394-400.
Walsh A, Edwards H, Fraser J. Attitudes and subjective norms: Determinants of parents’ intentions to reduce childhood fever with medications. Health Educ Res 2009;24(3):531-45.
Chiappini E, Principi N, Longhi R, Tovo PA, Becherucci P, Bonsignori F, et al. Management of fever in children: Summary of the Italian pediatric society guidelines. Clin Ther 2009;31(8):1826-43.
Sermet-Gaudelus I, Chadelat I, Lenoir G. Body temperature measurement in daily practice. Arch Pediatr 2005;12(8):1292-300.
El-Radhi AS. Why is the evidence not affecting the practice of fever management? Arch Dis Child 2008;93(11):918-20.
Meremikwu M, Oyo-Ita A. Physical methods for treating fever in children. Cochrane Database Syst Rev 2003;CD004264.
May A, Bauchner H. Fever phobia: The pediatrician’s contribution. Pediatrics 1992;90(6):851-4.
Finkelstein JA, Christiansen CL, Platt R. Fever in pediatric primary care: Occurrence, management, and outcomes. Pediatrics 2000;105:260-6.
Alpern ER, Alessandrini EA, Bell LM, Shaw KN, McGowan KL. Occult bacteremia from a pediatric emergency department: Current prevalence, time to detection, and outcome. Pediatrics 2000;106(3):505-11.
Stern RC. Pathophysiologic basis for symptomatic treatment of fever. Pediatrics 1977;59(1):92-8.
Adrogué HJ, Madias NE. Hyponatremia. N Engl J Med 2000;342(21):1581-9.
Al-Eissa YA, Al-Zaben AA, Al-Wakeel AS, Al-Alola SA, Al-Shaalan MA, Al-Amir AA, et al. Physician’s perceptions of fever in children. Facts and myths. Saudi Med J 2001;22(2):124-8.
Nijman RG, Oostenbrink R, Dons EM, Bouwhuis CB, Moll HA. Parental fever attitude and management: Influence of parental ethnicity and child’s age. Pediatr Emerg Care 2010;26(5):339-42.
Macknin ML, Piedmonte M, Jacobs J, Skibinski C. Symptoms associated with infant teething: A prospective study. Pediatrics 2000;105:747-52.
Baraff LJ, Schriger DL, Bass JW, Fleisher GR, Klein JO, McCracken GH Jr, et al. Management of the young febrile child. Commentary on practice guidelines. Pediatrics 1997;100(1):134-6.
Walsh AM. Parents’ Management of Childhood Fever. Brisbane: Queensland University of Technology; 2007.
Mackowiak PA. Diagnostic implications and clinical consequences of antipyretic therapy. Clin Infect Dis 2000;31 Suppl 5:S230-3.
Roth J, Rummel C, Harré EM, Voss T, Mütze J, Gerstberger R, et al. Is interleukin-6 the necessary pyrogenic cytokine? J Therm Biol 2004;29(7):383-9.
Richardson M, Lakhanpaul M, Guideline Development Group and the Technical Team. Assessment and initial management of feverish illness in children younger than 5 years: Summary of NICE guidance. BMJ 2007;334(7604):1163-4.
Hay AD, Costelloe C, Redmond NM, Montgomery AA, Fletcher M, Hollinghurst S, et al. Paracetamol plus ibuprofen for the treatment of fever in children (PITCH): Randomised controlled trial. BMJ 2008;337:a1302.
World Health Organization. Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals. Geneva: WHO; 2009.
Russell FM, Shann F, Curtis N, Mulholland K. Evidence on the use of paracetamol in febrile children. Bull World Health Organ 2003;81(5):367-72.
Schmitt BD. Fever phobia: Misconceptions of parents about fevers. Am J Dis Child 1980;134(2):176-81.
Sarrell M, Cohen HA, Kahan E. Physicians’, nurses’, and parents’ attitudes to and knowledge about fever in early childhood. Patient Educ Couns 2002;46(1):61-5.
Press S. Association of hyperpyrexia with serious disease in children. Clin Pediatr (Phila) 1994;33(1):19-25.
31. Ponvert C, Scheinmann P. Allergic and pseudoallergic reactions to
analgesics, antipyretics and non-steroidal anti-inflammatory drugs. Arch Pediatr 2007;14(5):507-12.
Gibb IA, Anderson BJ. Paracetamol (acetaminophen) pharmacodynamics: Interpreting the plasma concentration. Arch Dis Child 2008;93(3):241-7.
Scolnik D, Kozer E, Jacobson S, Diamond S, Young NL. Comparison of oral versus normal and high-dose rectal acetaminophen in the treatment of febrile children. Pediatrics 2002;110(3):553-6.
Bilenko N, Tessler H, Okbe R, Press J, Gorodischer R. Determinants of antipyretic misuse in children up to 5 years of age: A cross-sectional study. Clin Ther 2006;28(5):783-93.
Food and Drug Administration, HHS. Labeling for oral and rectal over-the-counter drug products containing aspirin and nonaspirin salicylates; Reye’s Syndrome warning. Final rule. Fed Regist 2003;68(74):18861-9.
Aronoff DM, Neilson EG. Antipyretics: Mechanisms of action and clinical use in fever suppression. Am J Med 2001;111(4):304-15.
Ipp M, Jaffe D. Physicians’ attitudes toward the diagnosis and management of fever in children 3 months to 2 years of age. Clin Pediatr (Phila) 1993;32(2):66-70.
Weiss J, Herskowitz L. House officer management of the febrile child. A survey. Clin Pediatr (Phila) 1983;22(11):766-9.
Published
How to Cite
Issue
Section
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.