Thermometer use among Mexican immigrant mothers in California

A Cross-Sectional Study on Subjective Fever Assessment in Children by Palpation: Are Fathers as Reliable as Mothers?

Background

Fever is common in pediatric patients. Often, parents rely solely on palpation when assessing their child's fever. The objective of the current study was to determine the accuracy of parents in detecting their child's fever by palpation.

Methods

A prospective cross-sectional study was conducted at the emergency department (ED) of a tertiary pediatric hospital. Infants and children, 0-4 years of age, presenting to the ED with both parents were included. Parents were separately asked if their child had a fever and, if so, were asked to assess the temperature by palpation. A nurse obtained the rectal temperature. The primary outcome measure was the accuracy of fathers and mothers in detecting fever.

Results

A total of 170 children with their parents were enrolled. The mean ages of the children, mothers, and fathers were 18.9 (SD 0.8) months, 31.1 (SD 6.4) years, and 33.7 (SD 6.9) years, respectively. No statistically significant difference was found between mothers and fathers in the ability to assess fever by palpation (OR 0.65, 95% CI 0.39,-1.08). Sensitivities for detecting fever by palpation for mothers and father were 86.4% and 88.2%, respectively (specificity among mothers: 54.2% and specificity among fathers: 43.1%). The overall negative and positive predictive values were 65.9% (95% CI 55%-75.7%) and 75.7% (95% CI 69.9%-80.8%), respectively.

Conclusions

Mothers and fathers do not differ in their ability to accurately assess their child's fever by palpation. The low positive and negative predictive values indicate that if temperature was not measured, physicians cannot rely on parents' reports.

Childhood asthma, air quality, and social suffering among Mexican Americans in California's San Joaquin Valley: "Nobody talks to us here"

Nearly one in five Mexican American children residing in California's San Joaquin Valley (the Valley) in 2007 had an asthma attack at some point in their life. Numerous epidemiological studies have suggested that compared with other ethnic groups and Latino subgroups residing in the United States, Mexican origin children have the lowest rates of pediatric asthma. Ethnographic research conducted in central California, however, suggests otherwise. Known for its agricultural produce, extreme poverty, and poor air quality, the Valley is a magnet for the Mexican immigrant farm worker population. We conducted an exploratory ethnographic study to examine health disparities, social suffering, and childhood asthma in the Valley. Many Valley residents believe that their children's health concerns are being ignored. Open-ended interviews uncovered a largely rural community suffering not only from the effects of childhood asthma but the inability to have their experiences taken seriously.

Knowledge and management of fever among Latino parents

Fever is a common childhood condition that is often misunderstood and incorrectly managed by parents. This study uses a questionnaire about fever administered to a convenience sample of Spanish-speaking-only parents bringing their child to a hospital-based urban pediatric clinic. The questionnaire elicits information about definition and cause of fever, concerns about fever, methods of temperature measurement, and treatment modalities used by the parents. Latino parents have numerous misconceptions about fever and its role in illness. Educational interventions should target fever definition, clarification of cause and potential harm of elevated temperatures, temperature monitoring, and safe treatment modalities. Owning a thermometer is strongly associated with correct knowledge of temperature values. Providing parents with a thermometer and educating them about its proper use may lead to an increase in appropriate monitoring and medical treatment of the febrile child.

Fever determination in young infants: prevalence and accuracy of parental palpation

OBJECTIVES

Pediatricians routinely advise parents to seek immediate medical attention if their young infant develops a fever. Many parents rely on palpation to assess their child's temperature. Our objective was to determine the prevalence and accuracy of parental palpation for fever in young infants.

METHODS

We enrolled a convenience sample of infants younger than 3 months presenting to a pediatric emergency department with any complaint. Parents answered questions regarding their usual fever determination practices and palpated their infants to assess for fever. Parental predictions were then compared with the standard rectal temperature obtained at triage.

RESULTS

Ninety-six infants were enrolled. Fifty-seven percent of parents reported palpation as a usual method of fever assessment, with 87% palpating for fever at least occasionally. Of the 78% of parents who owned a thermometer, nearly half used palpation regularly. As compared with the "gold standard" of rectal thermometry, parental palpation for fever had a sensitivity of 81%, specificity of 82%, positive predictive value of 59% and negative predictive value of 93%. After eliminating from analysis those infants whose parents had used a thermometer at home, we found a sensitivity of 67%, specificity of 84%, positive predictive value of 33%, and negative predictive value of 95%.

CONCLUSIONS

Many parents rely on palpation as a usual method of fever determination in young infants, including nearly half of those who own a thermometer. Parental palpation overestimates the presence of fever, but is likely to be accurate when parents report that their baby is not febrile. As a sole method of determining fever, parental palpation is unreliable.

Childhood asthma on the northern Mexico border

Children with asthma living on the northern Mexico border suffer not only from the physical aspects of this condition, but also from the lack of a clear biomedical definition and treatment plan for the illness. An ethnographic study involving participant observation and focused interviews in Tijuana, Mexico, sought to understand the intersection of diagnostic uncertainties surrounding childhood asthma on the part of parents, particularly mothers, living in acute poverty. Environmental factors such as dust and insects in impoverished homes probably acted as asthma triggers among many of the children in the study. Furthermore, management of children's asthma took place not only in biomedical clinics, but also in homes, traditional medical settings, and pharmacies, where mothers often sought remedies for their children's asthma attacks on an emergency basis. In all treatment settings, including biomedical ones, they often faced significant barriers to effective care, including the misuse of antibiotics. Thus, the role of pharmaceutical sales clerks, as well as pediatric asthma specialists, is explored in this article.

Parents' beliefs and practices regarding childhood fever: a study of a multiethnic and socioeconomically diverse sample of parents

OBJECTIVE

To examine childhood fever beliefs and practices in a multiethnic, multiracial, and socioeconomically diverse sample.

DESIGN

Cross-sectional survey.

PARTICIPANTS

Parents of children attending a hospital clinic, neighborhood health center, and a private practice.

RESULTS

Two hundred seventy-four parents were interviewed; 45% were Latino; 15%, African-American; 25%, white; and 14%, other (excluded from further analysis, leaving a final sample size of 235). Latinos (11%) and African-Americans (7%) were more likely than whites (0%) to have no thermometers (P < 0.006). Only 42% of parents knew the correct temperature for fever. Greater proportions of Latinos (55%) and African-Americans (44%) take their child to the emergency department for fever than whites (21%; P < 0.001 and P = 0.02, respectively). Multivariate analyses revealed that parents who had not graduated from high school had 5 times the odds of not using a thermometer to check for fever and triple the odds of not asking a health care provider for fever advice, and parents of uninsured children were 5 times less likely to bring their febrile child to the emergency department. Low-income parents significantly more often used the emergency department and remedies other than antipyretics for their febrile children. Latino parents were more likely to believe that certain Latino folk illnesses cause fever, and African-American parents had triple the odds of not knowing the correct temperature for fever.

CONCLUSIONS

Parents' beliefs and practices regarding childhood fever vary by race, ethnicity, sociodemographics, and the child's insurance coverage. Educating parents about fever, improving access to health insurance and primary care, and ensuring that families have thermometers may enhance appropriate use of health services and improve outcomes for febrile children.

The importance of cultural and linguistic issues in the emergency care of children

BACKGROUND

Rapid growth in the diversity of the US population makes it increasingly likely that emergency clinicians will encounter greater numbers of patients from different cultures, but little is known about the importance of culture and language in the emergency care of children.

OBJECTIVE

To conduct a critical review and synthesis of published studies on culture and language in the emergency care of children.

METHODS

PubMed was used to perform a literature search (using 17 search terms) of all articles on culture, language, and the emergency care of children published in English or Spanish from 1966 to 1999.

RESULTS

More than 2000 citations initially were identified; consensus review yielded 400 papers that were photocopied. A final database of 117 articles revealed the following: certain normative cultural values, such as the Navajo hozhooji (the importance of thinking and speaking positively), can have profound effects on informed consent and discussions of medical risk. For limited English proficient children and their families, studies document that medical interpreters frequently are not used, there is a lack of trained interpreters, there are more access barriers, and those who need but do not get interpreters have poor understanding of their diagnosis and treatment. Numerous folk illnesses, such as among Latinos, can affect care, because symptoms often overlap with important biomedical conditions, the first clinical contact may be with folk healers, and certain folk remedies are harmful or even fatal. Certain parent beliefs and practices can result in serious morbidity and fatalities (from lead poisoning, liver failure, and other causes), costly or unnecessary medical evaluations (eg, Fenugreek teas), and clinical findings easily confused with child abuse (eg, coining). Biased provider attitudes and practices can have profound clinical consequences, including ethnic disparities in prescriptions, analgesia, test ordering, sexual history taking, asthma care quality, and diagnostic evaluations.

CONCLUSIONS

Failure to appreciate the importance of culture and language in pediatric emergencies can result in multiple adverse consequences, including difficulties with informed consent, miscommunication, inadequate understanding of diagnoses and treatment by families, dissatisfaction with care, preventable morbidity and mortality, unnecessary child abuse evaluations, lower quality of care, clinician bias, and ethnic disparities in prescriptions, analgesia, test ordering, and diagnostic evaluations.

Fever education: does it reduce parent fever anxiety?

OBJECTIVE

The aims of the study were to determine the following: 1) if a fever education program (interactive or written) reduces parent fever anxiety; 2) if an interactive fever program was more effective as a teaching style than standard written material alone; and 3) if a fever program increases parent fever home management and reduces return emergency department (ED) visits.

METHOD

A quasiexperimental, pretest and post-test pilot study examining parental fever anxiety was conducted at The Children's Hospital of Philadelphia. Eligible participants consisted of 87 parents and their children, aged 3 months to 5 years presenting with fever >38.4 degrees C, and without coexisting serious illness.

RESULTS

Both the interactive fever education program and the standard written fever pamphlet were equally effective as teaching methods. Data revealed a 30% reduction in fever anxiety rated as moderate-severe on arrival to none-low post-fever education, increased parent fever home management skills with correct use of thermometer and antipyretics, and reduced unnecessary return ED visits.

CONCLUSION

Parents in the acute and nonacute care setting may benefit from an interactive fever education program that includes the definition and benefit of fever, the correct use of a thermometer, fever home management skills, and appropriate fever telephone follow-up.