Childhood fever: Parental paracetamol administration after consulting out-of-hours general practice

An evaluation of parents' and caregivers' preferences managing fever in children based on experiences in using ibuprofen and paracetamol: A systematic review

OBJECTIVE

This review aims to investigate parents' preference for and use of Ibuprofen and Paracetamol in managing and treating children's fevers as well as the factors influencing their decision-making and practices.

INTRODUCTION

Parents globally face concern over managing children's fever, seeking relief while ensuring safety, often relying on accessible medications like Paracetamol and Ibuprofen.

INCLUSION CRITERIA

The review included quantitative studies involving parents and caregivers managing fever in children aged 0-17 years. Studies published in English or in other languages with an English language version from January 2000 to March 2024 were included, excluding hospital-based or healthcare professional-managed studies.

METHODS

Searches were conducted using MEDLINE, PubMed, SCOPUS, and CINAHL databases using specific search strategies. Titles and abstracts were screened online, and full reports were obtained for any publication considered useful for this overview. Methodological quality was assessed independently by two reviewers using the JBI critical appraisal instrument. Data extraction was performed in Excel, and statistical meta-analysis was undertaken using JBI SUMARI software.

RESULTS

Approximately 27.4 % of participants utilized Ibuprofen, while 64.3 % opted for Paracetamol. Subgroup analyses revealed that 29.8 % and 63.2 % administered Ibuprofen and Paracetamol to children under five. Additionally, 20.3 % alternated between these medications. Syrup emerged as the preferred mode of administration, with prominent parental involvement in dosage determination. Factors influencing medication choices included efficacy, safety profile, age, weight, ease of administration, and healthcare provider recommendations.

CONCLUSION

The prevalence of Ibuprofen and Paracetamol usage for pediatric fever management varies significantly. Parental involvement is prominent, guided by factors like efficacy and healthcare provider recommendations. Understanding these dynamics is crucial for informed decision-making and optimizing pediatric medication practices.

IMPLICATIONS TO PRACTICE

This review highlights the importance of enhancing parental education on antipyretic use, emphasizing safe dosage practices and clear communication with healthcare providers. Healthcare professionals should address misconceptions and provide tailored guidance, fostering more effective and safer fever management strategies for children.

Assessment of Paracetamol Usage Practices and Perceptions among Caregivers for Children Post-COVID-19 in Saudi Arabia: A Cross-Sectional Analysis

Caregivers often use paracetamol in the management of pediatric illnesses without a clear rationale. This study evaluated the perception and practices of caregivers regarding the use of paracetamol in children in Southwestern Saudi Arabia. This study involved a cross-sectional design involving 373 caregivers of children under twelve. The questionnaire elucidated the reasons, usage frequency, and safe usage practices. Data were analyzed using SPSS, applying Chi-square tests and logistic regression. Most caregivers were in the age range of 31-40 years, and with intermediate education. Paracetamol was mainly used for fever, generalized pain and, diarrhea, with fewer opting for other self-care measures. Caregivers with primary or less education were more likely to perceive paracetamol as safe (AOR = 2.98 (1.3-6.73), p = 0.009) and less inclined to check warning labels (AOR: 0.11 (0.05-0.25), p < 0.001) and expiry dates (AOR: 0.063 (0.027-0.14), p < 0.001). The caregiver's education level significantly influenced the determination of treatment duration (χ2 = 21.58 (4), p < 0.001), dosage (χ2 = 30.70 (4), p < 0.001), and frequency of administration (χ2 = 17.77 (4), p = 0.001). In conclusion, inadequate health literacy can result in a lack of attention towards crucial safety information about pediatric paracetamol use. Hence, counselling initiatives should be undertaken to ensure the safe and effective use of paracetamol in children.

Determining the fever-related knowledge and practices of mothers with children aged 1-5 years presenting to a child emergency service with fever complaints in Turkiye

PURPOSE

This study aimed to evaluate and determine the knowledge and practices of mothers with children aged between 1 and 5 years presenting to a pediatric emergency service with fever complaints regarding fever management.

DESIGN AND METHODS

This study was descriptive and correlational study was conducted between March and May 2019 with mothers over the age of 18 who brought their children aged 1-5 years to the XX State Hospital Pediatric Emergency Department with fever complaints. To evaluate the descriptive characteristics of the mothers and their practices when their children had a fever, data were collected with a questionnaire form consisting of 36 open-ended questions and the Parents' Fever Management Scale-Turkish Version (PFMS-TR). The data were analyzed using the SPSS 21 software with frequency, percentage, mean, standard deviation, min-max values, chi-squared, Cronbach's alpha, ANOVA, t-test, Kruskal- Wallis test, post hoc analysis with Bonferroni correction and correlation analysis, where p < 0.05, was considered statistically significant.

RESULTS

Of the mothers included in the study, 36.9% (n = 118) were between the ages of 33 and 39, 33.4% (n = 107) were graduates of higher education and 57.2% (n = 183) were homemakers. The mean number of people living at the homes of the participants was 4.26 ± 1.24 (min = 3, max = 8), the mean number of their children was 2.0 ±,97 (min = 1, max = 6), and the mean age of their children was 2.90 ± 1. 37 (min = 1, max = 5). The most common practices of the mothers when their children had fever were taking off their clothes and giving them antipyretic drugs. Moreover, the inappropriate practices of the mothers included rubbing the child with a vinegar and water mixture (11.9%) and cold application (8%). While 55.9% of the mothers were worried that the child would suffer post-fever convulsions 25.9% of them were worried that the child would suffer brain damage. A significant relationship was found between the mean scores of the mothers on PFMS-TR and their educational and economic statuses (p < 0.05).

CONCLUSIONS

Fears of fever are common in mothers, but their knowledge and practices about fever are inaccurate / incomplete.

PRACTICE IMPLICATIONS

Parents should be informed about fever with up-to-date information by nurses, and the appropriate attitude should be established on this issue. Efficient educational activities can reduce fears of mothers and prevent ill-advised practices.

Factors Affecting Parent’s Practice Regarding the Management of Children’s Fever

Background

Fever is a common cause of doctor visits among children. Fever and its effects are a source of anxiety for parents. There is a discrepancy between parents’ understanding and actual practice, which is influenced by a range of variables. This study aimed to assess the factors that influence parents’ practices and home behaviors when their children had a fever.

Methodology

A cross-sectional study was conducted among 384 randomly selected Saudi parents attending primary healthcare centers of Taif city from February to April 2022. Data were collected using a pretested, self-designed questionnaire (α= 0.760) developed by the researcher through interviews. The questionnaire included questions on socio-demographic characteristics, five items to assess parents’ knowledge, and 12 items to assess parents’ evidence-based practices regarding childhood fever, level of worry and concerns, and difficulties encountered during management.

Results

About 43% of parents did not know the harmful degree of fever and 77% had a misbelief that fever is a harmful phenomenon. Non-evidence-based practices included the use of over-the-counter medications (in 76.6% of our sample) and unnecessary visits to health services (in more than 50%). Only 12% reported good practices. Half of the parents obtain their information about fever from doctors and 31.3% from the internet. The majority of parents reported high worry levels. Multiple linear regression analysis revealed that the most important significant predictors of parents’ practices are level of worry, source of information, knowledge, and mothers’ education level.

Conclusions

This study identified the gaps where parents’ practices regarding fever need education. Parents reported high levels of worry about the febrile child, which, in turn, led to poor practices such as unnecessary health visits and overuse of antipyretics. The study emphasized the importance of the role of doctors as the main source of parents’ information regarding fever. Hence, good informative communication between doctors and parents will decrease their worry and promote the practices of parents.

Management of acute fever in children: Consensus recommendations for community and primary healthcare providers in sub-Saharan Africa

Fever is one of the most common reasons for unwell children presenting to pharmacists and primary healthcare practitioners. Currently there are no guidelines for assessment and management of fever specifically for community and primary healthcare workers in the sub-Saharan Africa region. This multidisciplinary consensus guide was developed to assist pharmacists and primary healthcare workers in sub-Saharan Africa to risk stratify and manage children who present with fever, decide when to refer, and how to advise parents and caregivers. Fever is defined as body temperature ≥ 37.5 °C and is a normal physiological response to illness that facilitates and accelerates recovery. Although it is often associated with self-limiting illness, it causes significant concern to both parents and attending healthcare workers. Clinical signs may be used by pharmacy staff and primary healthcare workers to determine level of distress and to distinguish between a child with fever who is at high risk of serious illness and who requires specific treatment, hospitalisation or specialist care, and those at low risk who could be managed conservatively at home. In children with warning signs, serious causes of fever that may need to be excluded include infections (including malaria), non-infective inflammatory conditions and malignancy. Simple febrile convulsions are not in themselves harmful, and are not necessarily indicative of serious infection. In the absence of illness requiring specific treatment, relief from distress is the primary indication for prescribing pharmacotherapy, and antipyretics should not be administered with the sole intention of reducing body temperature. Care must be taken not to overdose medications and clear instructions should be given to parents/caregivers on managing the child at home and when to seek further medical care.