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Why is the evidence not affecting the practice of fever management?
  1. A Sahib M El-Radhi
  1. Dr A Sahib Mehdi El-Radhi, Petts Wood, Orpington, Kent BR6 0SB, UK; sahib.el-radhi{at}hotmail.co.uk

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Fever is a very common complaint in children and is the single most common non-trauma-related reason for visits to the emergency department.1 Parents are concerned about fever and its potential complications, but what knowledge do they actually have about fever and its management at home? The biological value of fever (ie, whether it is beneficial or harmful) is disputed and fever is vigorously treated in the hope of lessening its complications. The practice of alternating two types of antipyretics has become widespread at home and on paediatric wards, but is this practice supported by evidence and does it result in complications? There is still a significant contrast between scientific evidence on the one hand and current concept and practice on the other. Why is that the case in such a common complaint as fever?

Fever is often considered by parents and doctors as a major and harmful sign of illness, almost as an illness in itself rather than a symptom. Parents worry when their child is feverish and feel that fever may spiral upwards with a possible fatal outcome. Fever phobia, an exaggerated fear of fever in their children, is common among parents.2 Parents have a limited understanding of fever and little or no information about its beneficial role in diseases.3 These parental concerns lead to the increased use of antipyretics and of health services. In addition, there is often a widespread perception among paediatricians that fever is dangerous. The majority (65%) of paediatricians in Massachusetts, USA believe that fever itself could be dangerous to a child with seizures, with death and brain damage being the most serious complications.4

Current practice considers the liberal use of antipyretics a necessity and demands measures to abolish even a low degree of fever.5 Antipyretics are parents’ preferred method …

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