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Fever is a common symptom in children and probably the most common reason for a child to be taken to the doctor.1 It is a cause of anxiety for carers, bringing to the surface many fears, most of which are unfounded.2,–,5 The reaction of the health professional may reinforce these concerns, particularly if the nature of fever and its significance is not properly communicated and fever is managed as an illness rather than a symptom.3
Antipyretic use is widespread both in prehospital and hospital settings. When temperature reduction is seen as the end point, it is not surprising that various drugs and combinations of drugs have been used. The systematic review of studies comparing combined treatment of the commonly used antipyretics—paracetamol and ibuprofen—concludes that there is little benefit from a polypharmaceutical approach.6 It is also a reminder of how intensely research studies have pursued temperature reduction as the primary end point, perhaps at the expense of more important end points and of thinking of fever as a physiological response.
What is fever?
All forms of life have a range of preferred environmental temperatures and seem to have thermoregulatory mechanisms. As homeotherms, humans regulate and maintain core temperature within very narrow limits, despite much larger variations in ambient temperature.
Fever is not simply an elevated body temperature but a controlled elevation of body temperature above the normal range.7 8 The rise in body temperature results from an elevation of the hypothalamic …