Physicians’, nurses’, and parents’ attitudes to and knowledge about fever in early childhood

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Abstract

This study investigated physicians’, nurses’ and parents’ approach to fever in early childhood. A total of 2059 questionnaires was completed by the three groups. Though most of the responders (59.8%) believed that fever is a helpful bodily mechanism of the body, there was a significant difference between physicians (85.8%) and nurses and parents (63.9 and 43.1%, respectively) (P<0.001). The majority of parents (62.7%) believed it necessary to treat children with low-grade fever (<38 °C) without any other sign of illness, whereas the physicians and nurses did not (10.8 and 30.2%, respectively). Regarding antipyretic medication, 92.3% of the physicians and 84% of the nurses would start treatment for a fever 38–40 °C, whereas 38.8% of parents would do so for a fever of 37–38 °C. Febrile seizure served as a reason for antipyretic treatment for 34.3% of the nurses and 20% of the parents, compared to 8.7% of the physicians. Finally, fear of brain damage due to fever was noted in almost twice as many nurses as physicians (11.8% versus 7.2%) and in three times as many parents (24.0%) as physicians. Parents and some nurses consider fever a risk factor for serious morbidity, mostly febrile convulsions and brain damage, even though these associations have long since been disproven.

Introduction

Fever is defined in the literature as the “state of elevated core temperature, which is often, but not necessarily, part of the defensive responses of multicellular organisms to the invasion of pathogenic or inanimate matter recognized as alien to the host” [1]. Fever is part of the body’s defensive response to infection. It helps curtail the replication of invasive microorganisms and enhances natural killer cell activity and killing of natural killer-resistant malignant cells [2], [3], [4]. Physiologically, the febrile response consists of a series of complex physiologic reactions, namely, a cytokine-mediated rise in core temperature, generation of acute phase reactants, and activation of numerous physiologic, endocrinologic and immunologic systems. The whole process is regulated by the rostal hypothalamic or “preoptic” region [5], [6], which receives and sends signals via a continuum of neural structures and connections extending from the hypothalamus and limbic system, through the lower brainstem and reticular formation, to the spinal cord and sympathetic ganglia [7].

Clinically, fever is defined as an increase in body temperature of 1 °C or more above the mean standard: a rectal temperature of 1 °C above 38.0 °C or an axillary temperature of 1 °C above 37.2 °C (99°F) [8] and indicates the need to put the child under observation.

Though fever was considered a protective response for thousands of years, and was even induced by physicians to combat certain infections, the advent of antipyretic drugs, has led to the common belief that fever is maladaptive and harmful [9], [10].

The risk-benefit ratio of fever has generated considerable controversy in recent years [11]. There are few available studies on contemporary parental knowledge and management of fever in children compared to medical personnel. Kramer et al. [12] reported that “… parents and physicians show fundamental value differences concerning diagnostic testing, diagnostic error, and short- and long-term morbidity. These differences have important implications for diagnostic decision-making in the young febrile child”. This report suggests that a better understanding of this issue may point up areas requiring improved education. With this purpose in mind, we designed the present study to investigate and compare the approach of physicians, nurses and parents to fever in early childhood.

Section snippets

Methods

The study population consisted of three groups: (A) 1000 parents of children attending pediatric community (urban) clinics of the major HMO in Israel which serves >60% of the population; (B) 1000 primary care physicians, pediatricians, general practitioners and family medicine specialists working for the three major HMOs in Israel; and (C) 500 nurses working in pediatric community centers and well-baby clinics, a major pediatric hospital, and hospital pediatric emergency rooms.

An analysis of

Results

A total of 2059 completed questionnaires were evaluated. Compliance rates were 64.6% for physicians (93 questionnaires to physicians were returned unopened because of a change of address) and 93.4% for nurses. Although none of the 1003 parents who received the questionnaire refused to fill it out (100% compliance) they missed some of the answers. The responses of the parents, physicians and nurses to the main study questions are compared in Table 1.

Low-grade fever was considered harmful by

Discussion and conclusion

To the best of our knowledge, this is the first comparison of the approach to fever in children between parents and medical personnel. Parental opinions on health-related issues are shaped by information provided by physicians and nurses [15], in addition to the media, family members, neighbors, friends, etc. Obviously, physicians and nurses obtain their knowledge mainly from more established sources, such as textbooks, journals, lectures, and the Internet. Nevertheless, they are not free of

Acknowledgements

We thank Dorit Karsh from the Department of Epidemiology and the Statistics Section of Information and Statistics at Kupat Holim Clalit for statistical analysis. We thank the Kupat Holim Clalit, Mr. Y. Nave, Dr. D. Simon and Dr. G. Noieman for giving their permission and helping with the research. Our thanks to the secretarial team Mrs. Nitza Mahazri, Galit Machpood and Zehava Shpringer, nurses Rivka Gal, Rachel Rashman and Pnina Shany for their help in the project. The authors also wish to

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