Treat kids' discomfort, not fevers: Pediatricians

NEW YORK (Reuters Health) - Don't immediately reach for the medicine cabinet when your little one's forehead feels warm, according to a new report from the American Academy of Pediatrics (AAP) that says fevers alone are not a cause for intervention.

"The focus should be on comfort and not on absolute temperature," Dr. Janice Sullivan, the lead author of the report, told Reuters Health.

That's because fever can be help fight illness, by slowing down the reproduction of bacteria and viruses or stimulating the body's immune response.

"That's a benefit of fever," Sullivan said, "and may shorten the time that your child remains ill."

The guidelines on treating fever with over-the-counter medications, published in the latest issue of the journal Pediatrics, are the first the AAP has released.

The authors reviewed studies on the safety and efficacy of acetaminophen, marketed as Tylenol, and ibuprofen, marketed as Motrin and Advil.

Sullivan, a professor at the University of Louisville and head of the AAP's section on clinical pharmacology and therapeutics, said parents should recognize that fever is a sign that a child is ill, and they should take note of other symptoms - such as lethargy, pain or dehydration - to see if a call to the doctor is warranted.

"We discourage parents from waking their children to give them antipyretics (fever-reducing medications), because if their child is sleeping, there's no sign of discomfort," Sullivan said.

Yet one study cited in the report found that the vast majority of parents will wake their children to give them fever reducing medicine.

"A lot of families have fever phobia," Claire McCarthy, a pediatrician at Children's Hospital Boston, told Reuters Health. "What's really important is making the child feel comfortable."

McCarthy said the guidelines are useful in reiterating what pediatricians have been practicing for years. She is a member of the AAP, but was not involved in developing the guidelines.

When parents or doctors feel medicine is necessary, the guidelines recommend that they use children's formulas, not those made for adults.

Parents frequently give too much or not enough medication, Sullivan said. Her report stresses that dosing should be measured by weight, not age or height.

"I think that a lot of people don't realize how possibly dangerous acetaminophen can be," McCarthy said. Overdoses can cause harm to the liver.

Some studies have shown that alternating or combining the drugs may be more effective, but the report stops short of recommending that parents mix medications. There's not enough evidence to show it's safe, and the risk of overdosing a child is higher.

The guidelines also encourage parents not to give their children cough or cold medicine that includes acetaminophen or ibuprofen. Sullivan said parents often don't notice that these drugs are included in cough syrups, and end up giving their kids a double dose of fever reducer.

Last year, Johnson and Johnson, the maker of children's Tylenol, recalled massive amounts of its product over safety concerns. Sullivan said Tylenol and other children's fever reducers are safe, as long as parents give the correct dose.

The American Academy of Pediatrics is an organization of tens of thousands of pediatricians, and it publishes the journal Pediatrics.

SOURCE: bit.ly/ftFlRr Pediatrics, March 3, 2011.