Fever

Overview of Pediatric Fever Management

  • Event Announcement

    • 2025 Pediatric Virtual Symposium

    • Date: Live on October 10, 2025

    • Access: Through December 31, 2025

  • Speaker

    • Mary Jean Ohns, DNP, APRN, CPNP-AC/PC, CCRN

    • No disclosures noted

Objectives of the Presentation

  1. Identify common causes and associated conditions of fever in children

  2. Recognize concerning histories and physical examination findings associated with fever

  3. Describe effective anticipatory guidance strategies for parents in the management of fever including benefits of fever and common misconceptions

Case Study: Returning Fever

  • A case involved a 3-year-old male presented to the emergency department (ED) with a chief complaint (CC) of fever lasting 1 hour.

    • Temperature: 103℉, no medications given at home.

    • Immunization status: Up to date (UTD).

    • Symptoms: Child showed reluctance to drink, diagnosed with a viral illness.

    • Initial Treatment: Received a dose of Ibuprofen in the ED, subsequently took popsicle eagerly, and appeared playful.

    • Follow-up Challenge: Five hours later, the child returned to the ED due to the fever returning.

    • Key Learning: The mother believed that the administration of ibuprofen was a complete cure for fever.

Importance of Effective Communication

  • Empathetic Open-Ended Questions to Parents

    • “I know it can be stressful when your child has a fever. What are you most worried about right now?”

    • “Can you tell me what concerns you the most about the fever?”

    • “What scares you the most when your child has a fever?”

    • “What questions do you have?”

Historical Perspective on Treating Fevers

  • Ancient Greek Views: Fever considered beneficial.

  • Late 1800s Understanding: Fever viewed positively as a host response to combat infection until the advent of antipyretics changed this perspective.

  • Research Findings:

    • Original studies on fever benefits conducted in animals (Kluger, 1975) and in children with chicken pox (Doran et al., 1989) revealed lower itching and shorter scabbing time in untreated cases (p < 0.05).

    • Fever phobia – a term coined by Barton Schmitt in 1980, refers to an unrealistic fear of fever which led to many myths.

Fever as a Chief Complaint in the Emergency Departments

  • Data Source: National Hospital Ambulatory Medical Care Survey, 2022

  • Physiological Responses to Fever:

    • Heart rate increases by 10-15 bpm

    • Respiratory rate increases by 3-5 bpm per degree Celsius rise

    • Associated Symptoms: headache, shivering, muscle aches, cold extremities, tiredness, fussiness, poor appetite.

  • Impact of Fever: Fever increases metabolic demands on the body, leading to higher water requirements for hydration.

Differentiating Fever from Hyperthermia

  • Definitions:

    • Fever: Defined as having a body temperature of less than 41℃ (105.8℉) and regulated by the hypothalamus.

    • Hyperthermia: Occurs when the body temperature exceeds 41℃ (105.8℉) due to the loss of thermal control.

Causes of Fever

  • Fever is a physiological response and serves as a signal typically indicating the body’s fight against infections.

  • Infections: Viral infections account for approximately 10 times more cases in children than bacterial infections.

When Fever Is Present: Important Questions

  • Understanding the duration of the fever is crucial; for instance, a parent might say, "About an hour… I rushed her right here!"

  • Concept of Tincture of Time: Allowing time to assess any progression in symptoms can be beneficial in managing febrile illnesses effectively.

Role of Fever in Immune Response

  • Mechanism of Action:

    • Fever stimulates the immune system, enhancing the production of neutrophils and T-lymphocyte proliferation, making it harder for bacteria and viruses to thrive.

    • Reference: Kluger (1978) highlighted that fever is adaptive and physiologic for immune responses.

Common Fever Norms in Children

  • Viral Fever Characteristics:

    • Typically ranges between 101℉ and 104℉ (38.3℃ to 40℃).

    • Duration is usually 3-4 days; may extend to 5 days depending on the infection.

Fever Definition and Classification

  • Fever Threshold: Fever is defined as a body temperature greater than 100.4 ℉ (38 ℃)

  • Low-Grade Fever: Defined as ranging from 100.4 ℉ (37.8℃) to 102 ℉ (39℃).

Medication Dosage Guidelines

  • Acetaminophen dosing: 10-15 mg/kg/dose; up to 5 doses in 24 hours.

  • Ibuprofen dosing: 4-10 mg/kg every 6-8 hours (for children older than 6 months).

Goals of Treatment

  • Primary Goal: Ensuring comfort for the child rather than just normalizing temperature.

  • Treating fever can blunt the body's immune response, suggesting that some fever may be beneficial to recovery.

Evaluation of Immunization Status and Impact on Fever Management

  • The introduction of Hib vaccine in 1989 and pneumococcal vaccine in 2001 significantly changed the care approach and decreased severe bacterial infections.

    • At-risk groups: Infants prior to their first immunization and unimmunized children aged 3-24 months.

Evaluation and Management of Young Infants

  • Assessment of Febrile Infants (Ages 8-60 Days): Guidelines from AAP, 2021 outlines management strategies critical for this demographic.

Cases in Unimmunized Children

  • Unimmunized children often experience self-limited viral illnesses, although there remains a heightened risk for serious bacterial infections.

Importance of Vaccination Counseling

  • Engaging parents concerned about vaccines is vital. Effective communication approaches include:

    • Understanding parent values and motivations, clarifying misconceptions, and aligning vaccination schedules with parental comfort.

Addressing Health Literacy

  • The importance of redesigning health materials to better fit health literacy levels is emphasized, aiming to reduce disparities.

  • Statistics on Health Literacy: It is a stronger predictor of health outcomes than demographic factors such as age, race, or income.

Managing Fever Through Communication

  • Effective communication strategies can include short videos, handouts with visuals, teach-back methods, and the use of technology in education.

Practical Guidelines for Fever Management

  • Persistent fever may require an increased hydration strategy; recommendation is 1ml/kg for each degree over 100.4 F in addition to maintenance fluids.

Addressing Complex Cases

  • Recognizing serious concerns in prolonged fever cases:

    • Possible diagnoses include Kawasaki Disease, which necessitates immediate attention within the first 10 days to prevent serious cardiovascular implications.

Safety and Return to Emergency Department

  • Caregivers should return to the ED if the child:

    • Is under 3 months of age

    • Is immunocompromised or has complex medical needs.

Myths and Misconceptions about Fever

  • Dedication to addressing myths versus facts about fever to promote accurate understanding among caregivers.

Final Thoughts and Conclusion

  • Emphasis on the need for consistent messaging and education about fever management, reassuring parents that while it may be uncomfortable, fever is a beneficial response to infection.

  • Quote to Conclude: "The Soul Is Healed By Being With Children" - Dostoevsky

References

  • A comprehensive list of references including foundational texts in pediatric emergency care, guidelines from the American Academy of Pediatrics, and studies highlighting the evolving understanding of fevers in pediatrics.


My notes

Ask open ended questions to figure out what the parent is worried about. Ask = what are your questions instead of do you have any questions.


Fever sIp vaccines is a good sign and shows the vaccine is working.

Important to educate parents viral illnesses , can have fevers 4-5 days

Confirm temperature checked with thermometer , giving the correct dose, giving correct dose with syringe, and knowing the goal of the fever = comfort not decreasing to a normal fever.


Kaiser link to calculate sepsis in neonates.