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Children's Hospital
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New Haven, CT
06510-3202
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July 6, 2000
News this month Controlling fever is a major issue for both parents and the health professionals who care for children. When a child gets a fever, worried parents commonly call the doctor’s office. They wonder whether the child should be seen and how best to treat the fever at home. Years ago, children’s aspirin was the drug of choice in reducing fever. When giving aspirin to children was linked with a dangerous condition called Reye’s syndrome, doctors began recommending acetaminophen (brand name Tylenol ® ). Until recently, it was the drug most commonly used to treat fever. Then a third drug, ibuprofen, marketed as Advil ® or Motrin ® , came on the market in pediatric strength, making the decision over which fever reducer to use more complicated. Alternating Tylenol and Advil to reduce fever has
confused parents and may even be dangerous.
Now, some doctors are suggesting that parents use both Tylenol and Advil to reduce fever, with a few recommending alternating the medications every dose. Understandably, this has led to confusion among parents and concerns among doctors that children will not receive the proper dose. This concern was highlighted in a study in the May issue of Pediatrics. Pediatric researchers from Winthrop University Hospital in New York found that indeed, alternating these medications is a common practice in some groups and can indeed be confusing and even dangerous. They cited instances where the practice may have led to overdoses of pain-relieving medications in children. What’s more, they found no evidence that this type of fever management benefited children. Finally, they noted the practice is not recommended by the American Academy of Pediatrics, a belief held by some pediatricians. When should fever be treated?
In all, 161 doctors returned the surveys, which showed that nearly two-thirds (61.9 %) of respondents began fever therapy at a temperature of 101 degrees F. A smaller figure, 13 percent, used patient discomfort as the guideline for when they recommended treatment. Researchers noted there is presently no scientific
evidence that this combination is safe or achieves faster fever relief
than using one of the products alone.
Which medication is best? The American Academy of Pediatrics position 
Physician Referral Online A free and confidential service Physician Referral Online Request an appointment 203-688-2000
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 Controlling fever in children More than almost any other common condition, fever causes great worry in parents. They look at their red-cheeked child and wonder if the fever itself can somehow harm their child or if it’s a sign that a more serious illness is present. Indeed, the majority of the calls to our practice are related to fevers in children. "In most cases, fever is not serious and if anything, it’s
a good sign the child’s body is working to fight off an illness."
One common myth is that the higher the fever, the worse the illness. Obviously, extremely high fevers over 104 degrees F call for action, but usually there is not much difference between a 100 degree fever and a 102 degree fever. In most cases, fever is not serious and, if anything, it’s a good sign that the child’s body is working to fight off an illness. Since many types of bacteria and viruses don’t like hot temperatures, fever is nature’s way of fending off disease. Of course, even knowing this, parents often wish to give their children some type of medication to lower the fever and make the child more comfortable, which is very understandable. So by and large, when we recommend the use of these medications, it is as a comfort measure. Parents often ask if they should wake their child to give them the medicine. We feel that letting the child sleep is the best thing to do and then give the medication when she or he wakes up. That also might be a good time to offer a drink of clear liquids like water to make sure the child stays well hydrated. "Any infant age three months or younger with a fever is immediately brought in for an exam."
When to call the doctor Deciding which medication to use "Avoid giving too much medication, which can be very dangerous."
To avoid overdosing, parents should write down when medication was given, especially for those doses given in the middle of the night or if there is more than one sick child in the house. You want to avoid giving too much medication, which can be very dangerous. When it comes to a child’s medication, more is not better. We suggest using Tylenol (acetaminophen) first because, when taken properly, it’s one of the safest medications available. Sadly, though, acetaminophen poisoning can and does happen and can lead to liver failure. It’s a leading reason why children undergo liver transplants. Confusing packaging, dosage information To help with dosing information, our practice includes a simple dosing
chart in the baby books we give out. It’s also reasonable to
call your local pharmacist for simple dosage questions. Dr. Germain is a pediatrician on the attending staff of Yale-New Haven Children’s Hospital and an assistant clinical professor of pediatrics at Yale University School of Medicine. |
