Parents need better education to reduce drug overdoses in feverish children

More than 50 per cent of feverish children are given incorrect doses of medicine by parents and overdoses have almost trebled in the last two decades, according to a research review in the latest issue of the British-based Journal of Advanced Nursing.

Health professionals are also concerned about the increasing number of parents who give their children alternate doses of paracetamol and ibuprofen without leaving sufficient gaps between them.

“Our review found that overdosing with ibuprofen is now a particular concern, both in terms of dosage and frequency” says nurse researcher Anne Walsh from Queensland University of Technology in Australia.

“We also discovered that some parents are giving their children one fever-reducing drug and then trying another type within a few hours if the first one doesn’t have the desired result.”

The Australian research team reviewed more than 70 studies published worldwide since 1980 to see how parental attitudes and practices had changed when it came to treating common childhood fevers.

They found that:

• Latest figures show that the number of parents providing their children with overdoses has risen from 12 per cent in 1987 to 33 per cent. Meanwhile, correct doses have risen from a third to between 43 and 49 per cent.
• Many parents administer fever-reducing drugs in doses that are too low, too high or too frequent.
• Underdosing is more common in younger and low-weight children.
• Up to 27 per cent of parents alternate fever reducing drugs.

The researchers also discovered that parents consistently treat childhood fevers based on inaccurate temperature readings and suggest that they would be better off focussing on their child’s general well-being rather than just how hot they are.

“Parents knowledge about normal body temperature and what constitutes a feverish temperature is poor” adds Anne Walsh, from the University’s Institute of Health and Biomedical Innovation.

“They classify mild fever as high and actively reduce temperatures, sometime normal temperatures, with fever-reducing drugs such as paracetamol and ibuprofen.

“Overdoses have sharply increased over the last 20 years and recent studies have suggested that parents are giving children higher than recommended doses in about a third of cases.

“Other parents underdose their children and, when their temperature hasn’t reduced to a level they consider satisfactory, they seek professional assistance, placing burdens on already strained healthcare systems.”

Other key findings included:

• Today’s parents have similar worries to their 1980’s counterparts - including brain damage, febrile convulsions and death – regardless of how well educated they are or their socio-economic status. Attitudes to fever seem to be similar in all countries.
• The use of cold or iced water and aspirin to lower fever has reduced, especially after research showed links between Reye syndrome, a potentially fatal disease, and aspirin. But parents have increased their use of other fever-reducing drugs and often wake sleeping children to sponge them or give them medicine.
• Education programmes run for parents in various countries have helped them to handle fever more effectively and reduced unnecessary use of healthcare services.

“Caring for a feverish child is emotionally challenging for parents and the limited improvements in knowledge, attitudes and practices highlighted by our research point to the need for a closer examination of the subject” says Anne Walsh.

“It is also very important that parents receive advice and guidance from healthcare professionals before their child experiences his or her first feverish episode.

“Fever management education needs to highlight the benefits of mild fever and equip parents with the knowledge and skills they need to manage mild to moderate fevers.”

However the authors stress that although effective parental education will improve knowledge and reduce unnecessary concerns, parents shouldn’t hesitate to ask for professional advice if they are worried about a child’s fever.