Bitter pill… Reduding your child’s fever may actually slow their recovery
This winter, millions of parents will give children medicine to tackle a high temperature. But are we reaching for the paracetamol too quickly?
Some doctors and researchers now believe that parents – and many doctors – are ‘fever phobic’, over-anxious about children’s fevers and treating them too readily.
They point out that even official National Institute for Health and Clinical Excellence (NICE) guidelines say children should not be given medicine simply to tackle a fever.
And reducing a fever may slow recovery time, they say, because the temperature can help to kill the bacteria causing the illness.
Researchers at Great Ormond Street Hospital for Children found that, after four hours, meningitis bacteria cooled to a normal 37c grew faster than bacteria kept at fever heat (40c).
‘Fever may play an important role in controlling the growth of this type of bacteria early in the disease,’ the researchers concluded. ‘But more research is needed.’
So should parentsworry about a fever? It’s an important issue because, quite apart from patient recovery time, dealing with childhood fevers takes up a lot of a doctors’ time; fevers result in 30 per cent of visits to A&E.
And studies have found that 20 to 50 per cent of parents give their children doses of paracetamol or ibuprofen that are too high to tackle a fever.
Fever is defined as a temperature over 37.5c. The big worry is that it’s a sign of something serious. So if your child is also unusually sleepy, has a rash, cold extremities, a stiff neck or difficulty breathing, call your GP.
But most fevers are caused by a viral infection, and clear up on their own within a few days.
‘Fever is a symptom, not a diagnosis,’ says Dr Anthony Harnden, a GP in the department of Primary Health Care at Oxford University. ‘The justification for using drugs is to make a child more comfortable.’
That means tackling the pain of a sore throat, for instance – ibuprofen and paracetamol reduce pain and inflammation.
Dr Wouter Havinga, a locum GP from Gloucestershire, strongly believes fevers should be allowed to run their course.
‘I’m often called out by parents who are worried that their child has lost control of their temperature,’ he says. ‘They’ve given paracetamol, but it’s not coming down, so they strip them off and fan them. That’s no way to treat a sick person, but they believe the fever itself is harmful.’
The NICE guidelines state: ‘Do not routinely give anti-pyretic (temperature-lowering) drugs to a child with fever with the sole aim of reducing body temperature.’
There is evidence that a fever can actually be beneficial.
‘It’s one of the ways our bodies fight off infection,’ says Dr Havinga. ‘Viruses and bacteria are temperature-sensitive. Once your temperature starts getting up to about 40c, their reproduction rate slows down.’
A Lancet study involving 50 feverish children with malaria found that lowering temperature slowed recovery time.
The patients who had paracetamol and quinine took 16 hours longer to get the parasite out of their body than the children who just had quinine. Adults also appear to benefit from recovering naturally.
at the University of Miami found patients whose fever was ‘aggressively’ lowered as soon as it got to 38.5c did worse than those whose fever was treated only when it reached over 40c.
Parents also fear a temperature may lead to febrile convulsions. ‘They often think a child is hotter than it really is,’ says Dr Clinch. ‘Then they try to bring the temperature down with drugs, often giving too high a dose, because they are frightened it could lead to convulsions.’
These affect 3 to 5 per cent of under fives. They are similar to an epileptic fit. But they don’t last more than a few minutes and rarely have lasting effects.
As Professor Stephen Field, of the Royal College of GPs, explains: ‘You shouldn’t rely on medicine just to reduce temperature, but if the child is distressed or is uncomfortable, then we can recommend a drug.’