Diagnosis and treatment of pediatric fever by caretakers

Assessment of pediatric temperature is a multistep task involving both manipulative and cognitive skills. Emergency Physicians typically assume that parents possess these skills, but this assumption has never been fully tested. A prospective survey was conducted of caretakers of children < or = 36 months of age presenting to an inner city emergency department or pediatric clinic. Participants were asked to read a Fahrenheit scale mercury thermometer and to demonstrate use of that thermometer to "take" the temperature of an infant doll. They were then asked what temperature constituted a "fever" and what temperature would require antipyretic therapy. Caretakers were also asked how they would treat a fever in the child they had brought for treatment. Proportions of correct responses were tabulated and also compared by age and level of education of caretaker. Eighty-two of 92 caretakers (89.1%) possessed working thermometers in their homes. Thirty-six subjects (39.1%) were able to measure temperature appropriately using the mercury thermometer, 52 (56.5%) were able to read the mercury thermometer correctly, and 28 (30.4%) could both measure and read correctly. Sixty-seven subjects (72.8%) described correct treatment of fever. Overall, 27 subjects (29.3%) could measure, read, and treat fever appropriately. There was no statistically significant difference in age or percentage of high school graduates between caretakers who could successfully measure, read and treat and those who could not. In this inner city patient population, caretakers of any pediatric patient whose discharge instructions contain a reference to patient temperature should receive a brief refresher along with written instructions on temperature measurement and treatment.