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Nursing management of fever in children: a systematic review
Robin Watts1, Jeanette Robertson, Gail Thomas
1Director, The Western Australian Centre for Evidence Based Nursing and Midwifery, Perth, Australia.
Insights
Evidence review on nursing interventions for fever in children indicates limited benefit from sponging and risks associated with paracetamol use. Individualized care, prioritizing comfort and safety, is recommended.
Area of Science:
- Pediatric Nursing
- Evidence-Based Practice
- Fever Management
Background:
- Fever is a common symptom in children, prompting various nursing interventions.
- The effectiveness and safety of these interventions require rigorous evaluation.
Purpose of the Study:
- To review evidence on nursing interventions for fever in non-critically-ill children.
- To assess the impact of these interventions on patient outcomes.
Main Methods:
- Systematic review of randomized and quasi-randomized controlled trials (up to 1998).
- Inclusion of children aged 3 months to 16 years with fever.
- Narrative synthesis due to study heterogeneity.
Main Results:
- Limited evidence supports sponging for fever reduction in temperate climates; it may decrease comfort.
- Risks identified with sustained or high-dose paracetamol (acetaminophen) administration.
- No evidence supports antipyretics for preventing febrile convulsions.
Conclusions:
- Prioritize child comfort when managing fever, balancing benefits against potential harms.
- Routine sponging lacks evidence; paracetamol use should be cautious and selective.
- Individualized care based on intervention effectiveness and risks is essential.
Objectives:
The aim of the present review was to determine whether the best available evidence supports the types and timing of the various nursing interventions that are commonly used to reduce fever in non-critically-ill children, and to what extent the outcomes are influenced by these nursing actions.
Methods:
Studies included were randomised or quasi-randomised controlled trials that involved non-critically-ill children with a fever aged between 3 months and 16 years. The search strategy sought to identify both published and unpublished research reports in the English language and covered all major databases up to 1998. The methodological quality of each study was assessed by two independent reviewers using a piloted critical appraisal checklist. Despite all studies being randomised, heterogeneity precluded conduction of a meta-analysis; therefore, evidence was synthesised using narrative summaries.
Results:
Ten studies were assessed as being of sufficient quality to be included in the review. These studies addressed two of the intervention categories identified in the protocol: (i) administration of antipyretics (paracetamol); and (ii) direct cooling measures on the outcome measure (reduction of or prevention of increase in fever). The review found little benefit from sponging in temperate climates and usually at the expense of the child's comfort. There may be situations in high environmental temperatures and high humidity, or where there is a need for immediate temperature reduction, in which sponging may be warranted. Risks were identified when paracetamol was administered on a sustained basis over even a short period of time and above a relatively low total daily dosage. There was a lack of evidence to support the administration of antipyretics to reduce the incidence of febrile convulsions. There is a need for parental education that focuses on knowledge of the body's protective physiological responses and how to support these responses.
Conclusion:
The primary purpose for intervening when a child has a fever is to increase the child's comfort. This consideration should be weighed against any harm that might result from intervening. There was a lack of evidence to support the routine use of sponging. The administration of paracetamol should be used selectively and with caution. In summary, care needs to be individualised, based on current knowledge of the effectiveness and risks of interventions.