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Effectiveness and safety of interventions for fever-associated discomfort in children: A systematic review
Antonio Corsello1, Ilaria Alberti2, Sara Farhanghi1
1Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
Insights
Pharmacological treatments for fever-associated discomfort in children appear safe and effective. Physical methods like tepid sponging offer limited benefit and may increase discomfort, highlighting the need for more research.
Area of Science:
- Pediatrics
- Clinical Pharmacology
- Evidence-Based Medicine
Background:
- Fever is a common pediatric concern, with guidelines shifting focus from temperature reduction to alleviating discomfort.
- Existing interventions for fever-associated discomfort in children lack systematic analysis of their effectiveness and safety.
Conclusions:
- Pharmacological interventions for fever-associated discomfort in children are generally effective and safe.
- Physical methods like tepid sponging provide limited benefit and may worsen discomfort.
- The current evidence base is limited by small study numbers, heterogeneity, and risk of bias, necessitating high-quality research to guide clinical practice.
Aims:
Fever is one of the most frequent reasons for paediatric consultations. While traditionally managed by reducing body temperature, recent guidelines emphasize alleviating discomfort as the primary therapeutic goal. Although different interventions have been described to manage fever-associated discomfort in children, their effectiveness and safety has never been systematically analysed. The aim of this study was to review the evidence on the effectiveness and safety of pharmacological and nonpharmacological interventions for managing discomfort in febrile children.
Methods:
A systematic review was conducted following PRISMA guidelines (PROSPERO: CRD420250655721). PubMed, Embase and Cochrane Library were searched up to 31 January 2025, for studies involving children aged 29 days to 18 years that assessed interventions for fever-associated discomfort. Randomized controlled trials and observational studies were included. Risk of bias was assessed using Cochrane and STROBE tools. Results were synthesized narratively and grouped according to the type of intervention.
Results:
Eight studies (5 randomized controlled trials, 3 observational) involving 1877 children were included. Study designs, including dosage of antipyretics and quality varied across studies. Studies comparing ibuprofen and paracetamol provided conflicting results, while combination therapy (paracetamol + ibuprofen) appeared more effective than using a single drug in -one trial. Tepid sponging, despite reducing temperature, was associated with increased discomfort. No serious adverse events were reported.
Conclusion:
Pharmacological treatments appear effective and safe, whereas physical methods offer limited benefit. The available evidence is limited by the small number of studies, methodological heterogeneity, and concerns about risk of bias and outcome measurement inconsistency. New high-quality studies are needed to guide clinical practice for the management of fever-associated discomfort in children.
Related Concept Videos
01:22Methods of reducing fever
Pharmacological Methods of Reducing Fever:
01:25Increased Body Temperature
01:29Decreased Body Temperature
01:26Patterns of Fever
01:28Factors Affecting Body Temperature
Factors may include:
01:25Types of Fever
Here are the different types of fever: