Background
Methods
Study design
Questionnaire
Statistical analysis
Results
Methods for body temperature measurement
2012 n (%; 95% CI) n = 300 | 2015 n (%; 95% CI) n = 562 |
P
| |
---|---|---|---|
Children < 1 year of age
| |||
Axillary* | 118 (39.3; 33.8–44.9) | 283 (50.4; 46.2–54.5) | 0.001 |
Rectal | 124 (41.3; 35.8–46.9) | 192 (34.2; 30.2–38.1) | 0.020 |
Groin crease | 38 (12.7; 8.9–16.4) | 71 (12.6; 9.9–15.4) | 0.980 |
Oral | 0 (0.0; 0.0–0.0) | 1 (0.2; 0.0–0.5) | 0.950 |
Auricular | 18 (6.1; 3.3–8.7) | 7 (1.2; 0.3–2.2) | < 0.0001 |
Forehead | 2 (0.6; 0.0–1.6) | 8 (1.4; 0.4–2.4) | < 0.0001 |
Children > 1 year of age
| |||
Axillary* | 242 (80.7; 76.2–85.1) | 502 (89.3; 86.8–91.9) | 0.0003 |
Rectal | 9 (3.0; 1.1–4.9) | 20 (3.6; 2.0–5.1) | 0.660 |
Groin crease | 15 (5.0; 2.5–7.5) | 24 (4.3; 2.6–5.9) | 0.630 |
Oral | 2 (0.7; 0.0–1.6) | 1 (0.2; 0.0–0.5) | 0.240 |
Auricular | 29 (9.6; 6.3–13.0) | 6 (1.1; 0.2–1.9) | < 0.0001 |
Forehead | 3 (1.0; 0.0–2.1) | 10 (1.8; 0.7–2.9) | 0.370 |
Type of recommended thermometer
| |||
Digital* | 203 (67.7; 62.4–73.0) | 385 (68.5; 64.7–72.3) | 0.430 |
Auricular | 15 (5.0; 2.5–7.5) | 9 (1.6; 0.6–2.6) | 0.003 |
Other** | 32 (10.6; 7.2–14.2) | 168 (29.8; 26.1–33.7) | < 0.0001 |
Use of physical methods and antipyretics
First choice drug | |||
---|---|---|---|
2012 n (%) | 2015 n (%) |
P
| |
Paracetamol* | 295 (98.3; 96.1–99.3) | 546 (97.1; 95.4–98.4) | 0.656 |
Ibuprofen* | 4 (1.3; 0.5–3.4) | 12 (2.1;1.2–3.7) | 0.40 |
Other | 1 (0.3; 0.0–1.8) | 4 (0.7; 0.3–1.8) | 0.48 |
Second choice drug | |||
Paracetamol* | 19 (6.3; 4.1–9.7;) | 61 (10.8; 8.5–13.7) | 0.03 |
Ibuprofen* | 276 (92.0; 88.4–94.6) | 495 (88.1; 85.1–90-5) | 0.04 |
Acetylsalicilic acid | 2 (0.7; 0.2–2.4) | 0 (0.0; 0.0–0.0) | 0.12 |
Other | 3 (1.0;0.3–2.9) | 6 (1.1; 0.5–2.3) | 0.92 |
Choice of administration of paracetamol | |||
Oral | 249 (83.0; 78.3–86-8) | 517 (92.0; 89.4–94.0) | < 0.0001 |
Rectal | 51 (17.0;13.2–21.7) | 45 (8.0;6.0–10.5) | < 0.0001 |
Alternating use | |||
Yes | 34 (11.3; 8.2–15.4) | 69 (12.3; 9.8–15.2) | 0.40 |
Use of physical methods | |||
Together with antipyretic drug | 29 (9.7; 6.8–13.5) | 36 (6.4; 4.7–8.7) | 0.08 |
Before the antipyretic drug | 9 (3.0; 1.6–5.6) | 14 (2.3; 14.5–41.4) | 0.66 |
If fever persists | 153 (51.0; 45.4–56.6) | 242 (43.1; 39.0–47.2) | 0.15 |
Never* | 109 (36.3; 31.3–41.9) | 270 (48.0; 43.9–52.2) | < 0.0001 |
Discussion
✓ Rectal measurement should not be used routinely in children aged < 5 years because it is invasive and causes discomfort (evidence level III; strength of recommendation D). | |
✓ Oral measurement of body temperature should be avoided in children (evidence level III; strength of recommendation D). | |
✓ Axillary measurement using a digital thermometer is recommended in children aged < 4 weeks (evidence level III; strength of recommendation B). | |
✓ In the hospital or ambulatory care setting, axillary measurement using a digital thermometer or tympanic measurement using an infrared thermometer is recommended in children aged ≥4 weeks (evidence level II; strength of recommendation B). | |
✓ For measurements taken at home by parents/caregivers, axillary measurement using a digital thermometer is recommended in all children (evidence level II; strength of recommendation B). | |
✓ Use of a tympanic infrared thermometer is not recommended, as this mode of measurement is prone to operator-related error. | |
✓ Use of antipyretics in children is recommended only when the fever is associated with evident discomfort (eg, prolonged crying, irritability, reduced activity, reduced appetite, disturbed sleep) (evidence level I; strength of recommendation B). | |
✓ Use of physical methods to reduce fever is not recommended (evidence level I; strength of recommendation E). | |
✓ Paracetamol and ibuprofen are the only antipyretic drugs recommended for use in children (evidence level I; strength of recommendation A). | |
✓ Use of acetylsalicylic acid in children is not recommended because of the risk of Reye’s syndrome (evidence level III; strength of recommendation E). | |
✓ Because of their poor benefit– risk ratio, steroids should not be used as antipyretics in children (evidence level III; strength of recommendation E). | |
✓ Combined or alternating use of ibuprofen and paracetamol is not recommended (evidence level VI; strength of recommendation D). | |
✓ Rectal administration of antipyretics should be considered only in the presence of vomiting or other conditions that prevent oral administration (evidence level I; strength of recommendation A). |