A5V4d

Feverish illness in children
limitation. Physical methods may also cause shivering if the cooling is too much or too quick. 213 This
may cause vasoconstriction and an increase in temperature and metabolism.
Because there is limited evidence regarding clothing of the feverish child, the GDG agreed by
consensus that children with fever should be clothed appropriately for their surroundings, with the aim
of preventing overheating or shivering. The major consideration should be the comfort of the child,
and the prevention of over-rapid cooling that may cause shivering which may be distressing for child
and parents. Care also needs to be taken not to overdress febrile children. It is not possible to be
prescriptive about this because of varying environmental and other conditions, and the provision of
information about appropriate clothing is an important role for healthcare professionals. In view of the
lack of evidence from clinical studies for or against the use of physical cooling methods, the GDG
concluded that research in this area may be beneficial.
Recommendations
Number Recommendation
198
Physical interventions for reducing temperature
77 Tepid sponging is not recommended for the treatment of fever. [2007]
78 Children with fever should not be underdressed or over-wrapped. [2007]
Drug interventions
The primary method of temperature control is the use of antipyretic drugs such as paracetamol and
ibuprofen. Unlike the physical methods previously discussed, these do treat the proximal cause of
fever, the increased hypothalamic set-point, although neither physical nor pharmacological methods
treat the ultimate cause, for example an underlying infection. The GDG sought to identify the most
appropriate pharmacological treatment for fever (as distinct from the cause of the fever), considering
not only antipyretic efficacy but also safety and cost.
Review question
The clinical question outlined in the scope for the update is to establish the ’Effect on fever and
associated symptoms of treatment with:
paracetamol alone or non-steriodal anti-inflammatory drugs (NSAIDs) alone, compared
with placebo and with one another
alternating paracetamol and NSAIDs, compared with placebo, either drug alone, and
taking both at the same time
paracetamol and NSAIDs taken at the same time, compared with placebo, and either
drug alone and either drug alone.’
Although the question states that any NSAID will be included, after assessment of available evidence,
and based on the experience of the GDG, it was apparent that ibuprofen is the only NSAID in
common use in the UK and it is the only NSAID licenced for this indication in children.
This question includes ten specific comparisons:
paracetamol compared with placebo
ibuprofen compared with placebo
paracetamol and ibuprofen combined compared with placebo
paracetamol and ibuprofen alternating compared with placebo
paracetamol compared with ibuprofen
paracetamol compared with paracetamol and ibuprofen combined
paracetamol compared with paracetamol and ibuprofen alternating
2013 Update