A5V4d

Parental concern
Introduction
It is clear that febrile illnesses continue to have a considerable impact on childhood mortality and
morbidity. This impact is reflected in the concerns of parents and carers. Several authors have
conducted surveys of parents’ responses to acute illness in their children and found that fever, cough
and the possibility of meningitis were parents’ primary concerns when their children became acutely ill
(Kai, 1996; Hugenholtz et al, 2009). Parents reported that they experienced high levels of worry when
their children were ill, and had particular concerns that the presence of fever might herald potential
harm. Parents also had anxieties relating to the outcome of fever, believing that it could indicate
serious illness such as meningitis. They were fearful that fever itself could damage their children and
could also result in fits which they believed would result in permanent brain damage and even death.
This concern, which can lead to what has been described as fever phobia (Karwowska et al, 2002), is
quite widespread and tends to increase with the height of temperature, rapid onset and duration of
fever (Enarson et al, 2012). Additionally, it is important to recognise that fear of fever among parents
can be influenced by ethnicity and cultural beliefs. These, compounded with concerns parents have
for their children’s well-being and the need for reassurance, often prompt parents to request care from
both primary and secondary healthcare services (Hugenholtz et al, 2009; Taveras et al, 2004; Sands
et al, 2011).
In scientific terms, fever is a natural response to infection and is not harmful in itself. Instead, it is the
underlying infection that has the potential to cause harm. Indeed, there are some theoretical grounds
to suggest that fever is beneficial in the body’s response to infection. In any event, it is clear that
parents and carers could receive more useful advice about feverish illness from healthcare
professionals as well as recognition that their concerns are valid. This could include information about
detecting potential serious infections, how to manage fever appropriately at home and when to seek
further advice (Taveras et al, 2004; Kai, 1996).
Need for guidance
It is a requirement of the Children’s National Service Framework that all ill children should have
access to high-quality, cost-effective, evidence-based care. 15 Because it is difficult to evaluate the
severity of the illness, there is a need for evidence-based guidance to inform healthcare professionals
about how to judge whether a child who presents with a fever is likely to develop a serious illness.
Healthcare professionals also need advice to support their decision on whether to observe the child,
perform diagnostic tests, start treatment such as antibiotics or refer onwards for specialist care. The
guidance should also include advice on the best ways to detect fever, the management of fever itself,
and what to tell parents and carers who have made contact with healthcare services. The guidance
should be applicable to primary and secondary care and should take account of the number of
agencies that are involved in giving health care and giving advice to parents and carers. It is also
important that parental preferences, as well as the child’s best interests in terms of health outcomes,
should be taken into account when considering the various options for investigation and treatment.
Need for 2013 update
The decision to update the guideline was made based on deveopments in the NHS and new evidence
becoming available that could affect existing recommendations.
The introduction of new vaccination programmes in the UK may have significantly reduced the level of
admissions to hospital resulting from diseases covered by this guideline. For example, early analysis
of the pneumococcal vaccination programme in England shows that the incidence of pneumococcal
related disease has fallen 98% in children younger than 2 years since vaccination was introduced.
However, evidence suggests a 68% increase in the prevalence of disease caused by sub-types of
bacteria not covered by vaccination programmes. Also, potentially serious cases of feverish illness
are likely to be rare, so it is important that information is in place to help healthcare professionals
distinguish these from mild cases.
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2013 Update