Paracetamol for feverish children: parental motives and experiences

Objective

The sale of paracetamol products for children is increasing, and more children are accidentally given overdoses, even though the use of paracetamol against fever is still under discussion. This study explores Danish parents’ use of paracetamol for feverish children and their motives for this use.

Design

A cross-sectional survey using structured interviews.

Setting

Four general practices located in city, suburb, and rural area.

Subjects

A total of 100 Danish parents with at least one child under the age of 10 years.

Main outcome measures

Number of parents administering paracetamol to feverish children, situations triggering medication of a child, parental views regarding fever and effects of paracetamol, and sources of information on fever treatment.

Results

Three in four parents use paracetamol for feverish children, mainly to reduce temperature, to decrease pain, and to help the child fall asleep. Highly educated parents medicate more often than less educated. Parents often fear fever but this does not clearly affect their use of paracetamol. Many parents believe in perceived beneficial effects of paracetamol, such as increased appetite and well-being, better sleep, and prevention of fever seizures. These expectations of paracetamol influence parental use of the drug. Parents’ main source of information on fever and paracetamol is their general practitioner (GP).

Conclusions

Danish parents regularly treat feverish children with paracetamol. Although parents contact their GP for advice on fever treatment, paracetamol is sometimes given to children on vague indications. Clearer information for parents on when to give paracetamol as fever treatment may help regulate its use.Key Words: Antipyretic, children, family practice, fever, gender, paracetamol, parents, primary healthcareThe sale of child-friendly paracetamol products is increasing in Denmark, even though use of paracetamol as treatment of fever is still being debated.

• Parents give paracetamol to improve well-being, appetite, and sleep of feverish children – research only vaguely supports this use.
• Highly educated parents medicate more often than less educated.
• Danish parents’ main source of information concerning fever and its treatment is their general practitioner.

Fever is a common symptom in childhood and a frequent reason for parents to contact their general practitioner (GP) [1]. Antipyretics are widely used for treating feverish children [2–5]. In Denmark, the most common antipyretic substance for children is paracetamol. The sale of child-friendly paracetamol products, i.e. suppositories and mixtures, has increased 23% in the last five years (55.9–68.4 defined daily doses (DDD)/1,000 inhabitants/year) [5,6].Paracetamol is considered a safe drug when taken in prescribed doses; however, overdosing may cause liver failure and death. Recent studies also show that intoxication in children happens after repeated doses only slightly above recommendations [7]. The number of Danish children (aged 0–11 years) hospitalized with paracetamol or acetylsalicylic acid (ASA) poisoning has increased from 23 in 1997 to 81 in 2006 [8].The use of paracetamol against fever is still under discussion [9,10]. Fever involves discomfort; however, the rise in body temperature is believed to assist the immune response against infection [11,12]. A minority of children experience fever seizures; these are often frightening to parents, but today if short-lasting they are considered benign [13]. Paracetamol has shown to be an effective analgesic and antipyretic; however, it is still unclear if the drug increases the well-being, the sleep, or the appetite of a feverish child [14–16]. Paracetamol has not yet proved effective in preventing fever seizures [13,17,18]. Conversely, no studies have documented a positive effect of not giving paracetamol to feverish children. NICE guidelines recommend use of paracetamol mainly in cases of fever and discomfort or pain [19].Internationally, numerous parents regularly give paracetamol against fever [2,3,20]. The most frequent reason for giving the drug to a feverish child is simply to lower the temperature. Some parents believe that paracetamol relieves their children of discomfort, and gives them more appetite and energy. [3,20,21]. Additionally, paracetamol may be a way of coping with a sick child in a busy daily life [20].Some parents fear that fever might harm their child by causing seizures, brain damage, and even death, if the temperature is high or rapidly rising. This unrealistic fear, termed fever phobia, may be linked to the wide use of antipyretics among parents [22–24]. For some parents fever is considered the disease in itself, and paracetamol is believed to cure the child [20].This study aimed at exploring:

1. to what extent and in which situations parents give their children antipyretics;
2. if parental views of the effects of paracetamol are consistent with existing evidence, and if their views influence the use of the drug;
3. if fever phobia is present among parents and if it motivates them to give paracetamol;
4. where parents seek information on handling a feverish child.