Evidence-based management of uncomplicated pain and fever in children in the community setting

Introduction: Childhood fever is the most common reason for parents to seek medical attention.1 Despite successful educational interventions fever phobia persists.2 Healthcare professionals can play a pivotal role in educating parents on how best to manage such conditions. We provide practical, yet evidence-based, guidance on the management of children (aged 0-12 years) presenting in the community setting with pain and/or fever in association with common childhood ailments. Method Design: Electronic database searching (1966-August 2006) was conducted to identify articles relating to the management of pain and or fever in children aged 0-12 years. Additional articles were found through archives and the reference lists of identified articles. Recommendations: (1) Fever alone does not need to be treated. (2) Parents should watch for signs of development of potential serious problems (vomiting, irritability, lethargy, apathy) and seek further medical advice if a fever persists for more than 48 hours or if the child's condition deteriorates. (3) Paracetamol (15mg/kg) and ibuprofen (10mg/kg) are equally effective analgesics and antipyretics. (4) Both drugs are generally well tolerated, but the potential exists for more iatrogenic risks with ibuprofen use. (5) Alternating therapy is not recommended. Conclusions: While both paracetamol and ibuprofen may be appropriate for use in children, we need to encourage the quality use of all medicines. This means discouraging their use simply to lower temperature and primarily considering them for pain or fever with associated discomfort. Given that there is no obvious efficacy advantage to using ibuprofen, there appears no reason to change from continuing to use paracetamol as the first-line treatment of choice in paediatric patients