What are the options for fever reduction in the emergent management of pediatric patients with fever?

Updated: Sep 01, 2021
  • Author: Hina Z Ghory, MD; Chief Editor: Russell W Steele, MD  more...
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Reduction of fever is used to help comfort the child as well as provide for the optimal examination conditions and should be addressed in triage protocols. Acetaminophen and ibuprofen have both been used for fever control. [23] These drugs are sometimes alternated to achieve an overlapping period of fever control. [108, 109, 110] Some studies suggest that acetaminophen may reduce fever more quickly, while ibuprofen may have a longer-lasting effect on fever reduction. [22, 111]

In a study of children aged 6 months to 6 years whose fever could be managed at home (37.5-41°C) Hay et al, found that the use of acetaminophen and ibuprofen improved time without fever during the first 4 hours and was superior to acetaminophen alone, but not ibuprofen alone. [109]

The combination also decreased fever 23 minutes faster than acetaminophen alone, but no faster than ibuprofen alone. Time without fever during the first 24 hours was improved with the combination compared with either acetaminophen or ibuprofen. Dosage was calculated as acetaminophen 15 mg/kg/dose and ibuprofen 10 mg/kg/dose. [109]

The ED staff should be educated that a positive response to antipyretics (evidenced by a drop in the measured temperature) does not predict the absence of a potentially serious bacterial disease. [111]

Criteria for discharge from the ED do not necessarily include reduction of the child's fever to a certain level before discharge. No evidence indicates that fever reduction is necessary for the child to be discharged from the ED.

The infant with only a history of subjectively estimated fever whose rectal temperature is normal on repeated measurements and who has an entirely normal clinical evaluation may be assessed as not requiring laboratory studies. All such infants discharged home still warrant close follow-up and continued short-term monitoring of rectal temperature. [1]

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