© Borgis - Postępy Nauk Medycznych 9/2014, s. 633-637
*Teresa Jackowska1, 2, Alicja Sapała-Smoczyńska2, Aleksandra Rurarz3, Karolina Nowicka3
Wiedza rodziców o gorączce i o zasadach postępowania w przypadku jej wystąpienia u dzieci do 12 roku życia
Parents’ knowledge of fever and management procedures in the case of its occurrence in children under 12 years of age**
1Department of Pediatrics, Medical Center of Postgraduate Education, Warszawa
Head of Department: prof. Teresa Jackowska, MD, PhD
2Department of Pediatrics, Bielański Hospital, Warszawa
Head of Department: prof. Teresa Jackowska, MD, PhD
3Student Research at the Department of Pediatrics, Medical Center of Postgraduate Education, Warszawa
Streszczenie
Wstęp. Gorączka jest często pierwszym objawem infekcji wirusowej czy bakteryjnej. Pierwszymi osobami, które stwierdzają podwyższoną ciepłotę ciała u dziecka są rodzice, którzy są odpowiedzialni za racjonalne leczenie przeciwgorączkowe w warunkach domowych. Dlatego też wiedza rodziców o lekach przeciwgorączkowych jest niezwykle istotna. „Fobia gorączkowa”, czyli bezpodstawny lęk przed następstwami gorączki, może wpływać na nieracjonalne postępowanie rodziców/opiekunów.
Cel. Celem pracy było sprawdzenie wiedzy rodziców o zasadach postępowania w przypadku gorączki u dzieci, w zestawieniu z aktualnymi zaleceniami Amerykańskiej Akademii Pediatrii (AAP).
Materiał i metody. W Klinicznym Oddziale Pediatrycznym Szpitala Bielańskiego w Warszawie, w okresie 4 miesięcy przeprowadzono badania ankietowe wśród 200 rodziców dzieci w wieku 0-12 lat. Kwestionariusz składał się z 17 pytań jedno- i wielokrotnego wyboru.
Wyniki. 35% (70/200) rodziców prawidłowo rozpoznało próg gorączki (38°C). Leczenie przeciwgorączkowe przy temperaturze ciała 38,0°C zadeklarowało 86% (172/200) rodziców, natomiast 14% przy temperaturze niższej. Łączenie paracetamolu i ibuprofenu stosuje 52% (104/200) rodziców. 12% (24/200) ankietowanych nadal stosuje kwas acetylosalicylowy (aspirynę) u dzieci poniżej 12 roku życia. Pediatrzy są głównym źródłem wiedzy na temat odpowiedniego dawkowania leków przeciwgorączkowych. Wszyscy rodzice byli przekonani, że gorączka może spowodować co najmniej jeden efekt uboczny. Najczęściej wymieniano drgawki (76,5%), majaczenie (49%) i odwodnienie (40,5%). 10,5% rodziców (21/200) kontroluje gorączkę wyłącznie przy pomocy leków, pozostali łączą metody farmakologiczne z fizykalnymi.
Wnioski. Wiedza rodziców na temat gorączki u dzieci jest niezadowalająca i daleka od zaleceń Amerykańskiej Akademii Pediatrii. Zjawisko „fobii gorączkowej” jest szeroko rozpowszechnione. Zdecydowana większość rodziców uważa, że gorączka jest szkodliwa. Niektóre z zaobserwowanych zachowań rodziców narażają dzieci na ryzyko zbędnej podaży bądź nawet przedawkowania leków przeciwgorączkowych. W celu skutecznego kontrolowania gorączki u dzieci, potrzebne są programy edukacyjne skierowane do rodziców i opiekunów.
Summary
Introduction. Fever is often the first sign of both a viral or a bacterial infection. Parents are the first ones to notice the child’s increased body temperature. They are also responsible for a reasonable antipyretic therapy at home. The basis of this therapy lies in the parents’ knowledge of both the fever threshold and the administration of specified doses of antipyretics. “Fever phobia” a phenomenon defined as an unjustified fear of the consequences of fever, may cause parents’ irrational behavior.
Aim. The aim of the study was to test the knowledge of parents about the management rules in case of fever in children, in comparison with the current recommendations of the American Academy of Pediatrics (AAP).
Material and methods. Patients’ parents from the Department of Pediatrics at the Bielański Hospital in Warsaw were surveyed using a questionnaire between November 2013 and February 2014. Altogether, 200 parents of children aged 0-12 participated in this study. Parents were asked to define fever and their concerns associated with it, the methods of temperature measurement and fever management. The questionnaire consisted of 17 single and multiple choice questions.
Results. Only 35% of parents (70/200) correctly identified the fever threshold (38°C) in accordance with the guidelines. 86% of parents (172/200) declared antipyretic treatment for the temperature of 38.0°C, and 14% for a lower temperature. 52% of caregivers (104/200) combine acetaminophen and ibuprofen. Surprisingly, 12% of the respondents (24/200) continue to use aspirin in children aged below 12. Pediatricians were their primary source of information about the adequate doses of antipyretics. All parents were convinced that fever can cause at least one harmful side effect – the most commonly mentioned were seizures (76.5%), delirium (49%) and dehydration (40.5%). 10.5% of parents (21/200) declared using medications only, the remaining parents combine both pharmacological and physical treatment.
Conclusions. Parents’ knowledge related to managing fever symptoms in children is insufficient and frequently differs from the AAP recommendations. The phenomenon of “fever phobia” remains widespread among parents and the vast majority believe that fever is harmful. Some of the parents’ behaviors that were identified expose children to the risk of antipyretic drug overdose or misuse. Educational programs targeted at educating parents are needed to effectively manage fever in children.
Introduction
Fever in children is a symptom that always causes anxiety in parents and caregivers. Fever is a sign of an inflammatory process, most often induced by a viral or a bacterial infection. The increase of the body temperature is a physiological reaction controlled by the thermoregulatory center located in the anterior part of the hypothalamus. The mechanism is similar to the work of a thermostat, which under the influence of pyrogenic factors, such as interleukin 1α and 1β (IL-1), IL-6, INF-α, INFγ, and the tumor necrosis factor (TNF) causes an increase of the body temperature. It is a programmed answer of the organism to the appearance of a pathogen, supporting the defense by inhibiting the vital functions of the pathogenic microorganisms, a multiplication of T lymphocytes and an increased production of neutrophils (1). Not knowing the positive aspects of the febrile response, worried parents try to “normalize” the body temperature of their child at all costs. Parents’ concerns were described in 1980 by Barton D. Schmitt and called “fever phobia”, defined as an unjustified fear of fever and its possible severe complications (2). Pediatricians do not convince the parents about the actual role of fever effectively enough and do not always supervise antipyretic treatment of their patients. This favors the persistence of the phenomenon of fever phobia and mistakes when administering antipyretics at home.
Aim
Comparison of parental knowledge about fever and fever management with recommendations of the American Academy of Pediatrics (AAP), published in 2013 (3), and estimation of the prevalence of fever phobia and incorrect practices concerning the use of antipyretics in children.
Material and methods
The study was carried out for 4 months (from November 2013 to February 2014) at the Clinical Department of Pediatric Hospital in Warsaw using a questionnaire prepared for parents, the research by Schmitt et al. (2) and the guidelines of the American Academy of Pediatrics from 2013 (3). The questionnaire consisted of 17 single or multiple choice questions and referred to children under 12 years of age (fig. 1). It was developed in order to obtain information on the knowledge of the definition of fever and proper management in the event of its appearance, as well as concerns related to the potential complications of fever. Additional questions focused on the methods and the frequency of measuring fever, the sources of parental knowledge about the form of administration and the dosage of drugs. Parents were asked to choose the correct answer from among the proposed ones. In total, the responses of 200 out of 346 (57.8%) participants were included in the study. 23/346 (6.7%) questionnaires were rejected due to being improperly filled out, and 123 parents (35.5%) refused to participate in the study. The results are given in absolute numbers and as a percentage. The response rate to the questions was calculated based on the total number (200) of participants.
Demographics
Kinship: a) mother b) father c) other
How old are you? ............................................................................................
How old are your children? ...........................................................................
Place of birth: ..................................................................................................
What is your education level? a) primary b) secondary c) higher
Single choice questions
1. Which is the best place to measure the temperature of a child?
a) the armpit
b) rectum
c) the groin
d) oral cavity
e) ear
f) forehead
2. What body temperature would you consider a fever?
a) 36.5°C
b) 37°C
c) 37.5°C
d) 38°C
e) 38.5°C
f) 39°C
3. What body temperaturę would you consider as high fever?
a) < 38°C
b) 38.0-39.0°C
c) 39.1-40.0°C
d) > 40°C
4. What is the temperature of your child when you start to administer antypyretics?
a) < 38°C
b) 38.0-39.0°C
c) 39.1-40.0°C
d) > 40°C
5. What would have been the maximum values of your child’s body temperature without antipyretic medication?
a) < 41°C
b) 41.0-43.5°C
c) > 43.5°C
6. How often do you measure body temperature of your child during illness?
a) < 15 min
b) 16-30 min
c) 31-60 min
d) 61-120 min
e) > 120 min
7. Do you think that it is worth to give your child two or more antipyretics?
a) yes
b) no
8. Which method of antypyretic administration do you prefer?
a) orally
b) rectally |
9. If you administer drug rectally what is the reason?
a) the drug works faster and better
b) it is easier to administer
c) the order of a physician
d) if I am not able to give the drug orally because of the refusal of the child
e) if the child vomits
10. How do you calculate the appropriate dose of an antipyretic for your child?
a) according to the indications of a pediatrician
b) I read the package leaflet of the drug
c) I ask friends
d) according to the information gathered in the media, for example. internet, television, newspapers
11. What should be taken into account when calculating the appropriate dose of an antipyretic for the child?
a) weight
b) height
12. What do you think about the maximum dose of an antipyretic administered during a high fever?
a) it is more effective
b) it is more hazardous
13. What do you use to administer the appropriate dose of an antipyretic?
a) tablespoon or teaspoon
b) special dosimeter attached to the antipyretic
c) dosimeter from another drug
Multiple choice questions
14. What kind of thermometer do you use to measure the temperature of your child?
a) mercury/alcohol
b) electronic
c) ear
d) Infrared
e) pacifier thermometer
f) I do not have a thermometer
15. What are the side effects fever may cause?
a) seizures
b) brain damage
c) death
d) dehydration
e) serious illness
f) coma
g) delirium
h) blindness
i) other side effects
16. What antipyretics do you administer to your child?
a) acetaminophen (eg. Pedicetamol, APAP Panadol)
b) ibuprofen (eg. Nurofen, Ibum, Ibufen)
c) aspirin (e.g. Aspirin C Polopiryna S)
d) other (eg. pyralgina)
17. What other methods of decreasing body temperature do you use exept from antipyretics to reduce fever in a child?
a) washing child’s forehead with cold (15°C) water
b) cold compresses to the neck
c) washing child’s forehead with lukewarm (25°C) water
d) other – oral irrigation, undressing the child or ventilation
e) I use only antipyretic drug |
Fig. 1. Questionnaire.
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Piśmiennictwo
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2. Schmitt BD: Fever phobia misconceptions of parents about fever. Am J Dis Child 1980; 134: 176-181.
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