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To The Editor:
Fever in a child is a major source of parental anxiety and is one of the most common complaints that bring a child to seek care from their health care practitioner (Carson, 2003; Knoebel, Narang, & Ey, 2002). Many practitioners manage fever in a variety of ways, causing great confusion to parents and caregivers. As a pediatric nurse practitioner student and mother of four children, 1 was very glad to read a recently published article in Pdiatric Nursing (Carson, 2003) addressing the lack of evidence supporting the practice of alternating acetaminophen and ibuprofen in children who are febrile to help with fever management.
Fever is defined as an increase in the hypothalamic setpoint temperature of the body as a result of a pathologic stimulation (D'Auria, 2002). Constriction of the blood vessels develops, resulting in heat production and a rise in body temperature. Many experts define fever as a rectal temperature greater than 100.4°F (38°C), an oral temperature greater than 100°F (37.8°C), and an ear (tympanic) temperature greater than 100.4°F (38°C) (D'Auria, 2002; Hay, Hayward, Levin, & Sondheimer, 2002; Kayman, 2003). Symptoms associated with fever include chills, headache, irritability, somnolence, malaise, and anorexia (D'Auria, 2002; Knoebel et al., 2002). Many parents believe without treatment of the fever, the temperature will continue to rise to harmful levels, possibly causing seizures. It is this "fever phobia" that causes such high anxiety for parents caring for a febrile child (Carson, 2003; Knoebel et al., 2002; Mayoral, Marino, Rosenfeld, & Greensher, 2000).
Antipyretic therapy is definitely indicated for preventing fever-related complications. The two antipyretic medications used in children are acetaminophen and ibuprofen. Caution should be used for both of these agents due to their toxic renal effects. However, many health care practitioners recommend alternating acetaminophen and ibuprofen doses, even though no clinical trials of this treatment have been identified (American Academy of Pediatrics [AAP], 2001). Numerous...