Managing mild pain and fever in children requires a nuanced understanding driven by evidence-based practices. Despite advancements in paediatric pain management, misconceptions – such as the belief that children experience pain differently than adults – persist among caregivers and healthcare professionals alike. Pharmacists play a pivotal role in addressing these challenges by advocating the judicious use of analgesics. These agents effectively provide symptomatic relief in mild pain and discomfort associated with fever. Crucially, pharmacists must counsel caregivers on fever’s role as a natural, infection-fighting mechanism, emphasising that antipyretics should only alleviate discomfort rather than reduce body temperature indiscriminately.1

In this article, we take a step-by-step approach to the management of fever in children under five in primary care settings.

ADVICE FOR HOMECARE1,3-6

  • Reassure parents with anxiety about the child’s fever
  • Advise parents/caregivers on right measurement of body temperature
  • Advise the parent on the management of fever at home
  • Give clear instructions on how to administer medication
  • Advise parents on the correct use of antipyretic medication
  • When to seek further help.

For children experiencing fever, maintaining hydration is key to effective symptom management.7-9 Paracetamol’s safety and efficacy make it a go-to option, especially when dehydration is a concern. Ibuprofen, though effective in reducing fever and pain, should be reserved for cases where hydration is clearly adequate.8,10 Combining both medications alternately under professional guidance can also be a viable approach.11,12

REFERENCES

  1. Drake R. Management of mild pediatric pain and fever. Available at https://www.researchreview.co.nz/getmedia/8b1e2073-fe41-43ad-a3c7-34697534407d/Educational-Series-Paediatric-Analgesia.pdf.aspx?ext=.pdf . Accessed 12th April 2024.
  2. Fever in under 5s: assessment and initial management. London: National Institute for Health and Care Excellence (NICE); 2021 Nov 26. PMID: 31891472
  3. Chiappini E, Bortone B, Galli L, et al. Guidelines for the symptomatic management of fever in children: systematic review of the literature and quality appraisal with AGREE II. BMJ Open 2017;7:e015404. doi:10.1136/ bmjopen 2016 015404
  4. Richardson M, Lakhanpaul M; Guideline Development Group and the Technical Team. Assessment and initial management of feverish illness in children younger than 5 years: summary of NICE guidance. BMJ. 2007 Jun 2;334(7604):1163 4.
  5. Green R, Webb D, Jeena PM, Wells M, Butt N, Hangoma JM, Moodley RS, Maimin J, Wibbelink M, Mustafa F. Management of acute fever in children: Consensus recommendations for community and primary healthcare providers in sub Saharan Africa. Afr J Emerg Med. 2021 Jun;11(2):283 296.
  6. Green R, Jeena P, Kotze S et al. Management of acute fever in children: guideline for community healthcare providers and pharmacists. S Afr Med J. 2013 Sep 3;103(12):948 54.
  7. The Royal Children's Hospital Melbourne staff. Dehydration. Kids Health Info. The Royal Children's Hospital Melbourne. 2018 August. Available from: https://www.rch.org.au/kidsinfo/fact_sheets/Dehydration/.
  8. Kanabar DJ. A clinical and safety review of paracetamol and ibuprofen in children. Inflammopharmacology. 2017 Feb;25(1):1-9. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5306275/.
  9. Pitone ML. Dehydration. KidsHealth. 2023 June. Available from: https://kidshealth.org/en/parents/dehydration.html.
  10. Doria M, Careddu D, Iorio R, Verrotti A, et al. Paracetamol and Ibuprofen in the Treatment of Fever and Acute Mild-Moderate Pain in Children: Italian Experts' Consensus Statements. Children (Basel). 2021 Sep 30;8(10):873. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8534871/.
  11. Charde V, Sanklecha M, Rajan P, et al. Comparing the Efficacy of Paracetamol, Ibuprofen, and a Combination of the Two Drugs in Relieving Pain and Fever in the Pediatric Age Group: A Prospective Observational Study. Cureus. 2023 Oct 12;15(10):e46907. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10636696/.
  12. Tan E, Braithwaite I, McKinlay CJD, et al. Comparison of Acetaminophen (Paracetamol) With Ibuprofen for Treatment of Fever or Pain in Children Younger Than 2 Years: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(10):e2022398. Available from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2772373.

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