In our study, we found that mothers of febrile children tended to be more worried about adverse effects of fever such as seizures and brain damage. Moreover, following a child's fever, mothers were concerned about irrecoverable complications. In most studies, this issue is confirmed.[6,7,10,20] Compared to the findings of other studies, it seems mothers who participated in our study had little concern about death of children as a result of fever. They were mainly concerned about side effects and children becoming handicapped. Apparently, previous experience with children's fevers did not reduce their concern; early concerns over fever in children caused them to search for information, and perhaps this is why they were less concerned about death as an outcome of fever.
Walsh and colleagues conducted a study on 15 children's parents and concluded that they must provide parents of young children with consistent, reliable information preferably before their first child's first febrile episode.[11] Implementation of educational programs regarding the management of the febrile child are needed in the study carried out in Italy.[13]
Fever phobia continues to be a significant issue for Canadian parents. Identifying the cause (80.6%) and seriousness (87.4%) of fever were the most common stressors to them. As a result, they treat fever aggressively and often seek medical attention. The researchers recommended that good communication is important for medical staff caring for febrile children and typically leads to satisfied parents.[12] Karwowska et al., in their study found that parents of febrile children tended to be more worried about adverse effects of fever such as seizures, dehydration and brain damage than parents of otherwise well children.[7]
Evidence-based educational interventions are the best way to treat and prevent fever phobia and reduce unnecessary use of health services. Parents should be taught how simply to assess the child's wellbeing (e.g. skin color, activity levels, respiratory rate, and hydration). Media and the magazines have an important role in contributing to instruction and education of caregivers. Antipyretics should be used with indications, like other drugs, and not for fever per se.[21] A clinical trial study on 88 mothers of children aged 5 months to 6 years in Iran, confirmed the efficiency of educational interventions in improving mother's knowledge, attitude and practice regarding prevention of febrile seizure in children.[22]
Parents can reduce their concern and fear with different methods aligned with religious and spiritual believes. Our study showed that spiritual beliefs and emotional support have a considerable impact on maternal concerns. Emotional support from spouse, family members and medical staff, as well as spiritual beliefs such as prayer create hope for the child's full recovery and greatly reduce maternal concern.
Belief that problems are a way to achieve success and greater faith reduced anxiety.[23] The results of a study in this context showed that 80.9% of parents, in order to overcome the problems of their children, had trust in God.[24] Results of another study also showed that faith in God, trusting Him to solve problems and accepting a child's illness as a fact were the predominant (97.5%) method of coping.[25] A vast number of studies indicate the positive impact of prayer on the return of a patient's health. Researchers recommend using spiritual ceremonies beside medical treatment to control and treat diseases.[26]
This study showed that after developing a sense of concern, mothers attempted to find a solution and take quick action to lower fever. These measures included self-treatment at home, use of herbal medicine, referring to health centres and even superstitions.
Al-Nouri et al. concluded that the majority of mothers started antipyretic medication and antibiotics for children and applied a wet sponge with alcohol for them.[8] Another study showed that the majority of mothers started antipyretic medications for mild fever (less than 38.5° C) and only half used the correct dose of medication; most wet sponge application was done incorrectly.[10] Mothers in the present study sought reasons for the fever and took quick action to reduce the fever.
Parental awareness reduces misunderstanding and fear of fever. Appropriate measures promote better health during the fever phase and reduce times of medical visits. This shows the need for training by the media, physicians and health centres. While in healthy children a temperature up to 39°C does not require treatment with anti-fever medications, fear of side effects and lack of sufficient knowledge causes fever treatment in low temperatures.[3,5]
Overall, it can be said that lack of knowledge regarding what is the fever and how it could be treated still a main cause for concerns to febrile children among mothers; And since the majority of mothers interviewed conducted self-treatment measures such as using cold beverages and almost all were very concerned about irreversible complications of febrile seizure, it seems that providing correct information for mothers in health centres including information about febrile seizure, aetiology and prognosis of it, and how to measure a child's temperature at home are all appropriate. Based on technologies providing parents of young children with reliable information preferably before their first admissions to health care settings, and also introducing and teaching parents appropriate evidence-based websites is recommended. Parental education, especially for mothers, should be considered and, according to their spiritual beliefs, mental calmness should be provided for mothers.
One of the strengths of this study was exploring the immediate experiences of participants. However, interviewing just mothers of hospitalized children and the mothers excessive needs for support because of being in hospital for some days and also, due to the the nature of qualitative studies in type of sampling which is purposive and small numbers, the findings cannot be generalized and only provide basic information for further investigation specially in developing an empowering educational model in order to strengthen mothers in dealing with fevers.