about the potential for dose errors in the home
if the general public does not understand fully
the safe administration of common drugs
(Shone et al 2011, Samuels-Kalow et al 2013).
NICE (2013) has developed discharge
advice to be given to parents whose children
have been seen by healthcare practitioners.
The guidelines state that it is not necessary to
treat fever because fever is a natural process.
NICE (2013) acknowledges parental concerns
and recommends the use of ibuprofen and
paracetamol to treat symptoms associated with
fever such as pain and distress. In a systematic
review of studies comparing combined
treatment including paracetamol and ibuprofen
with either drug alone, Purssell (2011) noted
that studies are limited in concluding whether
both drugs should be used for the treatment
of fever and distress in minor illnesses. While
the studies reviewed demonstrated antipyretic
effects and improvements in patient comfort,
it was concluded that there is limited benefit
from combined treatment and that healthcare
professionals should be discouraged from
over-reliance on these medications for
the treatment of fever or distress and/or
discomfort.
Antipyretics
The use of antipyretics is controversial.
Historically, children with fever were routinely
given medication that reduced their
temperature effectively. However, the
long-term effect of this is unclear and there is
an increasing body of evidence suggesting
that fever is necessary for the immune system
to develop (NICE 2013). Together with the
risks of overdosing and long-term liver
damage, NICE (2013) recommends that
antipyretics should only be given when the
child is distressed and not with the sole
intention of reducing body temperature. The
guideline also recommends that only one
agent, either paracetamol or ibuprofen,
should be given and the use of the other agent
should only be considered if the child’s
discomfort persists before the next dose is due
(NICE 2013). Recommendations for the use
of antipyretics are shown in Box 1.
Complete time out activity 4