May 1, 2000 -- Your child is running a fever and you give her a child's fever medicine. The fever doesn't go down, so you call her pediatrician, who recommends taking a different kind of medicine and waiting for, say, six hours before giving the first medicine again. This practice is a common recommendation by doctors. The problem is that it is not based on scientific evidence.
In a recent report in the May issue of the journal Pediatrics, Clara E. Mayoral, MD, and her colleagues surveyed about 160 doctors, most of whom were pediatricians with 20 or more years of experience. Half of these doctors said that they regularly advised parents to use alternating therapy with acetaminophen (such as Tylenol) and ibuprofen (such as Motrin) to control high fevers in their children. Of doctors with less than five years experience, more than two-thirds recommended alternating medicines to control a child's fever as well.
Nearly a third of responding doctors said their choice of an anti-fever regimen was based on the recommendations by the American Academy of Pediatrics (AAP), when in fact, the AAP has no such recommendations.
Mayoral tells WebMD that where this idea to alternate fever therapy to bring down high fevers originated is a mystery. After searching medical literature from 1970 to 1998, she found no scientific data on this practice or its safety.
To further complicate things, several dosing schedules are being used. These include alternating acetaminophen and ibuprofen every two hours, every three hours, and alternating acetaminophen every four hours with ibuprofen every six hours. The first two of these schedules provide more than the recommended daily dose of acetaminophen, which is no more than five doses in a 24-hour period, explains Mayoral. The third schedule also exceeds the recommended daily dose and causes some confusion as to which drug should be given at the 12th hour. It is this confusion that is most dangerous, according to the authors, because parents may inadvertently overdose their child.
When managing fevers, parents need to keep in mind that fevers are not always bad, says Mayoral, who is director of general pediatrics at South Nassau Communities Hospital in Oceanside, NY. "There's been no documentation that fever at any point can cause brain damage. There have been some studies done in animals that suggest that a fever of greater than 107 degrees can cause some [damage], but such studies haven't been done in children," she says.
Parents should not worry excessively about fevers in children who are eating, drinking, and acting normally. In the case of a child who runs a fever of 103 degrees for several days, though, Mayoral recommends seeing a pediatrician.
She gave WebMD some tips on managing fevers in children. First, she says, don't bundle up the child. "It inhibits the shivering mechanism, which is the body's way of getting rid of the fever. Use a light blanket or wrap."
More advice: Make sure the child drinks enough fluids and keep the lines of communication open with the pediatrician about the fever. Also, keep in mind that different forms of the same medication are of different strengths. "For example, the infant's dropper form of acetaminophen has a higher concentration per milliliter than the one for children. Take a look and see exactly how much is needed," she explains.
Finally, she says, you don't necessarily have to bring the temps down to a normal level of 98.6 degrees. "Medicating fevers may mask how the child is doing," she says. "Understand that fever is not such a bad thing. It's the body's response to an infection. The infection might be viral and needs time to run its course," Mayoral says.
- Physicians often recommend alternating medications, such as Tylenol and Motrin, to help bring down a child's fever, but there is no scientific evidence to support this practice.
- Parents should be cautious about the doses of medications they are giving their children to avoid overdose.
- One expert says that fevers are not always bad, and parents should wrap their child in a light blanket, make sure they drink enough fluids, and keep lines of communication open with their pediatrician.