Physician's perceptions of fever in children - Facts and myths

Objective: To ascertain the knowledge and attitude of physicians, regarding fever in children, Methods: A self-administered questionnaire was mailed to 600 randomly selec ted pediatricians, family practice physicians, emergency medicine physician s and general practitioners, who practice in Saudi Arabia. Appropriateness of responses to questions was determined on the basis of current medical li terature. A rectal temperature of 38.0 degreesC is generally accepted as in dicative of fever in children. Results: Of the 600 physicians surveyed, 419 (70%) completed and returned t he questionnaire; 17% of the physicians were consultants, 28% specialists a nd 55% general practitioners. Fifty-eight percent of the physicians had 10 years or more of experience. A rectal temperature of less than 38.0 degrees C was considered to indicate fever by 38% of physicians. Nearly 84% of phys icians would initiate antipyretic therapy at a temperature of 38.5 degreesC or less and 56% cited a temperature of 40.0 degreesC or less to be dangero us. Only 5% believed that fever was not dangerous, while the remaining cite d the principal danger of fever to be convulsions (69%), brain damage (35%) , or death (8%). The responses to the main purpose of antipyretic treatment were to prevent convulsions (70%), to make the child comfortable (55%) and to prevent brain damage (29%). Approximately 53% of physicians reported th at the most serious consequences of febrile convulsions were brain damage, learning disability, epilepsy, or death. Only 26% of physicians agreed that a sleeping child with fever should be left undisturbed. Approximately 25% advised inappropriate dosage or administration intervals of paracetamol. Al most all physicians recommended sponging or bathing to reduce fever. All re spondents try to educate parents regarding fever and its management. Conclusion: A significant number of the surveyed physicians have demonstrat ed a serious lack of knowledge of the nature, dangers and management of an extremely common health problem. Physicians differ substantially in their k nowledge of, and attitude toward fever in children, which is perhaps attrib uted to their different background in medical education and clinical traini ng.