FEVER: Are we right to hit the panic alarm?

While on the subject of common childhood ailments, another one right at the top of the pile is fever. Once upon a time a child with a fever was put to bed and given chicken soup, but today – because of scares of meningitis and streptococcal sepsis – the emergency services are put on full alert.

Any child with a fever, rushed into hospital by a concerned parent, will go through a battalion of tests and an overnight stay of ‘watchful waiting’. Indeed, this is now considered best practice in America, and any doctor who fails to follow the protocol could be charged with neglect.

All well and good, and certainly understandable, but does it actually make any difference? In other words, have fewer children developed a more serious condition, or, indeed, died, because of the high alert procedures compared with the previous standard care?

The answer is unclear, but the new practice has had an enormous strain on hospital beds and lab tests, as one study has discovered.

Researchers from the University of California tracked the progress of 3,066 infants who all had temperatures of at least 38 degrees C (100 degrees F). Of these, 36 per cent stayed on in hospital, 75 per cent had laboratory tests, and 57 per cent were treated with antibiotics. Some bacterial infection was detected in 1.8 per cent of cases, and 0.5 per cent indeed had bacterial meningitis.

Would the cases of meningitis have been spotted any way? In all likelihood they would have been, not that anxious parents care less about the strain on hospital resources, and rightly so.

The verdict still has to be that American pediatricians in particular are over-reacting to what is, in 99 per cent of cases, a common and benign childhood condition.

But if it’s your child, and he happens to be in the 1 per cent, cold statistics count for nothing, we know.

(Source: Journal of the American Medical Association, 2004; 291: 1203-12).

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Written by What Doctors Don't Tell You

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