What is the first line treatment for pediatric fever?

First-Line Treatment for Pediatric Fever

Paracetamol (acetaminophen) is the preferred first-line treatment for pediatric fever to promote the child's comfort rather than focusing solely on normalizing body temperature. 1, 2

Understanding Fever in Children

Fever in children is a common clinical symptom that often causes parental concern. However, it's important to recognize that:

• Fever is not the primary illness but a physiologic mechanism with beneficial effects in fighting infection
• There is no evidence that fever itself worsens illness or causes long-term neurological complications
• The primary goal should be improving the child's overall comfort rather than normalizing body temperature

Treatment Approach

First-Line Medication

• Paracetamol (acetaminophen) is the preferred first-line antipyretic due to its safety profile 1, 3
  • Dosing: Based on weight rather than age 3
  • Administration: Oral route is preferable to rectal when possible 3
  • Purpose: To relieve discomfort associated with fever, not simply to reduce temperature 2

Alternative Options

• Ibuprofen can be considered as a second-line agent 4
  • Not recommended in children with chickenpox or dehydration 3
  • Not contraindicated in children with asthma 3

Important Considerations

• Physical methods of reducing fever (cold bathing, tepid sponging, fanning) are discouraged as they can cause discomfort 1, 3
• Combined or alternating use of antipyretics is generally discouraged in routine practice 3
• Antipyretics should be used only when fever is associated with discomfort, not simply to normalize temperature 2, 3

Special Populations

Children with Cancer/Neutropenia

For children with cancer who develop fever:

• Risk stratification is essential to determine appropriate management 1
• High-risk features include neutropenia (ANC <500/mm³), clinical instability, and central venous catheter presence 5
• For high-risk patients, monotherapy with antipseudomonal β-lactam or carbapenem is recommended 1, 5

Infants Under 12 Months

• Infants under 12 months with fever require special attention and consideration for lumbar puncture to rule out meningitis 1
• Newborns with fever should always be hospitalized due to elevated risk of severe disease 3

Patient Education Points

When counseling parents of a febrile child, emphasize:

• The child's general well-being is more important than the exact temperature
• Monitoring activity and observing for signs of serious illness
• Encouraging appropriate fluid intake
• Safe storage of antipyretics
• When to seek medical attention (persistent high fever, lethargy, poor feeding)

Common Pitfalls to Avoid

1. Focusing solely on temperature reduction rather than the child's comfort
2. Using physical cooling methods that cause discomfort
3. Administering antipyretics when there is minimal or no fever
4. Combining or alternating antipyretics unnecessarily, which may increase risk of dosing errors
5. Failing to dose antipyretics based on the child's weight

Remember that the goal of treating fever in children is to improve comfort, not necessarily to normalize temperature. Paracetamol (acetaminophen) remains the safest and most effective first-line option for most children with fever.