7 out of 10 pre-school children will get a fever every year so it's very common. But it makes parents anxious and is obviously miserable for the child.
Guidelines published last year by the National Institute for Health and Clinical Excellence (NICE) say either ibuprofen or paracetamol can be used for children unwell or distressed with fever. But they say that, due to the lack of evidence, the two drugs should not be given together or alternated.
The researchers from the University of Bristol and the University of the West of England, recruited children who had a temperature between 37.8 and 41 degrees centigrade, due to an illness that could be managed at home. Children were randomised to receive either paracetamol plus ibuprofen, just paracetamol, or just ibuprofen.
The medicines were given over a 48-hour period, with the group of children on both paracetamol and ibuprofen receiving them as separate doses. This group received one dose of paracetamol every four to six hours (maximum of four doses in 24 hours) and then one dose of ibuprofen every six to eight hours (maximum of three doses in 24 hours).
The children's condition was followed up at 24 hours, 48 hours and at day five. The researchers found that in the first four hours children given both medicines spent 55 minutes less time with fever compared to those given paracetamol alone. But giving two medicines was not markedly better than just giving ibuprofen.
However, over a 24 hour period, children given both medicines experienced 4.4 hours less time with fever than those given just paracetamol, and 2.5 hours less time with fever than those just given ibuprofen.
Dr Alastair Hay, consultant senior lecturer in primary health care at the University of Bristol, who led the study, said he believed the current guidance was too cautious and he said: "Doctors, nurses, pharmacists and parents wanting to use medicines to treat young, unwell children with fever should be advised to use ibuprofen first. If more sustained symptom control over a 24-hour period is wanted, giving both medicines alternately is better than giving one on its own. However, parents should keep a careful record of when doses are given to avoid accidentally giving too much."
A spokeswoman for NICE said the 2007 guidance recommended that more research should be conducted on the effectiveness and safety of alternating doses of paracetamol and ibuprofen in reducing fever in children who remain febrile after the first fever-reducing medicine.
Professor Steve Fields, chairman of the Royal College of General Practitioners, advised parents and carers of children with fever to follow the NICE guidance. "We believe parents should keep it simple. We do not see at this moment any need to change the advice.
September 2008
 A normal temperature is between 36-36.8C (96.8-98.24F). In children, any temperature of 38C (100.4F) or above is considered high and is called a fever. To find out if your child has a fever, place a thermometer under your child's armpit or use a special ear thermometer. |
