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correct time. The Health Protection Agency have produced an algorithm for vaccination in those with incomplete or uncertain vaccination status.7


Although fever commonly occurs after vaccina-


tion, this is part of the normal immune response and may be important in the development of acquired immunity. There is some evidence that the prophylactic use of paracetamol at the time of vaccination may blunt the antibody response to some vaccines,8


feels that all of the improvement is due to the reduction in fever, this may incorrectly increase their belief in the effectiveness of antipyret- ics as a general cure. Furthermore, there is no evidence that prophylactic use of these drugs prevents febrile convulsions.5 Because fever is a physiological response caused by pyrogens


so


this is no longer recommended, although advice about the safe use of antipyretics at a later time should still be given.9


ANTIPYRETIC AND PHYSICAL TREATMENTS. The fears that many parents and professionals have with regards to fever is well documented,10


and while fever is associated with


serious infections, it is the infection rather than the fever itself that is dangerous. Although antipyretic drugs are widely used and generally safe, both of the two main drugs used, paracetamol and ibuprofen, have toxicities and side-effects. While ibuprofen appears to have a slightly better antipyretic and analgesic profile, particularly that it has a longer effect time, there is little to choose between them in this regard.11 Paracetamol is associated with liver toxicity in large doses which


may be exacerbated by dehydration, malnourishment, fever and some drugs which are listed in the British National Formulary for Children.12


and in Ibuprofen has been linked to serious skin infections and


renal failure, and although the evidence for both is limited, it is suggested that it is used with care in children with infections such as varicella, where there is a risk of secondary infections,13 children who are dehydrated.14


Both drugs may be associated with


exacerbations of asthma, although this is rare.15 Although parents may report that their child has been better


since the administration of antipyretics, it is important to remember that these drugs inhibit a range of symptoms associated with the acute response to infection, including pain and inflammation, and this may be responsible for some of the recovery that appears associated with antipyresis.1


This is important because if a parent


resetting the hypothalamus at a higher level, the new high temperature will be ‘normal’ as far as the hypothalamus is concerned. Therefore physical methods, in the absence of antipyretic drugs, will serve only to cool the body, which will then return to the higher level. In its most extreme form this will result in rigours - shivering while febrile as a method of returning an inappropriate cooled body to the temperature of the hypothalamus. Thus tepid sponging, undressing and fanning have little effect on temperature in the absence of antipyretic medication, although they are also very unlikely to do any harm.16


‘While fever is associated with serious infections, it is the infection rather than the fever itself that is dangerous’


CONCLUSION Fever is a common symptom in children, most commonly reflecting only minor illness. However, a small number of children will have more serious infections, and the NICE ‘traffic light’ system can be used alongside parental and professional assessment to help differentiate these children. Parents and carers should also always be given ‘safety net’ advice about whom to contact and under what circumstances if the child does not get better.


REFERENCES 1. Blatteis CM. Fever: pathological or physiological, injurious or beneficial? Journal of Thermal Biology 2003;28(1):1-13.


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