Fever as a chief complaint in a pediatric emergency room

Fevers in children have been shown to be a common chief complaint presented to physicians both in the clinic and emergency room setting. Much literature is available concerning the causes, treatment, possible benefits, and dangers of fever. Although the causes of fever in most instances have been found to be benign and self-limiting, parents are concerned enough about this symptom to seek help in an emergency room. Thirty parents who brought their children to a pediatric emergency room with fever as the chief complaint were interviewed to examine why they were concerned about fever. Their perceptions of fever, past experiences, usual methods of treatment, and source of information regarding fever were investigated. Most parents perceived fever as an unknown danger. Their biggest fear was the possibility of brain damage. All the parents were able to describe behavioral changes such as irritability and decreased appetite that occurred in conjunction with the fever. They did not seem to relate the present febrile episode to past experiences, although 77% of the parents had prior experience with a febrile illness. The parents were found to be quite aggressive in their treatment of fever, using antipyretic measures as well as physical measures such as tepid baths. Although 87% of the parents reported having a private physician, 66% reported never having received instructions about fever from a physician. None of the children in this investigation was found to have a life-threatening illness. When asked why they chose to use an emergency room instead of their private physician, 53% of the parents mentioned reasons relating to the availability of their physician. Diagnostic studies were done on 57% of the children. None of the studies affected the diagnoses except to rule out more serious illness. Medical personnel need to be more aware of a parent's concerns about fever and provide information to help them understand fever, its causes, and therapy. Both fever and behavioral observations should be used as diagnostic tools.