title: Severity of illness and the use of paracetamol in febrile preschool children; a case simulation study of parents' assessments.
abstract: OBJECTIVE
  Misconceptions and exaggerated fear of fever may divert parents' attention from more predictive symptoms of childhood illness, such as appetite and level of activity. This study aims at exploring how specific predefined characteristics of febrile preschool children affected parents' assessment of the severity of the condition and the perceived need for treatment with paracetamol.
  
  
  METHODS
  Parents judged 24 constructed cases of febrile children with different levels of fever, appetite and activity, occurring at different times of the day. For each case they decided whether the child was moderately or severely ill, and whether or not they would prefer to administer paracetamol. Parents' decision-making was examined by discriminant analyses.
  
  
  RESULTS
  Of 466 invited parents, 267 supplied information about their families and 205 accepted to participate in judging constructed cases of febrile children. A total of 159 parents responded to all cases. When evaluating the severity of the illness, 119 parents (75%) responded to one or more of the four cues describing illness. Only one of four cues was used by 80 parents (67%), and 86 (72%) parents emphasized fever. When deciding to give paracetamol, one or more of four cues was used by 102 parents (64%), while 72 parents (71%) used only one cue, and 92 parents (90%) emphasized fever.
  
  
  CONCLUSIONS
  Parents focus on fever when they evaluate febrile illness and decide whether or not to give paracetamol. Educating parents to focus on their child's level of appetite or activity may improve management, especially when judgement is based on only one or two cues.
authors.affiliation: Department of General Practice and Community Medicine, University of Oslo, Oslo, Norway. per.lagerlov@medisin.uio.no
authors.forename: Per
authors.initials: P
authors.lastname: Lagerløv
authors.forename: Mitchell
authors.initials: M
authors.lastname: Loeb
authors.forename: Jorid
authors.initials: J
authors.lastname: Slettevoll
authors.forename: Ole-Christian
authors.initials: OC
authors.lastname: Lingjaerde
authors.forename: Arne
authors.initials: A
authors.lastname: Fetveit
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use*; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D001066:Appetite; D001831:Body Temperature; D002675:Child, Preschool; D003657:Decision Making; D016002:Discriminant Analysis; D005334:Fever / Q000188:drug therapy*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D009043:Motor Activity; D009664:Norway / Q000453:epidemiology; D010287:Parent-Child Relations; D016487:Parenting; D012044:Regression Analysis; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen