[The practice guideline 'Children with fever' (second revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].
The new version of the practice guideline 'Children with fever' has recently been published by the Dutch College of General Practitioners. There is no evidence to support antipyretic therapy in children with fever. Paracetamol (acetaminophen) is not advised for preventing seizures, but may be given to relieve other symptoms. Parents have a different attitude towards fever than do GPs. Parents are concerned about serious causes or complications of the fever. However, GPs are more interested in parameters other than fever. The practice guideline recommends that parents be advised and reassured, but also stresses that parents' concerns be considered as potential predictors of serious illness. Missed urinary tract infections can be a serious cause of fever. Therefore, urine should be examined in children younger than 2 years who are feverish with no apparent cause. Unfortunately, the guideline does not identify tropical diseases as a differential diagnosis. Finally, doctors must be alert to the possibility of dehydration. The complexity of identifying dehydrated children is discussed.
Licht-Strunk
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VU Medisch Centrum, afd. Huisartsgeneeskunde, Van der Boechorststraat 7, 108 BT Amsterdam. e.licht@vumc.nl
Koch
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D000082:Acetaminophen / Q000627:therapeutic use; D002648:Child; D003681:Dehydration / Q000150:complications / Q000175:diagnosis; D003937:Diagnosis, Differential; D005194:Family Practice / Q000592:standards*; D005334:Fever / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D009426:Netherlands; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012955:Societies, Medical; D016896:Treatment Outcome
D000082:Acetaminophen