title: Management of fever in children: summary of the Italian Pediatric Society guidelines.
abstract: OBJECTIVE
  This article summarizes the Italian Pediatric Society guideline on the management of the signs and symptoms of fever in children, prepared as part of the National Guideline Program (NGLP).
  
  
  METHODS
  Relevant publications in English and Italian were identified through searches of MEDLINE and the Cochrane Database of Systematic Reviews from their inception through December 31, 2007. Based on the consensus of a multidisciplinary expert panel, the strength of the recommendations was categorized into 5 grades (A-E) according to NGLP methodology.
  
  
  CONCLUSIONS
  In the health care setting, axillary measurement of body temperature using a digital thermometer is recommended in children aged <4 weeks; for children aged > or =4 weeks, axillary measurement using a digital thermometer or tympanic measurement using an infrared thermometer is recommended. When body temperature is measured at home by parents or care-givers, axillary measurement using a digital thermometer is recommended for all children. Children who are afebrile when seen by the clinician but are reported to have had fever by their caregivers should be considered febrile. In special circumstances, high fever may be a predictive factor for severe bacterial infection. Use of physical methods of reducing fever is discouraged, except in the case of hyperthermia. Use of antipyretics-paracetamol (acetaminophen) or ibuprofen-is recommended only when fever is associated with discomfort. Combined or alternating use of antipyretics is discouraged. The dose of antipyretic should be based on the child's weight rather than age. Whenever possible, oral administration of paracetamol is preferable to rectal administration. Use of ibuprofen is not recommended in febrile children with chickenpox or dehydration. Use of ibuprofen or paracetamol is not contraindicated in febrile children with asthma. There is insufficient evidence to form any recommendations concerning fever in children with other chronic conditions, but caution is advised in cases of severe hepatic/renal failure or severe malnutrition. Newborns with fever should always be hospitalized because of the elevated risk of severe disease; paracetamol may be used, with the dose adjusted to gestational age. Use of paracetamol or ibuprofen is not effective in preventing febrile convulsion or the adverse effects of vaccines.
authors.affiliation: Department of Pediatrics, University of Florence, I-50139 Florence, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Chiappini
authors.forename: Nicola
authors.initials: N
authors.lastname: Principi
authors.forename: Riccardo
authors.initials: R
authors.lastname: Longhi
authors.forename: Pier-Angelo
authors.initials: PA
authors.lastname: Tovo
authors.forename: Paolo
authors.initials: P
authors.lastname: Becherucci
authors.forename: Francesca
authors.initials: F
authors.lastname: Bonsignori
authors.forename: Susanna
authors.initials: S
authors.lastname: Esposito
authors.forename: Filippo
authors.initials: F
authors.lastname: Festini
authors.forename: Luisa
authors.initials: L
authors.lastname: Galli
authors.forename: Bice
authors.initials: B
authors.lastname: Lucchesi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mugelli
authors.forename: Maurizio
authors.initials: M
authors.lastname: de Martino
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000009:adverse effects; D000367:Age Factors; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage* / Q000009:adverse effects; D001365:Axilla; D001831:Body Temperature; D001835:Body Weight; D002648:Child; D005334:Fever / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007052:Ibuprofen / Q000008:administration & dosage / Q000009:adverse effects; D007231:Infant, Newborn; D007558:Italy; D017410:Practice Guidelines as Topic; D012955:Societies, Medical; D013821:Thermometers; D014432:Tympanic Membrane
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen; D007052:Ibuprofen