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Systematic Review ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Pediatr. | doi: 10.3389/fped.2018.00279

Symptomatic management of febrile illnesses in children: a systematic review and meta-analysis of parents’ knowledge and behaviors and their evolution over time

 Nathalie BERTILLE1, 2*,  Edward Purssell3, Nils Hjelm1,  Natalya Bilenko4,  Elena Chiappini5,  Eefje de Bont6, Michael Kramer7,  Philippe Lepage8,  Sebastiano Lava9, 10, Santiago Mintegi11, Janice Sullivan12, Anne Walsh13,  Jérémie F. COHEN1, 2 and  Martin Chalumeau1, 2
  • 1INSERM U1153 Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité, France
  • 2Department of General Pediatrics and Pediatric Infectious Diseases, Necker-Enfants Malades Hospital, France
  • 3Florence Nightingale Faculty of Nursing and Midwifery, King's College London, United Kingdom
  • 4Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
  • 5Department of Health Science, Azienda Ospedaliero Universitaria Meyer, Italy
  • 6Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Netherlands
  • 7Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
  • 8Queen Fabiola Children's University Hospital, Belgium
  • 9University Children’s Hospital Bern, Switzerland
  • 10Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Switzerland
  • 11Pediatric Emergency Department, Universidad del País Vasco, Spain
  • 12Department of Pediatrics, University of Louisville, United States
  • 13Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia

Recommendations to guide parents' symptomatic management of febrile illnesses in children have been published in many countries. The lack of systematic appraisal of parents' knowledge and behaviors and their evolution over time precludes an analysis of their impact and identification of targets for future educational messages.
We systematically searched for studies published between 1980 and 2016 that reported a quantitative evaluation of knowledge and behaviors of >50 parents for managing fever in children. We used MEDLINE and tracked related articles, citations and co-authors personal files. Study selection and data extraction were independently performed by 2 reviewers. For each item of knowledge and behaviors, we calculated mean frequencies during the first and last quinquennials of the studied period and assessed temporal trends with inverse-variance weighted linear regression of frequencies over years.
We observed substantial methodological heterogeneity among the 62 included articles (64 primary studies, 36,791 participants, 30 countries) that met inclusion criteria. Statistically significant changes over time were found in the use of rectal (98% to 4%) and axillary temperature measurement (1% to 19%), encouraging fluid intake (19% to 62%), and use of acetylsalicylic acid (60% to 1%). No statistically significant change was observed for the accurate definition of fever (38% to 55%), or the use of acetaminophen (91% to 92%) or ibuprofen (20% to 43%).
Parents' knowledge and behaviors have changed over time but continue to show poor concordance with recommendations. Our study identified future targets for educational messages, including basic ones such as the definition of fever.

Keywords: Health Behavior, Child, Fever, Parents, Meta-analysis

Received: 24 May 2018; Accepted: 13 Sep 2018.

Edited by:

Rianne Oostenbrink, Erasmus Medical Center, Erasmus University Rotterdam, Netherlands

Reviewed by:

Jean-ralph Zahar, Hôpital Avicenne, France
Beatriz Larru Martinez, Alder Hey Children's Hospital, United Kingdom  

Copyright: © 2018 BERTILLE, Purssell, Hjelm, Bilenko, Chiappini, de Bont, Kramer, Lepage, Lava, Mintegi, Sullivan, Walsh, COHEN and Chalumeau. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: PhD. Nathalie BERTILLE, INSERM U1153 Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité, Paris, France, nathalie.bertille@inserm.fr