Treating children with paracetamol using appropriate paracetamol dose and temperature controls Abstract

Treating children with paracetamol using appropriate paracetamol dose and temperature controls Abstract

Treatingchildren with paracetamol using appropriate paracetamol dose andtemperature controls

Abstract Child fever is one of the most frequent causes of concernto both parents and pediatricians. Some parents administerantipyretics to their children as soon as they notice any slightchange in temperature since they are of the illusion that a baby’stemperature should remain ‘normal’. Parents should understandthat fever does not worsen an illness but instead is a physiologicmechanism aimed at fighting an infection (Anderson &amp Woollard,1996). Numerous amount of research has been done to determine iffever worsens an infection or if it causes long-term neurologiccomplications, but none has been able to prove this theory.Therefore, a pediatrician focus should be more on treating the causeof the fever and not the normalizations of the child’stemperature. Some of the factors that should beconsidered when counseling a sick child’s parents are safe storageof the paracetamol medication, amount of fluids that the child shouldtake, the general well-being of the child, observing changes in thechild’s behavior, among others. The safety and effectiveness ofparacetamol and ibuprofen in treating a child with fever are notdifferent (Autret et al., 1997). It has also been found out thatcombining the two products would be more effective than using onesingle agent to treat child fever. However, it would be morecomplicated to monitor the progress of a child treated with acombined dose. Patient safety should be promoted by pediatricians,through drafting simplified formulas andinstructions.Introduction Childfever ever is among one of the most common symptoms treated bypediatricians, and other well averse healthcare providers. Accordingto (W.H.O, 2007) statistics, fever accounts for almost one-third ofall conditions that are treated by pediatricians. As soon as a parentor a child’s caregiver notices any slight change in the child’stemperature panic starts striking in. The parent is forced to visitthe physician or call in for advice at odd hours on how to controlthe fever. Since parents are of the illusionthat the baby’s temperature should be ‘normal’, their priorityis to find a way to reduce the temperature to the ‘normal’ level.A majority of parents, therefore, give antipyretics medication totheir children despite the fever being minimal. W.H.O (2007)statistics data indicate that over half of parents and childcaregivers consider temperatures of less than 38°C (100.4°F) to bea fever, while 24%-25% would administer antipyretics to childrenwhose temperatures are lower than 37.8°C (100°F). Additionally, 85%of parents confess to waking up their children with feverish symptomsto administer antipyretics. It has, however, been noted quite asignificant number of parents do not administer the correct dose ofantipyretics to their children. Statistically, 15% give wrong dosesof acetaminophen or ibuprofen. It is important for child caregiversto note that fever dosing should be based on a child’s weightrather than the age or height (Pendeville et al., 2000). In doing so,parents would administer the correct dose to their sick children. Despite the disparities between the views of parents andpediatricians on the issue of antipyretic treatment, the primarysource of information on how to manage fever comes from nurses andpediatricians. Pediatricians suggest that antipyretic therapy shouldonly be initiated when a child’s temperature goes beyond 38.3°C(101°F) (Kumpulainen et al., 2007). Statistics indicate only 13% ofpediatricians agree child discomfort is an indicator for use ofantipyretic drugs, while 80% are of the idea that a child should notbe woken up specifically to be administered with antipyreticmedication (W.H.O, 2007). Pediatricians are in support of antipyretictherapy performed by parents, and they should, therefore, giveappropriate counseling to parents on the use of antipyretics as amethod of treating child fever.Physiology of feverMajority of parents and child caregivers do not understandthat fever is not an illness but is a psychologic mechanism that thebody uses to counter infection (Anderson &amp Woollard, 1996). Thepresence of fever in the body inhibits the growth and multiplicationof viruses and bacteria that make a condition worse. Neutrophilproduction and the proliferation of T-lymphocyte which is enhanced byfever aid the body to counter the infection (Riad &amp Moussa,2007). It is also important to understand that most fevers run onlyfor a short duration, and the degree of fever is not always in unisonwith the worsening of the condition. According to (Anderson &ampWoollard, 1996), fever helps the body to recover more quickly fromviral infections as opposed to bacterial infections, although it maypose a certain degree of discomfort in children. It has not been conclusive on whether treating fever with ibuprofen,which is an antipyretic or a combining it with acetaminophen,increases the risk of complications of various infections (Hyllestedet al., 2002). Reducing fever using antipyretic medication, however,does come with its benefits. It helps the body to reduce the loss ofwater that contributes to patient dehydration, and also the reductionof a patient’s discomfort. On the other hand, lowering a patient`sfever may contribute to a delay in the diagnosis of the conditionthat a patient is suffering from, and thus wrong medication might beadministered to the patient.(W.H.0, 2007)research, concludes that children with fever, as compared to thosewith hyperthermia, are not at risk of suffering serious complicationssuch as brain damage. Fever is a physiologic response thatcontributes to an increase in the body’s hypothalamic set pointbeyond the normal range is 36-37°C (98-100F) (Kramer et al., 1991). Hyperthermia, on the other hand, is a rare pathophysiologic responsethat occurs when the body’s heat production is more than that itcan dissipate (Kramer et al., 1991). Some of the most commoncharacteristics of hyperthermia are a hot and dry skin, dysfunctionof the central nervous system that usually contribute to seizures andcommas.Temperatures beyond 41°C to 42°Cresult in adverse physiologic effects that generally contribute tohyperthermia. According to (Cranswick &amp Coghlan, 2000), mostpeople believe that temperatures above 40°C (104°F), contribute toan increased risk of heat-related conditions. For example, a toddlerwith a temperature of 40°C (104°F), as a result of a simpleillness, is different from another child with the same temperaturewhich is attributable to a rise in environmental heat. It istherefore quite complicated to extrapolate similar outcomes fromvarious illnesses.Treatment goals In order to determine whether the use of antipyretics should beappropriate in treating child fever, therapeutic end points must beput into consideration. It is important that when physicians counselparents and caregivers, they should emphasize on the comfort of thechild rather than the degree of fever. A child’s overall wellbeingshould be the primary goal of treating a sickly child. According toRussell et al. (2003), a febrile child has the followingcharacteristics decreased oral intake, reduced sleep, and alteredactivity levels. However, minimal research has been conducted todetermine the extent to which antipyretic medications improvediscomfort levels that are a result of fever. Some parents orcaregivers use external methods of cooling, such as sponge baths tonormalize a baby’s body temperature. Nevertheless, the use ofsponge baths is not advisable because the body can absorb some of thealcohol. Other clinical outcomes ofantipyretics such as analgesia may enhance their overall clinicaleffect. Many pediatricians still advocate for the use of antipyreticsregardless of the extent to which they work. They believe that theuse of antipyretics comes with accompanied benefits such as improvedcomfort, improved activity levels such as feeding, and reduced bodyirritation (Anderson, 1998). These being some of the most significantadvantages of the use of antipyretic medication, it is ofsignificance that physicians focus on them while giving parentalcounseling.There should be a balance onimproving the overall wellbeing of a child and merely the urge oflowering the body temperature (Anderson, 1998). Concern over theinjurious effect that fever poses on children by parents, nurses andphysicians has led to a description known as “fever phobia”.Parents and caregivers believe that if a child suffers from a highfever and is not treated, the child will suffer from seizures andbrain damage that will eventually lead to death. The creation of thisundue concern by physicians over the diverse effects of fever hasclearly no relationship with the risks. Parents should, therefore,not suffer from nomorthemia by waking up their children at night totreat them of fever.While there is no proofpointing out that reduced fever reduces child mortality from childrensuffering from a febrile illness, it should be noted that it does soto those suffering from chronic diseases (Boussetta et al., 2005).These types of disorders may result in limited metabolic reservessince these children’s bodies cannot handle increased metabolicdemands brought about by fever. Moreover, antipyretic therapy inchildren does not decrease the recurrence of seizures. Pretreatment with acetaminophen or ibuprofen is recommendedas a routine practice by a majority of pediatricians before a childgets immunized (Boussetta et al., 2005). This is to reduce thediscomfort that comes with the injections at the clinic and tominimize on a child’s febrile response. A recent study showed thatto reduce a child’s immune response to vaccines, treat the childearly with antipyretics. There has been minimal research on theeffects that fever poses to children and the benefits of antipyretictherapy. However, it is important to highlight that one of the mostimportant therapeutic objectives is the improvement in a patient`scomfort. Besides, there is limited evidence on whether temperaturereduction should be the primary goal in the treatment of fever usingantipyretics.Acetaminophen Paracetamol which is also referred to as acetaminophen replacedaspirin as the most preferred treatment method of fever after itemerged that there was a linkage between salicylates and Reyesyndrome. Safe does of acetaminophen are in the region of 10 to 15mg/kg and should be administered every six hours. Statisticsindicates that approximately 80% of children will feel the effectacetaminophen 30 to 60 minutes after taking the dose.AntipyreticInformation Despite physicians coming up withalternative dosing regimens, there is limited evidence to concludethat using an oral 30 mg/kg per dose or an injection of 40 mg/kg perdose, improves the efficiency of acetaminophen therapy in children(Würthwein et al., 2005). The use of a higher dose of injection isrecommended during surgery but not in normal clinical conditions. Theuse of a higher dose of acetaminophen in a typical clinical conditionwould lead to hepatotoxicity, which is very harmful to the body. Itis, therefore, advisable not to use such kind of doses. Cases of hepatotoxicity as a result of using the correctdose of acetaminophen are very rare. It is only in cases of acuteoverdosing that hepatotoxicity is likely to occur (Sheth et al.,1980). Moreover, physicians have been concerned over the possibilityof hepatitis as a result of a chronic overdose of acetaminophen. Oneof the most common and highly reported cases of patient overdoseoccurs in children. Cases have been reported where children receivemultiple supratherapeutic doses (15 mg/kg per dose) at closeintervals of less than four hours. In case a child receives a dose ofacetaminophen that was intended for an adult, the child may sufferfrom supratherapeutic dosing. A safety concern, however, is theeffect of acetaminophen children with asthma (Barr, 2008).

Ethicaland cultural issues of New Zealanders

Overthe last half-century, New Zealand which was traditionally a countryonly made up of two cultures has now become more diverse in terms ofethnicity and culture. The implication is that the country now hasmore responsibility to its indigenous population. Census data from2001 indicates that 67.6% were European New Zealanders while theMaori took up 14.6%.

Dueto the poor recruitment of nurses belonging to indigenous groups suchas the Maori, the New Zealand Nursing Council in 1992 came up with aconcept known as CulturalSafetythat would guard against how healthcare professionals work. Theconcept focuses more on the work ethic of nurses and healthcareprofessionals rather than the consumers of healthcare. Patients haveto fill in a form describing whether they were treated as well asthey wished. According to Cooney “unsafepractitioners diminish, demean and disempower those of othercultures, whilst safe practitioners recognize, respect andacknowledge the rights of others”(Cooney, 1994, p. 6).

Culturalsafety is important as focuses on the culture of diverse ethnicgroups. A nurse is more likely to take better care of a patient thatthey understand their culture, than one who they do not. A nurse whois culturally safe will focus more on the safe understanding of thepatient and the values that he/she brings to the practice.

Instructionsto parents and caregiversPediatricians needto counsel parents and on the correct usage, dosage and dosinginterval of acetaminophen and ibuprofen. In doing so, they will notonly be enhancing the safety of the children but also providinginsightful information that parents can pass to their peers. Whentreating child fever, parents should be careful not to administermedication used to treat cough and cold that contains acetaminophenand ibuprofen to their children as they also contain antipyretics(Barr, 2008). This is to counter the effect of an overdose on thechild. Moreover, there lacks proven research on the use of combinedproducts to treat child fever. Use of only one formulation should beadvocated for children that require liquid preparations. According tostatistics, over 80% of emergency room visits by children are as aresult of the overdose of Acetaminophen. Therefore, parents andcaregivers should learn how to handle and administer antipyretics totheir children.Summary Pediatricians need to make sure that they make parents understandthat fever by itself cannot harm a healthy baby. A fever may actuallyshow that the body is responding well to the pathogens infecting thebody. It, therefore, should be noted that the primary aim inantipyretic therapy is to improve the wellbeing of the child and notto lower its body temperature. If antipyretics such as Acetaminophenand Ibuprofen, are in the appropriate manner, they can be veryeffective. However, if not used in the right dosage, they might leadto toxicity and complicate the condition. The combination ofacetaminophen and ibuprofen as a combination therapy in children mayresult in an overdose. Pediatricians, must, therefore, be verycareful when administering such doses. The only way to minimize“fever phobia” in parents and caregivers is by pediatriciansemphasizing that use of antipyretics does not prevent seizures andbrain damage. Focus should instead be looking out for serious signsof illness, improving the comfort of a child, and advising parentsand child caregivers on the correct dosage of antipyretics.Pediatricians should only advocate for a single method ofadministering the dosage of acetaminophen and ibuprofen and alsoprovide clear dosage instructions, in order to promote child safety.


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