ORIGINAL ARTICLE Pediatrics http://dx.doi.org/10.3346/jkms.2013.28.11.1639 • J Korean Med Sci 2013; 28: 1639-1644 Fever Phobia in Korean Caregivers and Its Clinical Implications Young Ho Kwak,1 Do Kyun Kim,1 Fever is the most common complaint among children brought into the emergency Hye Young Jang,2 Jin Joo Kim,3 department (ED). ‘Fever phobia’ is a descriptive term for an unrealistic concern about the Jeong-Min Ryu,4 Seong Beom Oh,5 consequences of fever. ‘Fever phobia’ is prevalent among parents and even healthcare Eui Jung Lee,1,6 Ji Sook Lee,7 providers, worldwide. The aim of this study was to determine the implications of fever- 8 9 Jin Hee Lee, Jin Hee Jung, phobic ideas in Korean caregivers. A prospective, multi-center survey was conducted on 10 and Seung Baik Han Korean caregivers who visited the EDs with febrile children. In total, 746 caregivers were enrolled. The mean age of the subjects was 34.7 yr (SD ± 5.0). Three hundred sixty 1Department of Emergency Medicine, Seoul National University College of Medicine, Seoul; respondents (48.3%) believed that the body temperature of febrile children can reach 2Department of Emergency Medicine, higher than 42.0°C. Unrealistic concerns about the improbable complications of fever, Soonchunhyang University Seoul Hospital, Seoul; such as brain damage, unconsciousness, and loss of hearing/vision were believed by 295 3 Department of Emergency Medicine, Gachon (39.5%), 66 (8.8%), and 58 (7.8%) caregivers, respectively. Four hundred ninety-four University Gil Hospital, Incheon; 4Pediatric Emergency Center, Department of Emergency (66.2%) guardians woke children to give antipyretics. These findings suggest that fever Medicine, Asan Medical Center, Seoul; 5Department phobia is a substantial burden for Korean caregivers. of Emergency Medicine, Dankook University College 6 of Medicine, Cheonan; Graduate School of Key Words: Fever; Caregivers; Attitudes; Practice Variation Medicine, Department of Social and Preventive Medicine, Inha University, Incheon; 7Department of Emergency Medicine, Ajou University School of Medicine, Suwon; 8Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam; 9Department of Emergency Medicine, Seoul Metropolitan Boramae Medical Center, Seoul; 10Department of Emergency Medicine, Inha University College of Medicine, Incheon, Korea Received: 22 April 2013 Accepted: 17 September 2013 Address for Correspondence: Hye Young Jang, MD Department of Emergency Medicine, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul 140-743, Korea Tel: +82.2-709-9790, Fax: +82.2-710-3199 E-mail: [email protected] INTRODUCTION and ‘death’ respectively. Consequently, 63.5% of parents answer­ ed that they were very worried about fever. Schmitt (3) coined a Fever is one of the most common complaints among children descriptive term for this misconception as ‘fever phobia’ in the brought to medical attention (1). Because fever is not a disease early 1980s. but a symptom, healthcare providers should focus on determi­ Since then, some studies have described universal ‘fever­pho­ ning the probable cause(s) of the fever, rather than controlling bic’ ideas in parents, and even healthcare providers, in several the body temperature. However, previous studies have shown countries in diverse clinical settings (4­8). Although ‘fever pho­ that caregivers and healthcare providers have unrealistic fears bia’ seems to be a result of the lack of awareness of scientific regarding the consequences of fever (2­5). facts, the clinical implications can be substantial. An uncorrect­ According to a cornerstone survey conducted in the United ed fever phobic idea in parents and healthcare providers may States, a substantial number of caregivers have the unrealistic lead to unhealthy practices and poor management of febrile idea that fever can result in brain damage or even death (2). The children. For example, undue concerns regarding fever may survey showed that 12% of parents had an incorrect definition cause caregivers to give antipyretic agents more frequently than of clinically important fever, and surprisingly, 46% and 8% of recommended and to inappropriately wake a sleeping child parents believed that fever, in itself, could cause ‘brain damage’ just to give antipyretics. Fever­phobic ideas may also result in © 2013 The Korean Academy of Medical Sciences. pISSN 1011-8934 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. eISSN 1598-6357 Kwak YH, et al. • Fever Phobia in Korean Caregivers inappropriate use of medical resources. O’Neill­Murphy et al. and economic levels), 2) the children’s clinical history (febrile (9) reported that appropriate education could reduce fever pho­ convulsions, hypothermia caused by antipyretics), 3) knowl­ bia in caregivers. edge of fever and antipyretics (definition of fever, possible max­ The social burden of fever phobia should be studied in order imum body temperature due to the fever, possible adverse events to provide appropriate awareness and education regarding fe­ in fever, commercial/generic names of antipyretics used), and ver phobia in parents and healthcare providers. However, the 4) practice and management of febrile children (correct use of a extent and the level of fever phobia in guardians of young chil­ thermometer, fever­measuring method and frequency, use of a dren have not been examined in Korea. The aim of this study tepid bath and the liquid used for a tepid bath, and manage­ was to determine the implication of fever phobia in Korean ment of persistent fever despite antipyretics). caregivers. We investigated the diverse features and effects of We also analyzed whether the sociodemographic factors of fever­phobic ideas, including knowledge, experience, practice, the respondents may influence their ‘ideas on fever, such as the and management of fever. We also sought to determine proba­ major concern on the consequences of fever’ and ‘manage­ ble sociodemographic factors associated with fever phobia. ment of fever, such as the way antipyretics are administered’. MATERIALS AND METHODS Data analysis We used the chi­square test and the Cochran­Mantel­Haenszel Study design, setting, and population test for categorical variables. All tests were two­tailed and a P This study was a prospective multi­center survey of Korean care­ value of 0.05 was considered to indicate statistical significance. givers who brought a child (aged between 6 months and 7 yr) to All statistical analyses were performed using the SAS software a participating emergency department (ED) due to febrile ill­ (ver. 9.2; SAS Institute, Inc., Cary, NC, USA). nesses. From May to August 2008, a cross­sectional survey was conducted in six tertiary referral hospitals in the Seoul metro­ Ethics statement politan area, Gyeonggi­do, and Chungcheongnam­do in the This study was approved by the institutional review board of the Republic of Korea. The selected areas included the two areas Seoul National University College of Medicine (No. H­0803­045­ with the largest pediatric population in the country, Seoul met­ 238). The researchers at each hospital obtained an informed ropolitan area and Gyeonggi­do. consent before conducting the survey. Study protocol RESULTS Trained research assistants (resident physicians or nurses) ap­ proached the parents/guardians, mainly during the day time Demographics of subjects (from 9 am to 5 pm). Caregivers who agreed to participate were In total, 746 subjects were enrolled (Table 1). All caregivers were enrolled. We excluded subjects who brought critically ill chil­ Table 1. Demographic data of the participating guardians dren to the ED or declined to participate in the survey. We also excluded foreign guardians, because the questionnaire was Variables No. of subjects % written in plain Korean. Age of child (yr) 0-1 104 13.9 1-3 164 22.0 After verbal consent to participate was obtained, a 30­item >3 149 20.0 questionnaire was administered to the caregivers during their Not answered 329 44.1 stay at the ED. When the survey was completed, the question­ Sibling(s) No. of a child None 249 33.4 ≥1 497 66.6 naires were collected by the attending physicians on duty. After Educational background of ≤ High school 196 26.3 the completion of the questionnaires, brief educational sessions caregivers ≥ College 527 70.6 on appropriate fever management, such as the correct way to Not answered 23 3.1 measure body temperature, cut­off values for clinically signifi­ Relationship to child Mother 558 74.8 Father 11 1.5 cant fever, and probable complications of fever and their proper Relatives, other 112 15.0 management (2, 3) were provided to the caregivers. Teacher, etc. 35 4.7 Not answered 30 4.0 Monthly income (US $) of ≤ $2,000 80 10.7 Key outcome measures the family $2,000-3,500 294 39.4 The questionnaire was developed after a review of similar pre­ $3,500-5,000 205 27.5 vious studies (2, 4, 6, 7). The newly developed questionnaire ≥ $5,000 126 16.9 Not answered 41 5.5 contained multiple­choice questions on the following items: 1) Attending day care Yes 319 42.8 socioeconomic and demographic data of subjects (age, gender, No 389 52.1 number of children, relationship to the children, educational Not answered 38 5.1 1640 http://jkms.org http://dx.doi.org/10.3346/jkms.2013.28.11.1639 Kwak YH, et al. • Fever Phobia in Korean Caregivers Koreans, and their mean age was 34.7 yr (SD ± 5.0, range 18­ trade names while 70 (9.4%) knew the generic names of the an­ 61). The female to male ratio was 1.8:1 (62.6% vs 34.3%). The tipyretics used in managing fever. Significant number of guard­ numbers of mothers, fathers, grandparents, and other relatives ians were also worried about—improbable—adverse events of among the subjects were 476 (63.8%), 234 (31.4%), 26 (3.5%), antipyretic agents, such as ‘resistance to antipyretics’ (41.9%) and 10 (1.3%), respectively.