Background

Fever is one of the most common symptoms in children and one of the most frequent reasons for seeking medical care worldwide. However, the attitude towards it among parents and some healthcare workers is often irrational and anxious. This phenomenon, known as fever phobia, is well-studied in pediatrics and is described in various countries with different levels of social and medical structures [1].

International studies show that fever phobia is widespread globally - according to recent data, 57% to 74% of parents express severe anxiety when their child has a fever, and up to 50% believe that fever can lead to brain damage or even death of the child [2]. In a study from New Zealand, fever phobia was identified in 74% of parents, with nearly half of the respondents being extremely anxious about the mere fact of fever. Moreover, 62% of parents held at least one misconception about the consequences of fever in children: the danger of seizures, threat of respiratory arrest, brain damage, or death. In Korea, similar anxieties were noted in almost half of the parents, and 13% started giving antipyretics at temperatures below 38°C - not for medical indications, but "just in case". In the USA, Canada, and Australia, it has also been noted that up to 70% of parents consider fever dangerous, leading to excessive use of antipyretics and frequent emergency department visits for non-threatening conditions [3, 4].

In Russia, the situation is comparable: parental anxiety about fever, fears of febrile seizures, brain damage, and death are prevalent in 80-90% of families. More than 90% of patients with acute respiratory infections receive an antipyretic, and in 72% of cases, even with subfebrile temperature (below 38°C). Individual studies show that fever phobia is also characteristic of Russian doctors: 65% of pediatricians consider elevated temperature an independent risk factor and recommend reducing it by all available means, sometimes without considering clinical guidelines [5, 6, 7].

Despite numerous modern studies unequivocally demonstrating the protective role of fever in childhood (immunological activation, increased synthesis of interferons and antibodies), many parents continue to perceive it as a threat to the child's health. This leads to the following negative consequences: incorrect tactics for prescribing and administering antipyretics (exceeding dosage or frequency, using prohibited drugs or physical cooling methods with health risks); untimely consultation with a doctor (panic at safe temperatures, conversely, ignoring real signs of serious illness); and overloading medical facilities with false emergency cases.

Thus, both in Russia and abroad, educational work among parents and physicians regarding a rational approach to fever in children is relevant. The problem requires the active implementation of modern knowledge into daily practice - both in primary healthcare and in professional parental education. Studying the true beliefs of parents about fever, analyzing common mistakes, and forming constructive recommendations will significantly improve the quality and safety of medical care for children.

Objective

The objective of this study is a comprehensive investigation of mothers' beliefs and behaviors when caring for a child with fever at the outpatient stage, with a special focus on the prevalence and manifestations of fever phobia.

Materials and methods

A survey method was used to study mothers' attitudes towards fever in their children and the specifics of care provided when body temperature rises at the outpatient stage. The study involved 54 mothers with children aged 1 to 15 years who were observed between 2022 and 2024 in polyclinics and private medical centers in Yaroslavl. The average age of the examined children was 3.49 years.

The questionnaire consisted of questions covering several key aspects: frequency of temperature measurement, criteria for using antipyretics, preferred medications and formulations, intervals between doses, presence of allergic reactions to drugs, sources of information about treatment methods, use of physical methods to reduce temperature, and fears associated with fever.

Data were collected anonymously to ensure maximum honesty in responses. All questionnaires were carefully analyzed and statistically processed using Microsoft Excel. The main method of analysis involved calculating the percentage distribution of responses for each questionnaire item and identifying the most common patterns of behavior and opinions. This approach made it possible to establish quantitative parameters of mothers' behavior during childhood fever, identify main errors and misconceptions, and determine the frequency and reasons for using various pharmacological and physical methods of temperature reduction. The study results are used for further discussion and development of recommendations to optimize educational work with parents and healthcare professionals at the early stages of providing care to children with fever.

The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. All participants gave informed consent to participate in the study. The data were anonymized to maintain confidentiality.

Results and discussion

Analysis of 54 questionnaires completed by mothers revealed a wide range of behavioral and emotional responses to fever in a child, as well as specifics of care tactics.

The majority of mothers (40.7%) measure the child's body temperature 3-5 times a day, indicating a high level of anxiety and control over the child's condition. Meanwhile, 7.4% do this only 1-2 times a day, and such a low frequency is not always adequate for assessing the dynamics of the condition. Notably, a significant proportion of respondents (7.4%) measure the temperature 5-6 times a day, and 7.4% even 10-12 times a day, some - every 40 minutes or hour, which can cause additional stress for the child and increase parental anxiety.

Severe anxiety is observed in the choice of moment to start antipyretic therapy: only 1.8% of mothers give antipyretics at a temperature of 37.5-38.0 °C, while 79.6% start treatment at 38.0-39.0 °C, which aligns with generally accepted recommendations. However, 38.9% administer antipyretics at any temperature elevation, regardless of its level, reflecting widespread fever phobia and the risk of unnecessary medical intervention.

Interestingly, 18.5% use antipyretics for prophylactic purposes, which does not correspond to current clinical practice and can lead to undesirable consequences.

Only 1.8% of mothers strictly adhere to a 1-hour interval between doses. Other intervals vary: 14.8% maintain a 2-3 hour interval, 20.3% - 3-4 hours, 9.2% - 4-5 hours, and 20% - 6-8 hours. Such discrepancies may be due to insufficient awareness or irregular monitoring of the child's condition.

The most frequently used medications are ibuprofen (75.9%) and paracetamol (55.5%), which aligns with international and Russian recommendations. However, 14.8% reported using analgin (dipyrone), which is banned in pediatrics due to the risk of serious adverse effects. Various drug formulations are also used diversely: syrups (75.9%) remain the most preferred, followed by suppositories (27.7%), tablets (22.2%), while ampoule drugs and injections are rare (1.8% and 3.7%, respectively).

A serious finding is that 18.5% of mothers strive to reduce the temperature to the "conditional" norm of 36.6 °C, and 64.8% - to 37.0 °C. This indicates high anxiety and a lack of understanding of the physiological role of fever. Only a small portion (5.5%) focus on the safer threshold of 37.5-38.0 °C.

Allergic reactions were noted in 11.1% of children, most often to drugs like Ibuklin, Nurofen, and paracetamol. Only 35.2% of mothers receive dose calculations from doctors, 74.8% rely on the package insert, and 9.2% calculate the dose independently, which carries a risk of dosing errors and adverse effects.

It is noted that 7.4% of children received drugs banned in pediatric practice on the advice of relatives and acquaintances, and 31.5% received them based on a doctor's prescription, which necessitates a reassessment of the quality of medical care and educational work among healthcare professionals.

Physical methods of temperature reduction were used in 31.5% of cases, including vinegar rubdowns (25.9%), alcohol rubdowns (14.8%), cool compresses (24%), air baths (33.3%), and ice application (12.9%). Many of these methods are potentially dangerous and not recommended by modern pediatric protocols, reflecting the presence of myths and unreliable information among parents.

Common fears include the occurrence of seizures (18.5%), severe discomfort (22.2%), as well as rarer but more dangerous beliefs - intoxication by bacterial breakdown products, respiratory and cardiac arrest, brain damage, and dehydration. According to the survey, 81% of mothers consider elevated temperature a possible cause of their child's death, highlighting the high level of fever phobia. It is also interesting that 22.2% of respondents mistakenly believe that the absence of fever is a sign of low immunity, which contradicts the basics of physiology and immunology.

The study results confirm that fever phobia remains a significant problem in understanding and managing fever in children, both among parents and physicians. Incorrect behavior, including frequent unjustified temperature measurement, premature and excessive use of antipyretics, use of prohibited and inappropriate drugs, as well as dangerous physical methods, can lead to undesirable side effects, toxic reactions, and deterioration of the child's general well-being.

The detected high level of fear among parents requires strengthening information and educational work aimed at forming correct knowledge about the nature of fever, principles of its control, and safe tactics for providing care at home. Special attention must also be paid to the professional education of doctors to prevent the prescription of unproven or unsafe agents.

Such data are important for developing guidelines and protocols for managing fever at the outpatient level, as well as for creating educational programs for parents, which in the future will help reduce the burden on medical facilities and decrease the risk of complications.

Conclusions

Fever phobia is widespread among mothers of children of different ages and manifests as high anxiety and irrational fears, such as concerns about the occurrence of seizures, brain damage, respiratory and cardiac arrest, and possible death of the child when body temperature rises. The majority of parents measure the child's temperature multiple times, indicating a high level of stress and unjustified anxiety. There is a tendency towards premature and excessive use of antipyretics: a significant proportion of mothers use them at any temperature elevation or use drugs prophylactically, which does not align with current clinical recommendations.

Furthermore, many parents use medications banned or not recommended in pediatrics, as well as unsafe physical methods to reduce temperature - vinegar and alcohol rubdowns, ice application - which can lead to complications and worsening of the child's condition. Insufficient adherence to recommended intervals between antipyretic doses increases the risk of overdose and side effects. Drug doses for most children are calculated incorrectly: only a small portion are prescribed by doctors, while the majority of parents rely solely on the instructions or determine the dose themselves, increasing the likelihood of errors.

The high level of fear and low awareness among parents necessitate the active implementation of educational programs aimed at forming correct beliefs about the nature of fever, its physiological role, and safe methods of temperature control. Additional training for healthcare professionals is also required to improve the quality of recommendations and eliminate the prescription of inappropriate or unsafe agents. Conducting systematic educational conversations for parents and including a section on "Fever" in training programs for pediatricians and primary care physicians will contribute to optimizing the management of children with fever, reducing the level of fever phobia, and improving treatment outcomes.