ARTICLE IN PRESS

0020-7489/$ - se

doi:10.1016/j.ijn

�CorrespondE-mail add

anmerk@ath.fo

International Journal of Nursing Studies 45 (2008) 829–836

www.elsevier.com/locate/ijnurstu

What Greek mothers know about evaluation and treatment offever in children: An interview study

Vasiliki Matzioua,�, Hero Brokalakia, Helen Kyritsib, Pantelis Perdikarisc,Elpida Gymnopouloua, Anastasios Merkourisd

aSchool of Nursing, National and Capodistrian University of Athens, 123 Papadiamantopoulou St., Athens 11527, GreecebSchool of Nursing Technological Institute of Athens, TEI, Evias 31 St. Athens 15235, Greece

cChildren Hospital P&A Kyriakou, Thivon & Levadias St., Athens 11852, GreecedSchool of Nursing Technological Institute of Creta, TEI, 2, Alopis St., Athens 11852, Greece

Received 17 October 2004; received in revised form 10 March 2006; accepted 1 April 2006

Abstract

Background: Fever is one of the most common symptoms in childhood. Mothers’ insufficient knowledge about its

evaluation and treatment frequently leads to excessive fear and anxiety.

Objectives: To explore mothers’ knowledge concerning management of fever in their children, at home.

Design: Descriptive, correlational.

Settings: An emergency department of a pediatric hospital.

Participants: A total of 327 mothers with febrile children randomly selected in the waiting room.

Methods: Data collection was based on interviews by using a questionnaire which was specifically developed for this

study.

Results: Almost one out of three mothers (32.4%) evaluated fever as a temperature between 37–38 1C and the

38.1% of them considered that side effects could be a result of these temperatures. The majority of the mothers

(73.7%) administered antipyretics at body temperatures of 37–38.5 1C, usually without a medical instruction

(49.2%). Younger mothers with lower education levels and those who admitted to hospital for the first time

with children less than 12 months of age showed the poorest level of Knowledge about fever evaluation and

treatment.

Conclusions: Educational interventions by health care professionals aiming at educating young mothers with a low

educational level and those with a child younger than 12 months old who seek medical attention at hospital, for the first

time, are needed to dispel misconceptions about fever and to promote the appropriate management of the febrile child.

r 2007 Elsevier Ltd. All rights reserved.

Keywords: Children; Fever knowledge; Fever management; Home; Mothers

e front matter r 2007 Elsevier Ltd. All rights reserve

urstu.2006.04.021

ing author. Tel.: +302107461482.

resses: vmatziou@nurs.uoa.gr (V. Matziou),

rthnet.gr (A. Merkouris).

What is already known about the topic?

�

d.

Insufficient knowledge of parents concerning the

cause of fever in children and misconceptions about

its effects was reported nearly 30 years ago.

ARTICLE IN PRESSV. Matziou et al. / International Journal of Nursing Studies 45 (2008) 829–836830

�

Parental attitude towards fever treatment is usually

inappropriate.

�

In Greece, two studies in the past had reached to the

same conclusions.

What this paper adds

�

Greek mothers continue to have a very poor knowl-

edge of fever and of its proper management.

�

Young mothers with a low educational level and

those with a child younger than 12 months old had

the worst performance.

1. Introduction

Fever in children is one of the most common

symptoms for which parents seek medical and nursing

advice (Al-Eissa et al., 2000; O’Neill-Murphy et al.,

2001; May and Bauhner, 1992; Knoebel et al., 2002).

Parents frequently perceive fever as a disease rather than

as a symptom or sign of illness (Kai, 1996). Insufficient

knowledge of parents concerning the cause of fever and

their misconceptions about its effects on their children’s

health frequently lead to excessive fear and anxiety

(Rideout and First, 2001). This attitude was designated

‘‘fever phobia’’ (Schmitt, 1980).

Crocetti et al. (2001), found that 91% of parents

believe that fever can give rise to serious and permanent

complications in their children, such as encephalitis

(46%), convulsions (15%) and even death (8%). Accord-

ing to the researchers parental misconceptions about

fever have not changed in the last 20 years, and parents

continue to express excessive fear towards fever and take

inappropriate measures to treat it. In another study,

Sarrell et al. (2002) compared the attitude and behaviour

of doctors, nurses and parents towards fever. The results

showed that parents worried about the possibility of

brain damage three times more than the doctors, and they

considered a body temperature of below 38 1C that

should be treated, even without any signs of illness.

Impicciatore et al. (1997) studied the perceptions and

attitudes of 707 mothers towards fever and its treatment.

The researchers found that most mothers did not know

the measures that had to be taken in order to manage

fever. According to the results of another study

(Blumenthal, 1998), 75% of parents believe that the use

of a thermometer is the best method for evaluating fever

and 63.9% that the most effective treatment of fever is the

combination of antipyretics and physical means. Linder

et al. (1999) have found that 97.9% of parents use

pharmaceutical products for fever treatment and 57%

provide these products in unsuitable dosages, whereas

55.8% believe that antipyretics cause no side effects.

Two studies in Greece, in the past, have reached to the

same conclusions. In the first study, Anagnostakis et al.

(1983) found that parents had wrong perceptions about

fever and worried about temperatures that were

considered normal. In the second study it was found

that only 1.4% of parents correctly evaluated and

treated fever, whereas 64.6% used wrong dosages of

antipyretics (Mathioudakis et al., 1989).

The aim of the present study is the evaluation of

Greek mothers’ current knowledge and attitude towards

fever in children.

2. Methodology

2.1. Study sample

The study sample consisted of 327 mothers with

febrile children admitted to the emergency department

of the pediatric hospital ‘‘P&A Kyriakou’’ during the

period between December 2001 and March 2002.

The criteria set for participation in the study were the

mothers’ knowledge of the Greek language, a duration

of a febrile state of the child for at least 24 h before

seeking medical attention and the willingness to

participate in the survey. An ethical approval by the

Board of the Directors of the institution was obtained,

prior to initiation of the study.

2.2. Tool

A specific questionnaire was developed for the study.

The content validity of the instrument was based on an

extensive review of the Greek and international litera-

ture and other questionnaires (Anagnostakis, 1983;

Sarrell, 2002; Mathioudakis, 1989; Crocetti, 2001;

Blumenthal, 1998; Linder, 1999; Al-Eissa et al., 2000).

The original structure of the questionnaire consisted of

29 questions. A group of five scientists with clinical,

educational and research experience on the specific

subject, (three pediatricians and two nurses working at a

pediatric hospital) evaluated the items as irrelevant,

slightly relevant, quite relevant or relevant and made

comments for the clarity of the instrument. Only

questions, which were evaluated as quite relevant or

relevant by all experts, were included in the final version

of the questionnaire. The final instrument consisted of

16 questions covering issues common to fever and its

management. More specifically, five questions addressed

to general knowledge about fever and 11 had to do with

its management (four with the administration of

antipyretics and seven with the physical means).

All answers were classified as correct or wrong based

on data from the international literature (Schmitt, 1980;

Adam and Stankov, 1994; Poirier et al., 2000; Al-Eissa

et al., 2000; O’Neill-Murphy et al., 2001; Sarrell et al.,

ARTICLE IN PRESS

Table 1

Basic demographic characteristics of mothers

Variable n %

Age

o18 6 1.8

18–29 150 45.9

30–40 158 48.3

40–50 13 4.0

Number of children

1 118 36.1

2 181 55.4

X3 28 8.5

Educational level

Elementary school 15 4.6

Intermediate school 60 18.3

High school 182 55.7

University 70 21.4

Place of residence

Athens 293 89.6

Provinces 34 10.4

Source of information

Physician or nurse (or health

care professional)

308 94.5

Relatives or friends 89 27.3

Mass media 23 3.9

V. Matziou et al. / International Journal of Nursing Studies 45 (2008) 829–836 831

2002; Knoebel et al., 2002) that are consistent with the

information (oral or written) pediatricians of the specific

hospital give to parents.

In the question about the problems that high fever can

cause, those with at least one correct answer were

considered as correct. Two questions were also added

for the mother who brings her feverish child to hospital

for the first time and for the duration of fever that

preceded the admission to hospital. At the end of the

questionnaire, six questions were added to describe the

characteristics of the sample (children’s and mother’s

age, number of children, educational level, place of

residence and the source of information).

A pilot study with a sample of 20 mothers from the

pediatric ward was performed to determine the items’

reliability and the instrument’s clarity. It showed that the

majority of the questions were clear and easily under-

stood. The same version was given to the same mothers

after three weeks in order to evaluate the test-retest

reliability. The MacNemar test showed no significant

difference between the two measurements and the

percentage of agreement ranged from 85% to 100%.

2.3. Procedure

For the collection of data a face-to-face interview was

employed and all the interviews were conducted by a

member of the research group in the waiting room of the

emergency department. The subjects were informed

about the study, reassured about the confidentiality of

data and their right to refuse or cease their participation

at any time without any consequences for the treatment

of their children and finally requested to verbally

consent (before medical examination) for their partici-

pation in the study.

2.4. Statistical analysis

Statistical analysis was carried out by the statistical

package SPSS 10.0. It included descriptive statistics and

comparisons between groups, which were carried out by

the chi-square test.

3. Results

3.1. Participant’s characteristics

The children’s age ranged from 1 to 14 years

(mean ¼ 3.71, SD ¼ 3.73). Most of the mothers were

between 30 and 40 years of age (48.3%), had finished the

high school (55.7%), resided in rural areas (67.9%), and

reported doctors as the main source of information about

fever and its management (94.5%) (Table 1). Almost 3 out

of 10 mothers (28.1%) brought their febrile children to

hospital, for the first time. A substantial percentage of

them reported that their children were feverish at home

for two (41.3%), three (27.5%) and for more than four

days (7.9%), before seeking medical advise. Most of the

mothers have measured the armpit temperature (95.4%).

A temperature between 37 and 38 1C was considered as

fever by the 32.4% of them and as high fever by the

17.8%. Moreover, 38.3% considered that a temperature

of 37.5–38.5 1C was a very serious condition, which

probably could lead to side effects, such as convulsions

(82.6%), dehydration (25.8%) and encephalitis (17.7%).

A substantial percentage of mothers (70%) administered

antipyretics at temperatures of 37–38.5 1C, without

medical instruction (48.9%) and in few cases without

even measuring the temperature (4.9%). Almost half of

the mothers administered antipyretics at intervals less than

4h (55.6%). Finally, a significant percentage (29.1%)

determined the dosage of antipyretics by themselves.

3.2. Mother’s knowledge about fever and its management

Table 2 depicts the mothers’ knowledge about fever

and its management on a percent ratio of right–false

responses. From the total of 16 questions the average of

correct answers was 9.35 with a standard deviation of

2.06. A very low proportion of correct answers were

observed in questions related to the assessment of fever

as high and thus complications could occur (25.7% and

ARTICLE IN PRESS

Table 2

Mothers’ knowledge about fever and its management

Variables Correct

n (%)

Wrong

n (%)

No answer

n (%)

General knowledge about fever

1. Over what temperature do you consider that your child has fever? (X38 1C) 216 106 5

66.1% 32.4% 1.5%

2. Over what temperature do you consider that the fever is high? (X39 1C) 84 241 2

25.7% 73.7% 0.6%

3. Over what temperature may the fever cause side effects to the child? (440 1C) 53 263 1

16.2% 83.5% 0.3%

4. What side effects may a high fever cause? (At least one reported) 315 7 5

96.4% 2.1% 1.5%

5. What is the difference between rectal and armpit temperature? (0.5–1.0 1C) 233 94

71.3% 28.7% —

Antipyretics drugs

6. Do you administer antipyretics without medical instructions? (No) 165 160 2

50.5% 48.9% 0.6

7. Above what temperature do you administer antipyretics? (X38,5 1C) 94 229 4

28.8% 70% 1.2%

8. How often do you administer antipyretics? (X 4 h) 207 113 7

63.3% 34.6% 2.1%

9. Do you administer antipyretics without having measured the temperature? (No) 310 16 1

94.8% 4.9% 0.3%

Physical measures

10. If the fever is high do you give a bath to your child? (Yes) 109 215 3

33.3% 65.7% 0.9%

11. Which is the proper temperature of the water hot, cold or lukewarm?

(Lukewarm)

146 181

44.6% 55.4% —

12. Must the bath last below 10, 10 to 15 or above 15min? (10–15min) 15 312

4.6% 95.4% —

13. Which is the best interval for a bath when a child has fever, every 1–2 or longer

than 3 h? (43 h)

81 246

24.7% 75.3% —

14. Do you dress your febrile child with extra clothes? (No) 236 44 2

72.2% 27.2% 0.6%

15. When your child has fever, do you administer more fluids? (Yes) 282 44 1

86.2% 13.5% 0.3%

16. When your child has fever, do you place sponging? (Yes) 211 116

64.5% 35.5% —

In the table, the numbers and phrases in parentheses correspond to the correct answers.

V. Matziou et al. / International Journal of Nursing Studies 45 (2008) 829–836832

16.2%, respectively), and this misconception resulted in

the administration of antipyretics at low temperatures

(70%). Moreover, low proportions of correct answers

were observed in questions related to necessity, duration

and proper intervals for a bath as a physical mean to

lower the children’s temperature (33.3%, 4.6% and

24.7%, respectively).

3.3. Mother’s knowledge about fever and its management

in relation to the parameters studied

From the analysis of the data it was found that mothers’

age and their educational level in addition to the previous

experience of a feverish state in addition to the children’s

age influenced fever evaluation and treatment. Mothers with

children younger than 12 months old knew less about fever

and its treatment than mothers with older ones (Table 3).

Mothers older than 30 years knew to a greater extent how

to define fever (71.9% vs. 59.6%, Po0.05) and when to

administer antipyretics (36.8% vs. 19.9%, Po0.05) and

fluids (90.6% vs. 81.4%, Po0.05). Mothers with a

university degree gave more right answers about fever and

its treatment in contrast with mothers of a primary or

secondary education, except for the question on the

frequency of antipyretics’ administration (Table 4). Finally,

it was found that the previous experience with regard to

fever treatment, contributed to the more appropriate

evaluation and treatment of a febrile child (Table 5).

ARTICLE IN PRESS

Table 3

Mothers’ knowledge about fever and its treatment in relation to children’s age

Variablesa o12 months old 412 months old P

Correct

n (%)

Wrong

n (%)

Correct

n (%)

Wrong

n (%)

Over what temperature do you consider that your child has fever? (X38 1C) 54 52 162 59 o0.001

50.9% 49.1% 73.3% 26.7%

Over what temperature may the fever cause side effects to the child?

(X40 1C)

16 90 68 153 0.002

15.1% 84.9% 30.8% 69.2%

What side effects may a high fever cause? (At least one reported) 10 96 43 178 0.021

9.4% 90.6% 19.5% 80.5%

What is the difference between rectal and armpit temperature? (0.5–0.1 1C) 89 17 144 77 o0.001

84.0% 16.0% 65.2% 34.8%

Above what temperature do you administer antipyretics? (X38.5) 13 93 81 140 o0.001

12.3% 87.7% 36.7% 63.3%

How often do you administer antipyretics? (X4 h) 77 29 130 91 0.015

72.6% 27.4% 58.8% 41.2%

If the fever is high do you give a bath to your child? (Yes) 20 86 89 132 o0.001

18.9% 81.1% 40.3% 59.7%

18.7% 81.3% 36.3 63.7%

Which is the best interval for a bath when a child has fever, every 1–2 or

longer than 3 h? (43 h)

40 174 41 72 o0.001

Which is the proper temperature of the water hot, cold or lukewarm?

(Lukewarm)

35 71 111 110 0.003

33.05% 67.0% 50.2% 49.8%

When your child has fever, do you place sponging? (Yes) 37 69 174 47 o0.001

34.9% 65.1% 78.7% 21.3%

aIn this table only the statistically significant variables are shown and the numbers and phrases in parentheses correspond to the

correct answers.

V. Matziou et al. / International Journal of Nursing Studies 45 (2008) 829–836 833

4. Discussion

International literature confirms that mothers’ knowl-

edge about fever and its treatment is very limited. They

do not even know above which temperature fever is

defined and frequently choose inappropriate measures

for its treatment (Crocetti et al., 2001; Van Stuijvenberg

et al., 1999; Linder et al., 1999; Keagle, 1999; Edwards

et al., 2001). The results of the present study confirmed

these findings.

The febrile child is defined as the child who has fever.

Fever is defined as a rectal temperature above 38.8 1C,

an oral temperature above 37.8 1C, and an armpit

temperature above 37.2 1C (May and Bauhner, 1992;

Adam and Stankov, 1994; Al-Eissa et al., 2000; O’Neill-

Murphy et al., 2001; Crocetti et al., 2001; Sarrell et al.,

2002). However, many studies have shown that mothers

seek medical advise for their children at hospitals even at

lower temperatures (May and Bauhner, 1992; Kelly

et al., 1996; Sarrell et al., 2002). In our study, one out of

four mothers brought their children to hospital, even

though they have measured a lower temperature,

between 37 and 38 1C. Seeking medical services in order

to treat such children is possibly due to the mothers’

fear, anxiety and lack of knowledge on this subject

(Kinmonth et al., 1992; Poirier et al., 2000). On the

contrary, the care of children with high fever at home is

explained by the fact that children of older age are able

to describe their symptoms with accuracy and report

changes concerning their health status to their parents,

so that the necessary actions can be taken.

In the majority of the children an armpit temperature

was measured by their mothers. Greek mothers prefer

the armpit than the rectal temperature, despite the fact

that the latter is considered more reliable and is

recommended by doctors in Greece. It seems that

parents avoid measuring the rectal temperature of their

children, due to the fear of causing an adverse event

(Al-Eissa et al., 2000; Knoebel et al., 2002). Further-

more, almost half of the parents participating in the

study did not have any information about the difference

between the armpit and rectal temperatures, apparently

due to lack of information given by health professionals.

In our sample it was observed that mothers older than

30 years of age follow an aggressive and inappropriate

treatment of fever, resulting in the use of antipyretics

ARTICLE IN PRESS

Table 4

Mothers’ knowledge about fever and its treatment in relation to their educational level

Variablesa Up to Secondary

School

High School University P

Correct

n (%)

Wrong

n (%)

Correct

n (%)

Wrong

n (%)

Correct

n (%)

Wrong

n (%)

Over what temperature do you consider that your

child has fever? (X38 1C)

41 34 122 60 52 16 0.021

54.7% 45.3% 67% 33% 76.5% 23.5%

Over what temperature do you consider that the fever

is high? (X39oC)

19 56 35 147 30 38 o0.001

25.3% 74.7% 19.2% 80.8% 44.1% 55.9%

Over what temperature may the fever cause side

effects to the child? (X40 1C)

12 63 22 160 18 50 0.022

16% 84% 12.1% 87.9% 26.5% 73.5%

What side effects may a high fever cause? (At least

one reported))

64 11 182 00% 68 00% o0.001

85.3% 14.7% 100% 100%

Above what temperature do you administer

antipyretics? (X38.5)

12 63 60 122 22 46 0.019

16% 84% 33% 67% 32.4% 67.6%

How often do you administer antipyretics? (X4 h) 54 21 131 51 21 47 o0.001

72% 28% 72% 28% 30.9% 69.1%

Do you administer antipyretics without having

measured the temperature? (No)

64 11 177 5 67 1 o0.001

85.3% 14.7% 97.3% 2.7% 98.5% 1.5%

If the fever is high do you give a bath to your child?

(Yes)

22 53 54 127 33 35 0.013

29.3% 70.7% 29.7% 70.3% 48.5% 51.5%

Which is the proper temperature of the water hot,

cold or lukewarm? (Lukewarm)

32 43 71 111 42 26 0.005

42.7% 57.3% 39% 61% 61.8% 38.2%

aIn this table only the statistically significant variables are shown the numbers and phrases in parentheses correspond to the correct

answers.

Table 5

Mothers’ knowledge about fever and its treatment in relation to the prior experience with fever

Variablesa Prior experience No experience P

Correct

n (%)

Wrong

n (%)

Correct

n (%)

Wrong

n (%)

Over what temperature do you consider that your child has fever?

(X38 1C)

170 65 46 46 o0.001

72.3% 27.7% 50% 50%

Above what temperature do you administer antipyretics? (X38.5 1C) 84 151 10 82 o0.001

35.7% 64.3% 10.9% 89.1%

If the fever is high do you give a bath to your child? (Yes) 88 147 21 71 0.012

37.4% 62.6% 22.8% 77.2%

When your child has fever, do you administer more fluids? (Yes) 210 25 72 20 0.009

89.4% 10.6% 78.3% 21.7%

When the child has fever, do you place sponging? (Yes) 178 57 33 59 o0.001

75.7% 24.3% 35.90% 64.1%

aIn the table only the statistically significant variables are shown the numbers and phrases in parentheses correspond to the correct

answers.

V. Matziou et al. / International Journal of Nursing Studies 45 (2008) 829–836834

ARTICLE IN PRESSV. Matziou et al. / International Journal of Nursing Studies 45 (2008) 829–836 835

and the repetition of their administration before the

completion of their action. Schmitt (1980) recommends

treating the febrile child with an antipyretic drug only if

the temperature is over 39.8 1C and the child feels

uncomfortable. Another important finding is that al-

most all children had consumed antipyretics before

attending the hospital, no matter their temperature was.

Almost half of the mothers had dispensed antipyretics

on their own initiative and a substantial number had

determined the dosage by themselves.

Administration of antipyretics under medical super-

vision occurred with mothers whose children were

younger than one year old and with those of a low

educational level. It seems that the fear and inability of

the mothers to evaluate their children health condition

due to the young age and the easy access to a

pediatrician by the mothers residing in urban areas,

contributed to the request for medical advise. Anti-

pyretics dosage was prescribed by doctors mainly for

children younger than two years of age whose mothers

were of a higher educational level and for children

residing in urban areas.

For children younger than one year of age, parents

experience excessive fear and anxiety, resulting in

seeking a medical instruction about antipyretic dosage.

Although mothers of higher educational levels have

greater knowledge about the side effects, they frequently

seek for medical advise. This finding agrees with that of

all the previous studies in the international literature

concerning fever management by parents (Mathioudakis

et al., 1989; Adam and Stankov, 1994; Blumenthal,

1998; Kai, 1998; Van Stuijvenberg et al., 1999; Poirier

et al., 2000). Only a small percentage of the sample used

physical means in order to reduce temperature prior to

the use of antipyretics (Sarrell et al., 2002; Purssell,

2000) This fact demonstrates the drug dependency that

characterizes Greek parents, as well as the erroneous

impression that fever is a life threatening condition for

their children.

Mothers did not know that fever treatment must be

firstly managed by physical means, such as a lukewarm

bath for 5–10min which reduces temperature because it

promotes the abduction of the heat by contact and its

transfer from the skin to the water (Adam and Stankov,

1994; Zuckerman, 1998). The results of the study

showed that mothers of higher educational levels and

residents of non-urban areas used a bath as the first

choice to fever treatment. For the latter, perhaps, this is

due to the difficulties in consulting a pediatrician or even

a pharmacist, a problem that results in taking more

traditional but concurrently proper and harmless

measures.

A remarkable finding is that 25% of parents dressed

their children, when in a feverish state, with extra

clothes, in an attempt not to catch a cold. However, one

of the means for reducing body temperature is the

removal of clothes (Kramer et al., 1985; Kai, 1996;

Edwards et al., 2001). This attitude is, possibly, due to

the erroneous perception of parents, who correlate fever

to cold weather and common colds. Physical means are

recommended to enhance dissipation of body heat and

include the removal of excessive clothing or blankets,

adequate hydration and a cool surrounding environ-

ment (Adam and Stankov, 1994).

Educational programs have been reported to influence

these misconceptions in many studies. Kelly et al. (1996)

reported that parents had insufficient knowledge about

fever management and that with a suitable educational

program this lack of knowledge could be overcome, so

that parents treat fever correctly and efficiently, at

home. O’Neill-Murphy et al. (2001) studied the anxiety

of 87 parents who admitted their children to hospital

with fever. They implemented an educational program

with regard to fever and its treatment at home. After the

educational intervention a re-evaluation of the parents’

anxiety took place using the Anxiety Face Scale. The

results showed that the education and re-education of

parents reduced their anxiety to a great extent and lead

to the correct management of fever.

5. Conclusion

The message of this survey is that mothers in Greece

have a very poor knowledge of fever and its proper

management. Temperature is not assessed accurately

and there is a wide variation in the way fever is

managed. It seems that fever phobia is deep seated and is

mainly historic, having been passed from one generation

to another. Changing that perception will be a very

difficult task.

Educational interventions are needed to dispel care-

giver misconceptions about fever and to promote the

appropriate management of the febrile child. In the

present study, it was shown that such programs should

aim at educating young mothers with a low educational

level and those with a child younger than 12 months old

who seek medical attention at hospital, for the first time.

Therefore, pediatric health care providers have a unique

opportunity to make an impact on parental under-

standing of fever and its management. Future studies are

needed to evaluate the effectiveness of such interventions

and their ability to counteract fever phobia.

References

Adam, D., Stankov, G., 1994. Treatment of fever in childhood.

European Journal of Pediatrics 153, 394–402.

AL-Eissa, Y.A., AL-Zamil, F.A., AL-Sanie, A.M., AL-

Salloum, A.A., AI-Tuwaijri, H.M., Al-Abdali, N.M., AL-

Azzam, S.A., 2000. Home Management of fever in children:

ARTICLE IN PRESSV. Matziou et al. / International Journal of Nursing Studies 45 (2008) 829–836836

rational or ritual? International Journal of Clinical Phar-

macology and Toxicology 54 (3), 138–142.

Anagnostakis, D., Skordis, N., Matsaniotis, N., 1983. Fever

phobia what parents know about fever. Bulletin of A’

Pediatric Clinic. University of Athens 30, 38–42.

Blumenthal, I., 1998. What parents think of fever? Family

Practice 15 (6), 513–518.

Crocetti, M., Moghbeli, N., Serwint, J., 2001. Fever phobia

revisited: have parental misconceptions about fever changes

in 20 years? Pediatrics 107, 1241–1246.

Edwards, H.E., Courtney, M.D., Wilson, J.E., Monaghan, S.J.,

Walsh, A.M., 2001. Fever management practices: what

pediatric nurses say? Nursing and Health Science 3,

119–130.

Impicciatore, P., Violante, A., Bonati, M., 1997. Helping

parents to cope when their preschool children are acutely

ill. British Medical Journal 314, 373.

Kai, J., 1996. What worries parents when their preschool

children become acutely ill. British Medical Journal 313,

983–986.

Kai, J., 1998. Parents and their child’s fever: do as I say not as I

do? Family Practice 15 (6), 505–506.

Keagle, M., 1999. Pediatric fever: friend or foe. Physician

Assistant 23, 39–40.

Kelly, L., Morin, K., Young, D., 1996. Improving Caretakers’

Knowledge of Fever Management in Preschool Children: is

it Possible? Pediatric Health Care 10, 167–173.

Kinmonth, A.L., Fulton, Y., Cambell, M.J., 1992. Manage-

ment of feverish children at home. British Medical Journal

305, 1134–1136.

Knoebel, E., Narang, A., John, L., 2002. Fever: to treat or not

to treat. Clinical Pediatrics 41, 9–16.

Kramer, M.S., Naimark, L., Leduc, D.G., 1985. Parental fever

phobia and its correlates. Pediatrics 75, 1110–1113.

Linder, N., Sirota, L., Snapir, A., Eiscn, I., Davidovitch, N.,

Kaplan, G., Barzilai, A., 1999. Parental Knowledge of the

Treatment of Fever in Chlidren. Isreal Medical Association

Journal 1, 158–160.

Mathioudakis, I., Tsapra, E., Agianidou, K., Koukoutsakis, P.,

Sinaniotis, K., 1989. Fever and its treatment from parents’

view. Pediatriki 52, 268–273.

May, A., Bauhner, H., 1992. Fever phobia: the pediatrician’s

contribution. Pediatrics 90, 851–857.

O’Neill-Murphy, K., Liebman, M., Barnsteiner, J., 2001. Fever

education. Does it reduce parent fever anxiety? Pediatric

Emergency Care 17 (1), 47–51.

Poirier, M.P., Davis, P.H., Gonzalez-Del Rey, J.A., Monroe,

K.W., 2000. Pediatric emergency department nurses’

perspectives on fever in children. Pediatric Emergency Care

16 (1), 9–12.

Purssell, E., 2000. Physical treatment of fever. Archives of

Disease in Childhood 82, 238–239.

Rideout, M.E., First, L.R., 2001. Fever: measuring and

managing a sizzling symptom. Contemp Pediatrics 18,

42–50.

Sarrell, M., Avner Cohen, H., Kahan, E., 2002. Physicians’,

nurses’ and parents’ attitudes to and knowledge about fever

in early childhood. Patient Education and Counseling 46,

61–65.

Schmitt, B.D., 1980. Fever phobia. Misconceptions of parents

about fevers. American journal of diseases of children 134,

176–181.

Van Stuijvenberg, M., de Vos, S., Tjiang, G.G., Steyerberg,

E.W., Derksen-Lubsen, G., Moll, H.A., 1999. Parents’ fear

regarding fever and febrile seizures. Acta Paediatrica 88,

618–622.

ZucKerman, L.H., 1998. Counseling parents on fever manage-

ment. Pediatric Nursing Today 3, 2–3.