發燒恐懼症？ 孩子體溫升高時醫生的建議

The American Academy of Pediatrics has some advice for parents who get all hot and bothered by a child's fever:

Chill out.

In a myth-busting new report, the academy advises against treatment every time a kid's temperature inches up.

"There's a lot of parental anxiety about fever. It's one of the most common reasons people bring their child to the doctor," said Dr. Henry Farrar, co-author of the report and an emergency room pediatrician at Arkansas Children's Hospital.

There is no proof that untreated fevers lead to seizures or brain damage. Nor is there evidence that lowering fevers reduces illness, according to the report, which focused on children older than 3 months.

Temperatures under 100.4 degrees are not considered fever. There's no harm in treating a true fever with over-the-counter acetaminophen or ibuprofen. And it makes sense to do so when the child is feeling ill. But the No. 1 reason to use fever-reducing medicine is to make a sick child feel more comfortable, the authors said.

The report - released online Monday in the journal "Pediatrics" - emphasizes that fever is not an illness but a mechanism that helps fight infection. Fevers can slow the growth of viruses and bacteria, and enhance production of immune-system cells.

"The fact is, no one has ever been able to say that a fever below a certain point is not associated with a serious infection, or that a fever above a certain point is associated with a serious infection," Farrar said.

Many experts recommend calling the doctor if a child's temperature hits 104 degrees, but Farrar said parents should pay attention to symptoms, such as whether the child is cranky, lethargic, or not drinking liquids and avoiding food. Those are often better measures of how sick a child is and whether medical attention should be sought, the authors said.

Co-author Dr. Janice Sullivan said infants younger than 3 months are an exception. Parents should get medical help when their temperatures rise above 100.4 because infants can be very sick without showing obvious signs, said Sullivan, a pediatrics and clinical pharmacology professor at the University of Louisville.

Another exception is kids with heat stroke - a medical emergency with symptoms including fever higher than 104 degrees, hot dry skin and rapid pulse caused by overexposure to heat and not enough fluids.

Children with special medical needs, including certain heart conditions, also should be seen by a doctor when their temperatures are mildly elevated, Sullivan said.

And when giving kids fever-reducing medicine, Sullivan said parents should be sure to use correct dosing devices, not kitchen teaspoons, which vary widely in size and lead to undertreatment and overtreatment.

But the biggest cause of overtreatment? Over-worried parents.

- Posted by David W Freeman，CBS News，HealthWatch.

退燒應以兒童舒適為目的

    有關研究顯示，父母對兒童發燒的恐懼，即所謂的“發燒恐懼症”導致了退燒藥對乙酰氨基酚和布洛芬的大量應用。

    許多家長錯誤地認為，兒童發燒是極危險的，可能導致大腦損傷或驚厥，因此需要立即治療。然而，紐約聯合醫院醫學中心兒科主任 Jeffrey L. Brown 醫生說：“隻有外源性兒童發燒，如大熱天悶在車廂裏引起中暑時的發燒，才與大腦損傷相關。內源性發燒一般不會造成大腦損害。”

    Brown 醫生指出，有關研究表明，過度治療發燒並不能預防兒童驚厥，而且這種驚厥與大腦損傷和學習能力低下無關。但對於六個月以下的嬰兒，發熱可能意味著嚴重的問題，父母應立即帶嬰兒去就診。

    美國兒科學會藥物委員會主任 Richard Gorman 醫生指出，發燒的治療應嚴格限製為以兒童舒適為目的。但經常在臨床上見到的情況是，當孩子已經舒適時，醫生還進行過度的治療。他認為，如果兒童體溫達38.8℃，但舒適地躺在沙發上，那麽無需對其發燒進行治療；如果兒童呈痛苦、煩躁、激惹表現，那麽，醫生建議在溫度超過38.3℃時應予以治療。多項研究表明，不治療低燒實際上可能有助於兒童更快地消除感染。體溫升高是身體防禦機製的一部分，它使身體成為一個不利於病毒或細菌生存的宿主。