Paediatric Fever Management Practices and Antipyretic Use Among Doctors and Nurses in Australian Emergency Departments

Anastasia Mutic¹, Rui Zhi Tan¹, Eunicia Tan^{2

3}, Michael C Fahey^{1

4}, Emily Callander⁵, Libby Haskell^{6

7}, Shane George^{8

9

10}, Meredith L Borland^{11

12}, Naomi Loftus^{1

13}, Jeremy Furyk^{14

15}, Natalie Phillips^{10

16}, Jane Bourke¹⁷, Stuart R Dalziel^{6

18}, Simon Craig^{1

13}; PREDICT Network

Affiliations

¹ Department of Paediatrics, Monash University, Clayton, Victoria, Australia.
² Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
³ Emergency Department, Middlemore Hospital, Auckland, New Zealand.
⁴ Department of Paediatric Neurology, Monash Health, Clayton, Victoria, Australia.
⁵ School of Public Health, University of Technology Sydney, Sydney, Australia.
⁶ Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.
⁷ Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
⁸ Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia.
⁹ School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia.
¹⁰ Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
¹¹ Emergency Department, Perth Children's Hospital, Nedlands, Western Australia, Australia.
¹² Divisions of Emergency Medicine and Paediatrics, School of Medicine, University of Western Australia, Crawley, Western Australia, Australia.
¹³ Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia.
¹⁴ University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.
¹⁵ School of Medicine, Deakin University, Geelong, Victoria, Australia.
¹⁶ Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia.
¹⁷ Department of Pharmacology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia.
¹⁸ Departments of Surgery and Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.

PMID: 41178609
PMCID: PMC12580986
DOI: 10.1111/1742-6723.70165

Paediatric Fever Management Practices and Antipyretic Use Among Doctors and Nurses in Australian Emergency Departments

Anastasia Mutic et al. Emerg Med Australas. 2025 Dec.

. 2025 Dec;37(6):e70165.

doi: 10.1111/1742-6723.70165.

Authors

Affiliations

¹ Department of Paediatrics, Monash University, Clayton, Victoria, Australia.
² Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
³ Emergency Department, Middlemore Hospital, Auckland, New Zealand.
⁴ Department of Paediatric Neurology, Monash Health, Clayton, Victoria, Australia.
⁵ School of Public Health, University of Technology Sydney, Sydney, Australia.
⁶ Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.
⁷ Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
⁸ Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia.
⁹ School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia.
¹⁰ Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
¹¹ Emergency Department, Perth Children's Hospital, Nedlands, Western Australia, Australia.
¹² Divisions of Emergency Medicine and Paediatrics, School of Medicine, University of Western Australia, Crawley, Western Australia, Australia.
¹³ Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia.
¹⁴ University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.
¹⁵ School of Medicine, Deakin University, Geelong, Victoria, Australia.
¹⁶ Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia.
¹⁷ Department of Pharmacology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia.
¹⁸ Departments of Surgery and Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.

PMID: 41178609
PMCID: PMC12580986
DOI: 10.1111/1742-6723.70165

Abstract

Objectives: To examine variation in practice and adherence to international clinical guidelines for the management of fever among Australian Emergency Department (ED) clinicians.

Methods: Cross-sectional survey across 22 Australian EDs. Clinical vignettes were used to determine compliance with international best practice guidelines (use of antipyretic monotherapy to alleviate fever-associated child distress) for paediatric fever treatment. Comparisons were made between specialist paediatric EDs and general (non-specialist paediatric) EDs, and between medical and nursing staff.

Results: Of 539 survey respondents (300 doctors, 239 nurses; overall response rate 65.9%), only 9.3% (50/539, 95% confidence interval [CI] 7.1%-12.0%) adhered to evidence-based practice guidelines. Specialist paediatric ED clinicians demonstrated less than half the adherence of those from general EDs (5.4% [11/204] vs. 12.4% [38/307], difference -7.0%, 95% CI -11.7% to -1.9%). In a febrile settled child with normal hydration, the proportion of respondents who opted for antipyretics more than doubled in the context of elevated vital signs (40.4% [218/539] vs. 83.1% [44/539], difference -42.7%, 95% CI -46.8% to -38.2%). Nearly half of respondents (239/539, 46.8%, 95% CI 42.4%-51.2%) endorsed giving combined antipyretic therapy. In a febrile settled child, most participants would give antipyretics for temperature reduction (453/539, 84.0%, 95% CI 80.7%-86.9%) and for decreased fluid intake (468/539, 87.5%, 95% CI 84.4%-90.0%). Over one-third (192/539, 36.0%, 95% CI 32.1%-40.2%) recommended using antipyretics for febrile convulsion prevention during the current illness.

Conclusions: Fewer than 10% of Australian ED clinicians self-report practice consistent with international consensus recommendations for paediatric fever management.

Keywords: antipyretics; child; emergency departments; febrile; fever.

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Conflict of interest statement

Simon Craig and Shane George are section editors of Emergency Medicine Australasia.

References

1. Holt J., White L., Wheaton G. R., et al., “Management of Fever in Australian Children: A Population‐Based Sample Survey,” BMC Pediatrics 20, no. 1 (2020): 16, 10.1186/s12887-020-1911-y. - DOI - PMC - PubMed
1. Australian Institute of Health and Welfare , Emergency Department Care 2023–2024: Australian Hospital Statistics. Cat. No. HSE 182 (Australian Institute of Health and Welfare, 2025), https://www.aihw.gov.au/hospitals/topics/emergency‐departments.
1. Sullivan J. E. and Farrar H. C., “Fever and Antipyretic Use in Children,” Pediatrics 127, no. 3 (2011): 580–587, 10.1542/peds.2010-3852. - DOI - PubMed
1. Clericetti C. M., Milani G. P., Bianchetti M. G., et al., “Systematic Review Finds That Fever Phobia is a Worldwide Issue Among Caregivers and Healthcare Providers,” Acta Paediatrica 108, no. 8 (2019): 1393–1397, 10.1111/apa.14739. - DOI - PubMed
1. Schmitt B. D., “Fever Phobia: Misconceptions of Parents About Fevers,” American Journal of Diseases of Children 134, no. 2 (1980): 176–181. - PubMed

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Paediatric Fever Management Practices and Antipyretic Use Among Doctors and Nurses in Australian Emergency Departments

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Paediatric Fever Management Practices and Antipyretic Use Among Doctors and Nurses in Australian Emergency Departments

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Abstract

Conflict of interest statement

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