Correspondence (letter to the editor): Additional Comments Regarding Diagnosis and Treatment

From the perspective of a pediatrician in private practice, I wish to add 5 short points to the article (1).

The degree of the fever is never a measure for the severity of the illness in infants. The recommendation to administer an antipyretic above a certain temperature—in the article, that is >40°C—is misleading and supports doctors' and parents' fever phobia.

In clinical practice, antipyretics can be used like a test in case of uncertainty. Within 45 minutes after the administration of a weight-appropriate medication, a child that was seemingly seriously ill before will be well. A child with pneumonia will certainly be afebrile, but clinically it is still ill.

Metamizole was unjustifiably not mentioned as an antipyretic. It offers a wide range of use after the third month of life and can be used without restriction in children (2). In our own experience it is notably more potent in fever than paracetamol/acetaminophen or ibuprofen (3).

A febrile child will always have abnormal, ie accelerated, breathing. Parents need to be instructed that the breathing should return to normal roughly three quarters of an hour after an antipyretic drug has been administered.

The cause of fever in children is usually an inflammation of the upper respiratory tract. Since paracetamol is not an anti-inflammatory substance, pediatricians in private practice should always prefer a preparation containing ibuprofen, especially because of better responsiveness of further inflammation-dependent symptoms, such as nausea, middle abdominal pain, sore eyes, vomiting, headache, and aching limbs.