Abstract

Introduction

This study was conducted to determine the factors affecting fever management of parents who bring their children to the emergency room with high fever.

Methods

This descriptive study was conducted with the parents of children aged 6 months to 5 years who presented to the pediatric emergency department of a state hospital in the southeastern region of our country with complaints of high fever. Data for the study were collected using the “descriptive characteristics form” prepared by the researcher and the “parent fever management scale”. In the evaluation of the data, percentages, means, standard deviations, The study was completed with the participation of 252 parents. Percentage, mean, standard deviation, Kruskal-Wallis, Mann-Whitney U, ANOVA, t-test, and post hoc Scheffe and Jonckheere-Terpstra tests, which are advanced analysis techniques, were used in the evaluation of the data.

Results

As a result of the analysis, the average score of the participants on the parental fever management scale was calculated as 31.43±4.50. It was determined that parental fever management was influenced by factors such as the educational level of the mother and father, economic status, and place of residence.

Conclusion

Considering the minimum and maximum scores that can be obtained from the parent fever management scale, it can be stated that parents’ fever management is above average.

Introduction

Fever, defined as a body temperature of ≥37.5 ⁰C,¹ is not a disease but one of the body’s important defense mechanisms.² Factors such as viral or bacterial infections, tissue damage and edema play a role in the etiology of fever, which can occur as a symptom of any disease.^{2, 3} The possibility that fever, which is usually self-limiting,¹ may cause seizures/convulsions, brain damage or physical damage in the child causes parents to worry.⁴ Fever is one of the most common reasons for emergency admission in children.³ It is thought that this may be due to the feeling of anxiety that fever creates in parents. In one study, it was found that the majority of the families participating in the study were afraid of their children’s having fever, believed that fever was harmful and thought that fever could cause their children to have seizures.⁵ In a study conducted in Türkiye, it was found that the majority of parents were overly anxious when their children had fever and were afraid that their children would have convulsions.⁶ In a nationwide study conducted in Australia to examine parents’ knowledge, beliefs and management of fever, it was found that parents thought that fever had harmful effects such as seizures, dehydration, serious illness and brain damage.⁷ Parents’ feelings of fear and anxiety related to fever and their knowledge or thoughts about the harms of fever may affect their management of fever. At the same time, the belief that fever may cause seizures, brain and physical damage may cause parents to experience anxiety and panic.⁴This state of anxiety and panic may cause parents to resort to wrong practices to reduce fever. In the literature, it has been reported that when children have fever, some parents apply warm shower, remove the child’s clothes, and give antipyretics, while others use methods such as vinegar water, alcohol, and cologne.^{5, 8} In order to prevent parents from resorting to wrong practices related to fever management, it is important to investigate and reveal the factors affecting fever management and then inform parents about the identified factors. This study was conducted as a descriptive study to determine the factors affecting the fever management of parents who brought their children to the emergency room with high fever.

Materials and Methods

Aim and Type of the Study

This study was conducted as a descriptive study to “determine the factors affecting the fever management of parents who brought their children to the emergency room with high fever”.

Population and Sampling of the Study

The data of the study were collected between March and June 2024. The population of the study consisted of parents (mother or father) of children between the ages of 6 months and 5 years who presented to the pediatric emergency department of a state hospital in the southeast of Türkiye with the complaint of high fever. The number of individuals to be included in the sample was calculated using the A-priori Sample Size Calculator for Multiple Regression program (alpha level 0.05, effect size 0.15, number of variables 13 and desired statistical power level 0.95) and it was determined that at least 190 individuals should be reached as a result of the calculation.⁹ The study was completed with the participation of a total of 252 parents (mother or father).

Inclusion criteria were as follows: Parents who had a child between the ages of 6 months and 5 years, who brought their child to the emergency room with the complaint of high fever, who could read and write and who agreed to participate in the study were included in the study.

Data Collection Tools

The data of the study were collected in the pediatric emergency department of a state hospital in the southeast of Türkiye between March and June 2024 by the researchers conducting the study. The data were collected with face-to-face interview method using the “Descriptive Characteristics Form” and “Parent Fever Management Scale” prepared by the researchers. It took an average of 10-15 minutes to complete these forms.

Descriptive Characteristics Form: This form, prepared by the researcher, consists of 14 items about the sociodemographic characteristics of the participants.

Parent Fever Management Scale (PFMS): This scale, which aims to measure parents’ practices related to the management of childhood fever, was developed by Walsh et al. in 2008. The Turkish validity and reliability study of the scale was conducted by Cinar et al.¹⁰ in 2014. The scale consists of a total of eight items and is a five-point Likert-type scale. The minimum score is 8 and the maximum score is 40. As the score obtained from the scale increases, parents’ fever management increases positively. In the validity and reliability study of the scale, Cronbach alpha value was calculated as 0.79.¹⁰ In this study, Cronbach alpha value was found as 0.81.

Ethical Dimension of the Study

Before starting the study, the necessary Harran University Clinical Research Ethics Committee permission (decision no: HRU/24.02.30, date: 18.03.2024) and institutional permission were obtained from the clinical research ethics committee of a university. After the purpose of the study was explained to the participants, written and verbal consent was obtained from the participants who agreed to participate in the study. The study was conducted in accordance with the Declaration of Helsinki.

Statistical Analysis

After the data of the study were uploaded to the SPSS program, the necessary analyses were performed. Percentage, mean, standard deviation, Kruskall Wallis, Mann-Whitney U, One-Way ANOVA, t-test, post hoc Scheffe and Jonckheere-Terpstra tests, which are advanced analysis tests, were used in the evaluation of the data. Statistical significance level was accepted as p<0.05.

Results

Table 1 shows the sociodemographic characteristics of the participants. The mean age of the children of the participants was calculated as 27.80±14.61 (months). It was determined that the gender of the majority of the participants’ children was female (52.2%), the degree of closeness was mother (58.3%), the mother’s educational status was primary or secondary school (42.9%), and the father’s educational status was high school (44.4%). It was determined that the majority of the parents’ incomes were equal to their expenses (52.0%), they noticed when their child had fever by touching (42.1%), their children had not had febrile illnesses before (75.4%), their children had not had convulsions before (77.0%), their children did not have any chronic diseases (85.3%), and they were afraid of their children having convulsions when they had fever (54.4%). It was also found that the majority of the parents usually applied to the emergency unit between 16.00-24.00 hours when their child had fever (41.2%) and applied to the emergency room 2-6 hours after the child had fever (25.4%) (Table 1).

When the status of the participants according to the PFMS was evaluated, it was found that 47.2% of the parents mostly measured the child’s temperature when the child had a fever, 52.4% mostly wanted to know what the child’s temperature was, 41.3% mostly wanted to make sure that the child had plenty of fluids, 54.8% mostly used antipyretics, 53. 6% mostly checked the child’s fever during the night, 42.1% mostly and 41.3% always slept in the same room with the child when the child had fever, 29.8% sometimes and 29.8% mostly woke the child at night to give antipyretics, and 51.6% mostly took the child to the doctor (Table 2).

Table 3 shows the fever management scale scores of the parents and the mean score of the parents on the PFMS was calculated as 31.43±4.50 (Table 3).

The comparison of the socio-demographic characteristics of the parents and the mean scores of the PFMS is shown in Table 4. It was determined that there was a statistically significant difference between mother’s and father’s education levels and PFMS, and the mean PFMS scores of those whose mother and father’s education level was university and above were significantly higher (p≤0.001). In addition, it was found that there was a statistically significant difference between the economic status of the parents and the places where they lived and the mean scores of the parents whose incomes were higher than their expenses (p≤0.001) and who lived in urban areas (p=0.003) were significantly higher. It was determined that there was no significant difference between the PFMS and the gender of the child, the status of being the mother or father of the child, the methods of recognizing that the child had a fever, the child’s previous febrile illnesses and convulsions and the presence of chronic diseases, the situation that the child was most afraid of when the child had a fever, the time of admission to the emergency unit and the time period from the onset of the child’s fever to the application to the emergency service (Table 4).

Discussion

The approach of parents is very important in the management of fever³, which is one of the most common causes of emergency admission in childhood. For this reason, it is important to determine the knowledge and attitudes of parents about fever management and to correct any mistakes with trainings in terms of child health and then public health. In our study in which we examined the factors affecting the fever management of the parents of children admitted to the emergency department with the complaint of high fever, it was determined that the majority of the parents knew that their child had fever by touching the child and they were afraid that their children would have convulsions when they had fever. In some studies, conducted in Türkiye, similar to our findings, it was found that the majority of parents recognized that their child had fever by touching the child and that they were most afraid of their child having convulsions.^{6, 11, 12} In a study conducted in Malaysia, it was reported that very few parents recognized that their child had fever by touching the child.¹³ It is thought that this difference in the literature may be due to cultural and economic factors between countries. Detection of fever by parents by touching may lead to inaccurate detection of fever and thus delays in early intervention for fever. Failure to intervene early in fever will lead to the development of convulsions, which is an important complication of fever and a condition that parents fear. Therefore, it is recommended that practices or trainings should be planned to increase the level of knowledge of parents about fever management. In addition, in our study, it was found that the majority of parents usually applied to the emergency room between 16.00 and 24.00 when their children had fever and applied to the emergency room approximately 2-6 hours after the child’s fever broke out. It is thought that the reason why they applied to the emergency room between 16.00 and 24.00 is due to the fact that outpatient clinics are closed after working hours. It is thought that when the child’s fever first broke out, the parents tried to reduce the fever at home with their own means, so they applied to the emergency room approximately 2-6 hours later. In a study, it was determined that the majority of parents applied to the emergency room if the child’s fever did not decrease for a day.¹⁶ When the studies examining the fever management of parents were examined, it was found that the mean scale scores of the fever management method of the parents ranged between 33.71±3.40 and 36.22±3.46.^{8, 14-16} In this study, the mean score of the parents in the PFMS was calculated as 31.43±4.50. Based on the minimum and maximum mean scores that can be obtained from the scale, it is seen that the mean scores of the parents are above the average.

In our study, when the mean PFMS scores of the parents according to the sociodemographic characteristics of the parents were compared, it was determined that there was a significant difference between maternal and paternal education levels and PFMS, and the mean PFMS scores of the parents with university and higher education level were significantly higher. When the literature was examined, similar to our study findings, studies indicating a relationship between parental education level and parental fever management were found.^{14, 17, 18} In these studies, it was determined that as the level of education increased, the fever management of parents increased positively. It is thought that the possibility that parents’ reading and research potential or awareness on health may have increased as their educational level increased, which might be the reason for this difference. In the literature, unlike our findings, there are also studies in which it was determined that there was no relationship between parental education level and parental fever management.^{2, 8} In our study, it was also found that there was a statistical difference between the economic status of the parents and the places where they lived and PFMS scores, and that the mean PFMS scores of parents whose incomes were higher than their expenses and who lived in urban areas were higher. The fact that parents have higher income levels or live in urban areas may facilitate their access to accurate information about childcare. Therefore, it is thought that the mean fever management scores of parents having higher income levels and living in urban areas may be higher. Similar to our findings, Yiğit and Sarıalioğlu¹⁴found that parents whose income was higher than expenses and who lived in urban areas had higher mean fever management scores. Higher mean fever management scores were reported for parents living in urban areas by Yazıcı and Kutlu¹⁷and for parents whose income was higher than expense by Kayhanlar Gulcan and Canbulat Sahiner¹⁸. In our study, it was determined that there was no significant difference between the gender of the child, the status of being the mother or father of the child, the methods of recognizing that the child had fever, the child’s previous febrile illness and convulsions, and the presence of chronic disease and the PFMS. When the literature was examined, similar to our findings, it was found that some studies stated that there was no relationship between the gender of the child,^{8, 14} being a mother or father,¹⁴ having a chronic disease⁸ and parental fever management. In contrast to this study, Ekim and Üstünel²found that the mean fever management scores of parents whose children did not have a history of previous febrile illness were higher.

Study Limitations

The limitation of this study is that it was conducted in a single center and only with the parents of children who were admitted to the emergency unit.

Conclusion

If fever, which is an important symptom of childhood diseases, is not treated correctly, many complications may occur. For this reason, it is important that parents, who are with the child at every moment, have the right information about fever and can make the right interventions in case of fever. The first step to be taken in this regard is to determine the status of parents regarding fever management and then to eliminate the problems identified. In our study, it was determined that fever management was at a better level for parents who were university graduates, whose income was higher than their expenses and who lived in urban areas. It is thought that this difference is due to the fact that parents living in urban areas have more opportunities to obtain information, and individuals whose income is more than their expenses and who are university graduates have a higher awareness of accessing correct information. In this direction, it is recommended that all parents, especially parents living in rural areas and parents with low educational and economic levels, should be given training on fever management.