Fever in Children. Italian Pediatric Society Guidelines 2016. 1-16.





Recommendation 1: Rectal measurement should not be used routinely in children aged < 5 years because it is invasive and causes discomfort (evidence level III; strength of recommendation D). 


 Recommendation 2: Oral measurement of body temperature should be avoided in children (evidence level III; strength of recommendation D). 

 Recommendation 3: Use of a mercury thermometer is not recommended because of the risk of breakage and metal toxicity (evidence level III; strength of recommendation E). 

 Recommendation 4: Axillary measurement using a digital thermometer is recommended in children aged < 4 weeks (evidence level III; strength of recommendation B). 

 Recommendation 5: In the hospital or ambulatory care setting, axillary measurement using a digital thermometer or tympanic measurement using an infrared thermometer is recommended in children aged ≥ 4 weeks (evidence level II; strength of recommendation B). 

 Recommendation 6: For measurements taken at home by parents/caregivers, axillary measurement using a digital thermometer is recommended in all children (evidence level II; strength of recommendation B). Use of a tympanic infrared thermometer is not recommended, as this mode of measurement is prone to operator-related error.

Recommendation 8: Use of physical methods to reduce fever is not recommended (evidence level I; strength of recommendation E). 

 Recommendation 9: Use of physical methods is recommended in cases of hyperthermia (evidence level I; strength of recommendation A). (heat stroke and sunstroke).

 Recommendation 10: In itself, the degree of fever should not be taken as an indicator of the risk for severe bacterial infection (evidence level III; strength of recommendation E). 

 Recommendation 11: In special circumstances, such as age < 3 months, concomitant leukocytosis, or an increase in C-reactive protein, high fever may be a predictive factor for severe bacterial infection (evidence level III; strength of recommendation C).

 Recommendation 12: Use of antipyretics in children is recommended only when the fever is associated with evident discomfort (eg, prolonged crying, irritability, reduced activity, reduced appetite, disturbed sleep) (evidence level I; strength of recommendation B).

 Recommendation 13: Paracetamol and ibuprofen are the only antipyretic drugs recommended for use in children (evidence level I; strength of recommendation A). 

 Recommendation 14: Use of acetylsalicylic acid in children is not recommended because of the risk of Reye’s syndrome (evidence level III; strength of recommendation E). 

 Recommendation 15: Because of their poor benefit– risk ratio, steroids should not be used as antipyretics in children (evidence level III; strength of recommendation E). 

 Recommendation 16: Combined or alternating use of ibuprofen and paracetamol is not recommended (evidence level VI; strength of recommendation D).

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