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Table 3 Main recommendations by the Italian fever guidelines [4]

From: Knowledge, attitudes and misconceptions of Italian healthcare professionals regarding fever management in children

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).
Oral measurement of body temperature should be avoided in children (evidence level III; strength of recommendation D).
Axillary measurement using a digital thermometer is recommended in children aged < 4 weeks (evidence level III; strength of recommendation B).
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).
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.
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).
Use of physical methods to reduce fever is not recommended (evidence level I; strength of recommendation E).
Paracetamol and ibuprofen are the only antipyretic drugs recommended for use in children (evidence level I; strength of recommendation A).
Use of acetylsalicylic acid in children is not recommended because of the risk of Reye’s syndrome (evidence level III; strength of recommendation E).
Because of their poor benefit– risk ratio, steroids should not be used as antipyretics in children (evidence level III; strength of recommendation E).
Combined or alternating use of ibuprofen and paracetamol is not recommended (evidence level VI; strength of recommendation D).
Rectal administration of antipyretics should be considered only in the presence of vomiting or other conditions that prevent oral administration (evidence level I; strength of recommendation A).