Defining fever-related discomfort in children: an international Delphi consensus
European journal of pediatrics · 2026 · DACH
Source and licence
- Authors
- Gregorio P Milani, Edward Purssell, David Martin et al.
- Title
- Defining fever-related discomfort in children: an international Delphi consensus
- Journal
- European Journal of Pediatrics, 2026
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC13534207
Licence statement of the original publication
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Recommendations
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Abstract
Fever is one of the most common symptoms in childhood and a frequent reason for medical consultation. Current guidelines recommend treating fever only when discomfort is present. However, the concept of fever-related discomfort remains poorly defined and inconsistently applied in clinical practice and research studies. We aimed to develop an expert-based definition and a pragmatic clinical framework for the assessment and management of discomfort in febrile children. An international modified Delphi consensus was conducted to develop an operational definition and pragmatic clinical framework for fever-related discomfort in children. A steering international committee developed initial statements, which were evaluated across three iterative online Delphi rounds by seven international experts from high-income countries. Agreement was assessed using a 5-point Likert scale, with consensus predefined as ≥ 75% agreement. Experts’ feedback was used to refine statements between rounds. The panel reached consensus that fever-related discomfort is a multidimensional construct encompassing behavioral, emotional, and functional indicators. A traffic-light system was developed to stratify discomfort severity into: green (no intervention needed); amber (case-by-case intervention); and red (intervention always indicated) categories. Key clinical indicators were identified for each category. The framework was considered applicable across pediatric age groups and care settings, with individualized clinical judgment recommended for children with chronic conditions or those in intensive care.
Conclusion: This international Delphi consensus provides a preliminary expert-derived framework for defining and assessing fever-related discomfort in children. Future studies are warranted to evaluate its reliability, feasibility, cultural applicability, and clinical validity across larger and more diverse populations and healthcare settings.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00431-026-07340-4.
Contents of the original publication
The section headings of the original.
- Introduction
- Material and method
- Study design
- Steering committee and literature review
- Participants
- Questionnaire
- Delphi procedure
- Analysis and consensus definition
- Results
- Discussion
- Limitation
- FSUPPSupplementary Information
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