Move Over, Dr. Spock; Here Comes the World Wide Web
Source: Impicciatore P, et al. Reliability of health information for the public on the world wide web; Systematic survey of advice on managing fever in children at home. BMJ 1997;314:1875-1881.
For generations, important sources of pediatric information for parents have been books like those of Benjamin Spock, MD. The rapid growth of computer-based electronic communication, as well as the escalation of the number of homes with computers linked to the Internet, have opened a new and largely unsupervised source of medical information accessible to parents. Access to the medical information on the Internet is virtually instantaneous, often considerably faster than being able to contact a pediatrician. However, there are real concerns about the accuracy and currency of medical information that parents may obtain.
Impicciatore and associates made a systematic search of the world wide web concerning the home management of children with fever in order to assess the quality of medical information that is currently available to parents. The keywords "fever management," "child," and "parent information" were entered using Yahoo and Excite search engines. The search terms were also entered in French, Italian, German, and Spanish.
The computer search found 41 relevant web pages. Thirty-two of these had been developed by hospitals, professional organizations, and health care organizations, while nine were set up by individual practitioners or educational organizations. The information from each of the pages was assessed for the following: the minimum temperature considered as fever; the optimal site for measuring temperature; pharmacological and physical treatment of fever; and the indications for seeing a physician. The information from each web site was compared to guidelines published in a definitive text on fever management.1 Only four web pages adhered closely to these guidelines for the management of children with fever.
Twenty-eight sites gave a specific temperature above which a child was considered febrile. This ranged from 37.4°C-38.3°C for rectal measurement; 37.4-37.8°C for oral measurements; and 37.0-37.6° for axillary measurement. Twenty-six sites indicated the optimal site for measuring temperature; rectal and/or oral sites were recommended most often, and forehead strips were discouraged. Antipyretic drugs were recommended in 32 of the websites, with paracetamol being most frequently recommended. However, only a quarter of the sites gave specific instructions about dose and frequency of administration. Two web sites recommended the use of aspirin despite its association with Reye’s Syndrome. One site actually recommended the use of dipyrone, despite the fact that it has been banned in the United States because of an association with agranulocytosis. In addition to antipyretic drugs, most sites recommended tepid baths. Some recommended these when the temperature exceeded 38.5°C. Two web sites recommended cold water or alcohol sponging.
Thirty-six web sites gave at least some indication of when the parents should call their physician. Twenty-seven sites listed warning symptoms such as convulsions, breathing difficulty, stiff neck, and difficulty in arousing. The age of a child below which a doctor should be called was mentioned in 21 sites and ranged from 2 months to 6 months.
Impicciatore and associates conclude that only a few of the web sites gave complete and accurate information about the common and widely discussed condition of fever in children, its diagnosis, and management. It is likely that information about more complicated and controversial issues may be even more problematic. Pediatricians should realize that, increasingly, their patients may use their home computers for medical information, and this information may be incomplete, inaccurate, or both. hap
Reference
1. El-Radhi AS, Carrol J. Fever in Pediatric Practice. Oxford: Blackwell Scientific;1994:229-231.
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