Evaluation of Fever in Infants and Young Children

Evaluation of Fever in Infants and Young ChildrenJennifer L. Hamilton, MD, PhD, FAAFP, Drexel University College of MedicineSony P. John, MD, Chester County Hospital

Fever• In children less then 36 months of age has the

potential for serious consequences

Urine Testing• Important!• Higher incidences of Urinary Tract Infections are

occuring in children• UTI’s are the most common source of infection in

children less than 3 months old• UTI’s are the second most common source of

infection in children 3-36 months old (pneumonia is the first)

Signs of serious bacterial infections• Cyanosis• Poor peripheral circulation• Petechial rash• Inconsolability

Define a fever• A clinically significant fever in children younger

than 36 months old is a rectal temperature of 100.4 F or greater

• Axillary, tympanic and temporal artery measurements have been shown to be unreliable.

Neonates (up to 28 days old)• When parents report a clinically significant fever

they may have a serious bacterial infection, even if they do not have a fever at the time of their initial medical evaluation

Teething• Teething is rarely associated with a fever of more

than 100.4 F

History and Physical• The history and physical exam cannot identify all

children with serious bacterial infection• Judicious use of imaging and laboratory testing is

valuable

U Bags• Urine cultures taken from a urinary bag have an

85% false positive rate

Labs• WBC counts and absolute neutrophil counts have

been used to identify serious bacterial infection, including occult bacteremia

Current Guidelines• Complete blood count with differential and blood

cultures for infants 3 months or younger with a fever

Diarrhea• In neonates and young infants, diarrhea with a

fever suggest a systemic illness• Stool culture and fecal WBC counts are

recommended

Lumbar Puncture• LP’s are recommended for all febrile neonates • Infants and children WITH clinical signs of

meningitis should also have an LP

Flu• Children who test positive for influenza are

unlikely to have a coexistent serious bacterial infection

• They still have significant risk for UTI• Patients who test positive for influenza do not

need more invasive testing