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