Pediatric Fever

The bulk of this episode is based on the UK NICE guideline: Feverish illness in children under 5, published in 2013. http://guidance.nice.org.uk/CG160

The guideline covers:

Thermometers and the detection of fever

Clinical assessment of the child with fever (using the traffic light system)

Management by remote assessment

Management by the non-paediatric practitioner

Management by the paediatric specialist (investigations summarized below)

Antipyretic interventions

The Traffic Light System in assessing risk for serious infection

This assessment tool takes into consideration color/appearance, activity, respiratory, circulation and hydration, and "other" parameters. For each parameter, their associated signs and symptoms are assigned a color code: "green" (low risk), "amber" (intermediate risk) and "red" (high risk). The table can be found here.

Age-appropriate investigations for pediatric fever

Once the risk for serious infection is determined, the following investigation should be performed:

Age

CBC diff

BC

CRP

UA/UC

LP

CXR

Stool culture

<1mo

yes

yes

yes

yes

yes

if indicated

if indicated

1-3mo

yes

yes

yes

yes

if unwell, or WBC >15 or <5M/mL

if indicated

if indicated

>=3mo, RED

yes

yes

yes

yes

yes

yes

if indicated

>=3mo, AMBER

yes

yes

yes

yes

if <1yr

if fever >39 and WBC >20

if indicated

>=3mo, GREEN

no

no

no

yes

no

no

if indicated

And at the same time, empiric parenteral antibiotic coverage for meningitis (3rd generation cephalosporin plus ampicillin/amoxicillin) should be started if LP is indicated.