Fever Evaluation in Children

Aka: Fever Evaluation in Children, Triage of the Child with Fever

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II. Causes: Serious fever causes with cryptic presentations

  1. HSV Encephalitis (or Neonatal HSV)
  2. Meningococcemia
  3. Kawasaki Disease
  4. Occult Bacteremia
  5. Fever of Unknown Origin

III. Indications: Immediate Evaluation

  1. Age under 2 months
    1. Assess for Neonatal Sepsis
  2. Inconsolable or constant whimper
    1. Assess for serious illness
  3. Rectal Temperature >104 degrees Fahrenheit
  4. Signs of Meningitis or Meningococcemia
    1. Stiff neck
    2. Purpura
    3. Difficult to arouse or Delirium
  5. Dyspnea (beyond simple congestion)
  6. Dysuria

IV. Indications: Routine clinical evaluation

  1. Age 2 to 6 months
    1. Assess for serious infection
  2. Fever persists longer than 48 to 72 hours
    1. Assess for Bacterial Infection
  3. Fever cleared for more than 24 hours, then recurred
    1. Assess for Bacterial superinfection
  4. No site of infection for more than 24 hours
    1. Assess for Fever Without Focus (Occult Bacteremia)
    2. Exercise higher level of suspicion in age <18 months

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