26 April 2013

Febrile child (Medical students)

Measuring Temperature
  • Use electronic thermometer in the axilla (all ages) or infra-red tympanic thermometer (from 4 week).
  • Do not use forehead thermometers (surface temperature may not correspond with core temperature)
  • Measure temperature in axilla. Do not routinely measure temperature by the oral or rectal routes.
  • Fever:  >37.5C (>99.5F) taken in axilla.
 Caring for the Febrile Child
  • Do not under-dress a child with fever. Tepid sponging and bathing are not recommended.
  • Give paracetamol or ibuprofen if the child is uncomfortable, not drinking enough, or miserable (irrespective of temperature).
  • No need for antipyretics if the child is happy or to prevent fever after immunization. Antipyretics do not reduce risk of febrile fits.
  • Encourage drinking (as child can become dehydrated - water loss by evaporation and sweating).
Further Advice to Parents
  • Identify a non-blanching rash using a clear glass. Even few petechiae are significant.
  • Check child during the night
  • No nursery/school while the fever persists
  • Seek medical advice if:
child's health getting worse
fever >5 days
parents more worried
parents not coping 
Febrile Infant

The febrile infant poses a difficult challenge, for the following reasons:
  • Presention with non-specific symptoms (irritability, poor feeding, changes in sleep pattern)
  • Difficult to distinguish viral infections from the more serious bacterial illness in its early stages
  • Bacterial infections are relatively common and potentially serious because of the immature immune system. Most cases of meningococcal and pneumococcal disease occur in the first year of life.
  • Prompt diagnoses (sepsis screen) and treatment (iv cefotaxime or ceftriaxone) decreases morbidity and mortality.
Sepsis Workup
  • Take all reports of fever seriously.
  • Apart from a clinical examination, assessment of febrile infant often includes a sepsis screen: CXR, CBC, CRP, BC, LP, Urine
  • The younger the child, the lower the threshold for performing a full/partial sepsis screen. In older children, investigations are guided by signs of specific illnesses (meningism, respiratory, septicaemia, UTI).
  • Apart from age, the presence of ‘red flags’ (irritability, altered LOC, respiratory and circulatory compromise) are an important consideration.