Febrile child (Medical students)
Measuring Temperature
- Use an electronic thermometer in the axilla (all ages) or infra-red tympanic thermometer (from 4 weeks) or temporal artery thermometers
- Forehead chemical thermometers are unreliable (surface temperature may not correspond with core temperature)
- Measure temperature in the axilla. Do not routinely measure temperature by the oral or rectal routes.
- Fever: >37.5C (>99.5F) axillary temperature.
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 a child can become dehydrated - water loss by evaporation and sweating).
- 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:
infant < 3 months with fever (even if the child looks well)infant < 12 months with fever and looks unwellsymptoms (pain, rash, vomiting, breathless, etc)child's condition is poor or deterioratingfever >5 daysparents are worried or not coping
The febrile infant poses a difficult challenge, for the following reasons:
- Presents 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) decrease morbidity and mortality.
- 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).
- Red flags are suggestive of serious illness (irritability, altered LOC, respiratory and circulatory compromise).