Fever, Pediatric
Basics
Description
Description
- Fever is defined as a temperature of 38°C (100.4°F) rectally:
- Oral and tympanic temperatures are generally 0.6–1°C lower
- Tympanic temperatures are not accurate in children younger than 6 mo. When measuring pull posteriorly and superiorly on the external ear at the midpoint between the apex of the helix and inferior border of the lobule
- Axillary temperatures are unreliable
- Children who are afebrile but have a reliable history of measured fever should be considered to be febrile to the degree reported
- Accounts for up to 20% of children presenting to the ED. Challenge is to identify those with significant underlying infections
Etiology
Etiology
- General:
- Bacteremia
- Infants ≤90 d: E. coli and group B streptococcus
- Older infants: Streptococcus pneumoniae. Haemophilus influenzae type B less common with widespread immunizations
- Viral illness, often accompanied by exanthem (varicella, roseola, rubella), coxsackievirus (hand-foot-and-mouth disease)
- H. influenzae type B and S. pneumoniae vaccines have reduced incidence of Haemophilus and pneumococcal disease
- CNS: Meningitis, encephalitis
- Head, eyes, ears, neck, and throat (HEENT): Otitis media, facial cellulitis, orbital/periorbital cellulitis, pharyngitis (group A β-hemolytic streptococcus, herpangina, adenovirus pharyngoconjunctival fever), viral gingivostomatitis (herpes and coxsackievirus), cervical adenitis, sinusitis, mastoiditis, conjunctivitis, peritonsillar/retropharyngeal abscess
- Respiratory: Croup (paramyxovirus), epiglottitis, bronchiolitis (respiratory syncytial virus [RSV]), pneumonia, empyema, influenza
- Cardiovascular: Purulent pericarditis, endocarditis, myocarditis
- Genitourinary (GU): Cystitis, pyelonephritis
- GI: Bacterial/viral gastroenteritis, intussusception, appendicitis, hepatitis
- Extremity: Osteomyelitis, septic arthritis, abscess, cellulitis
- Miscellaneous: Herpes simplex virus infection in the neonate, Kawasaki disease, vaccine (DPT) reaction, heat exhaustion/stroke, factitious, familial dysautonomia, thyrotoxicosis, collagen vascular disease, vasculitis, rheumatic fever, malignancy, drug induced, overbundling (uncommon, recheck 15 min after unbundling)
- Occult bacteremia occurs in association with a host of clinical entities. The group at highest risk are those ≤24 mo with a fever of ≥39.4°C and a WBC of 15,000 cell/mm3
- Hyperpyrexia (temp >41°C (105.8°F) commonly associated with serious infection. Temperatures >42°C often have a noninfectious cause such as hyperthermia, head injury, drug ingestion, malignant hyperthermia
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Citation
Schaider, Jeffrey J., et al., editors. "Fever, Pediatric." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307391/all/Fever__Pediatric.
Fever, Pediatric. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307391/all/Fever__Pediatric. Accessed December 11, 2024.
Fever, Pediatric. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307391/all/Fever__Pediatric
Fever, Pediatric [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 11]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307391/all/Fever__Pediatric.
* Article titles in AMA citation format should be in sentence-case
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ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
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