Fever, Pediatric

Fever, Pediatric is a topic covered in the 5-Minute Emergency Consult.

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  • Fever is defined as a temperature of 38°C (100.4°F) rectally:
    • Oral and tympanic temperatures are generally 0.6°C–1°C lower.
  • Tympanic temperatures are not accurate in children younger than 6 mo.
  • Axillary temperatures are generally unreliable.
  • Children who are afebrile but have a reliable history of documented fever should be considered to be febrile to the degree reported.


  • Bacteremia (Haemophilus influenzae type B, Streptococcus pneumoniae), viral illness, often accompanied by exanthem (varicella, roseola, rubella), coxsackievirus (hand-foot-and-mouth disease), abscess:
    • 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 diarrhea, intussusception, appendicitis, hepatitis
  • Extremity: Osteomyelitis, septic arthritis, 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)

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