Febrile Illness in Children

Question 1

Fever vs. hyperthermia

Answer 1

➢ Fever
○ ↑↑ body temp w/ ↑↑
hypothalamic set-point
➢ Hyperthermia
○ ↑↑ body temp w/ normal
hypothalamic set-point

Question 2

T/F Rectal temperature is considered most accurate

Answer 2

T

Question 3

Recommended temperature techniques based on child age

Answer 3

Axillary in children < 28 days and axillary or IR in children 28 days
to 5 years

Question 4

Fever with identifiable cause

Answer 4

❖ OM
❖ Strep throat
❖ UTI

Question 5

Fever without identifiable cause

Answer 5

❖ Discoverable with additional testing
❖ Hidden or “occult” illnesses much less frequent with immunizations

Question 6

Febrile Infants (neonates) 0-28 days old

Answer 6

▶ MCC - viral
▶ Always use extreme caution
▶ This age group has a ↑↑ likelihood of sepsis
▶ Strongly consider hospitalization and parenteral abx in ALL cases
▶ Always perform a full septic evaluation:

Question 7

Febrile illness in INFANTS LESS THAN 3 MONTHS
OLD definition & most common cause

Answer 7

▶ Acute febrile illness with etiology inapparent
after history and physical exam
▶ Defined as body temperature > 38 degrees C
(100.4 degrees F)
▶ Infection is most common cause
▶ Noninfectious causes include immunizations,
malignancy and certain medications

Question 8

Febrile illness in CHILDREN AGED 3 MONTHS TO
36 MONTHS

Answer 8

▶ Acute febrile illness with uncertain etiology after
history and physical exam
▶ Defined as body temperature > 38 degrees C (100.4
degrees F)
▶ Infection is most common cause
▶ Noninfectious causes include immunizations,
immunological or rheumatological conditions or
periodic fever syndromes

Question 9

Self limiting viral infections

Answer 9

❖ Bronchiolitis
❖ Enterovirus
❖ Influenza virus
❖ Respiratory syncytial virus (RSV)

Question 10

Bacterial causes of Febrile illness

Answer 10

❖ Urinary tract infection
❖ Otitis media, sinusitis
❖ Bacteremia
❖ Pneumonia
❖ Meningitis

Question 11

Occult or “hidden” bacterial infections

Answer 11

❖ Haemophilus influenzae type b
❖ Streptococcus pneumoniae

Question 12

Other causes of febrile illness

Answer 12

▶ Immunizations within 72 hours
▶ CNS disorders
▶ Malignancies
▶ Autoimmune disorders
▶ Metabolic disorders

Question 13

Meningitis Typically present with:

Answer 13

▶ Irritability
▶ Decreased activity/lethargy
▶ Headache
▶ Fever

Question 14

Infants ≤30 days old are at ↑↑risk for ____

Answer 14

Meningitis

Question 15

T/F Meningitis can present rapidly or gradually

Answer 15

T

Question 16

BACTERIAL MENINGITIS complications:

Answer 16

▶ Sensorineural hearing loss
▶ Vision changes
▶ Seizures
▶ Hydrocephalus
▶ Cognitive impairment
▶ Learning disabilities
▶ Emotional problems

Question 17

An event in infancy or childhood usually occurring between three months and five (six for us) years of age, associated with fever, but without evidence of intracranial infection or defined cause

Answer 17

FEBRILE SEIZURE

Question 18

______ are most commonly associated with febrile
seizures

Answer 18

Acute respiratory illnesses

Question 19

Common bacteria involved in Febrile seizures

Answer 19

Gastroenteritis, especially when caused by Shigella or Campylobacter

Question 20

Recurrent febrile seizures occur in __-__% of cases

Answer 20

30%–50%

Question 21

Workup for febrile seizures

Answer 21

▶ CBC and Blood Cultures
▶ WBC >20,000 with extreme left shift may indicate bacteremia
▶ Meningitis and encephalitis must be considered even if physical signs
are absent especially in infants < 18 months
▶ Strongly consider lumbar puncture
▶ Simple febrile seizures do not have long term adverse consequences
▶ Prophylactic treatment with phenobarbital or valproic acid may be affective if indicated by familial environment

Question 22

See a child immediately to evaluate febrile illness if:

Answer 22

1. < 3 mo + fever > 100.4°F
2. Fever is > 104°F
3. Crying inconsolably or
   whimpering
4. Crying when moved or touched
5. Difficult to awaken
6. Neck is stiff
7. Purple spots/dots on the skin
8. Breathing is difficult (not better
   after nasal passages are cleared)
9. Drooling saliva or unable to
   swallow
10. A convulsion has occurred
11. Child has sickle cell disease,
    splenectomy, human immunodeficiency virus (HIV), chemotherapy, organ transplant,
    chronic steroids
12. Acts or looks “very sick” (i.e. toxic)

Question 23

See within 24 hours to evaluate a child for febrile illness if:

Answer 23

1. 3–6 mo old
   a. Unless the fever occurred w/i 48 h
   post dtap vacc + no other serious sx
2. Fever > 104°F (especially if < 3 yrs)
3. Dysuria
4. Fever > 24h w/o obvious cause or
   identified site of infection
5. Fever has subsided for > 24 h, then
   returned
6. Fever > 72 h

Question 24

SAFE and EFFECTIVE medications to treat fever

Answer 24

● Acetaminophen (>2 mo) w/ fever >102.2 °F
○ Dosage of 15 mg/kg Q 4–6 h
● Ibuprofen (>6 mo)
○ Dosage of 10 mg/kg Q 6–8 h (½ dose Q 4 h)
○ Ibuprofen is longer lasting

Question 25

MANAGEMENT of fevers in children

Answer 25

▶ Remember most fevers are viral and require conservative care ▶ Parent education and reassurance is most important ▶ Discuss dosing of Tylenol 15 mg/kg and ibuprofen 10mg/kg* ▶ Discuss what to expect as illness progresses ▶ Follow-up in 24/48 hours ▶ ER precautions given and documented