Fever without focus

Question 1

Febrile child key points

Answer 1

Febrile neonates ≤28 days of corrected age require investigations (FBE, CRP, blood, urine and CSF cultures ± CXR) and empiric IV antibiotic therapy
In Febrile infants >28 days of corrected age and <3 months, have a low threshold for investigation and treatment based on clinical appearance and presence (or absence) of a clinically obvious focus
In infants <3 months of age, hypothermia or temperature instability can be signs of serious bacterial infection (or other serious illness)
The severity of illness cannot be predicted by the degree of fever, its rapidity of onset, its response to antipyretics or the presence of febrile seizures; the appearance of the child is the most useful indicator

Question 2

most common causes of fever in children

Answer 2

viral infections

Question 3

most common serious bacterial infections in children without a focus are:

Answer 3

UTI

Question 4

causes of serious bacterial infections in children

Answer 4

UTI
Pneumonia
Meningitis
Bone and joint infections
Skin and soft tissue infections
Mastoiditis
Bacteremia
Sepsis

Question 5

Important history to enquire about in febrile child

Answer 5

Localising symptoms eg cough, headache, photophobia, diarrhoea, vomiting, abdominal pain, musculoskeletal pain, rash
Travel
Sick contacts
Immunisation: children <6 months age or with incomplete immunisation
Medication: prior treatment with antibiotics may mask signs of a bacterial infection
High risk: prematurity, immunosuppression/oncological conditions (see Fever and suspected or confirmed neutropenia), central line in situ, chronic lung disease, congenital heart disease, previous invasive bacterial infections, children of Aboriginal, Torres Strait Islander, Pacific Islander or Maori origin, multiple health service presentations

Question 6

Features suggestive of an unwell child

Answer 6

https://www.rch.org.au/clinicalguide/guideline_index/Febrile_child/

Question 7

mng febrile child <3mo

Answer 7

https://www.rch.org.au/uploadedImages/Main/Content/clinicalguide/charts/Febrile%20child%20CPG_29%20day%20plus%20flowchart_Feb2025.png

Question 8

mng febrile child >3mo

Answer 8

https://www.rch.org.au/uploadedImages/Main/Content/clinicalguide/charts/Febrile%20child%20CPG_3%20month%20plus%20flowchart_Feb2025.png

Question 9

when to consider consultation with peads team in febrile child

Answer 9

Unwell child
Septic shock
Infants <28 days corrected age with fever (should be admitted for empiric antibiotics)
Barriers to follow-up within 24 hours due to social or external factors (consider admission)
High-risk child
Advice needed regarding empiric treatment
Prolonged fever of unclear cause