approach to child with fever

Question 1

most accurate way to measure body temp

Answer 1

rectal

Question 2

axillary normal temp

Answer 2

97.6 (36.4)

Question 3

oral normal temp

Answer 3

98.6 (36.7)

Question 4

rectal or tympanic normal

Answer 4

99.6 (37.4)

Question 5

fever definition

Answer 5

a child has a fever when his or her rectal temperature is 100.4 (38) or higher or oral temp is above 101 (38.3)

Question 6

children age 3 months and older.

Answer 6

• 39 rectally is fever
• if ill appearing, do it all, and admit.
• MC. UTI, followed by bacteremia and pneumonia.
• CXR: looking for pneumonia
• UA/UC
• incompletely immunized children require this workup no matter what age.

Question 7

Children age 30 days to 3 months

Answer 7

• fever is 38 rectally.
• predominance of group B strep and gram negatives in younger group and shifting to s pneumonia in the older group.
• blood culture, urine culture, WBC, UA, CSF. 5-15 K WBC is normal
• UA
• CXR: young infants with respiratory findings: RR > 50, coryza, cough, nasal flaring, grunting, stridor, rales, rhonchi, wheezing, retractions, or if have WBC> 20 and still no source

Question 8

Neonates 0-30 days old

Answer 8

• fever 38 rectally.
• appear ill, no fever but still gets workup
• listeria, group B strep, E. Coli, klebsiella
• do all even if well appearing.
• blood cultures mandatory
• CSF for gram stain, culture, cell count, viral culture/pcr
• UC/UA
• Stool