Child with Fever

Question 1

Body temp by body area

Answer 1

Axillary = 97.6
Oral = 98.6
Rectal or Tympanic = 99.6
rectal or tympanic temp reading is slightly higher than an oral temp reading. 
the most accurate is rectal

Question 2

When does someone have a fever?

Answer 2

Rectal temp is 100.4 or higher

OR oral temp is above 101

Question 3

What are serious bacterial illnesses we are worried about with young children

Answer 3

Sepsis
Meningitis
Pneumonia
UTI
Osteomyelitis or septic joint

Question 4

Children 3 months or older with a fever

Answer 4

Fever changes to 39 rectally
if ill appearing, do full work up and admit - err on the side of caution
MC SBI are UTIs (catheter), bacteremia (CBC with diff, blood cultures), pneumonia (CXR)
CXR: any sign of LRTI with fever or child with WBC >20000 and no LRTI
reasons for UA: any girl under 2 with fever without source, boys not circumcised, with fever and no source, circumcised boys with fever and no source.
Incompletely immunized require workup like younger child

Question 5

children 30 days to 3 months with fever

Answer 5

Fever is 38 rectally
group B and gram neg 30-60 and s pneumoniae for 60-90
any ill appearing infant gets a full sepsis workup and is admitted for empiric abx therapy
order CBC, UA, CXR even if they look normal
if after that you still havent figured out what’s wrong then admit them just in case
Normal WBC is 5-15,000

Question 6

children 0-30 days of age with fever

Answer 6

Fever is 38 rectally
can be normothermic or hypothermic with significant infection
Have a high risk of SBI
increased risk of virulent bacteria
DO IT ALL EVEN IF WELL APPEARING!! you are more than likely referring them onto peds
Blood cultures are mandatory
CSF for gram stain, culture, cell count, viral culture/PCR