Febrile Child Flashcards
What are frequently isolated organisms causing bacteriaemia in children?
E. Coli and Staph
What are not good predictors of serious illness in a febrile child?
- Degree of fever
- Its rapidity of onset
- Its response to antipyretics
- Febrile convulsions
Hx features in febrile child?
- Localising symptoms
- Travel Hx
- Sick contacts
- Immunisation Hx
Localising symtoms to assess on Hx?
- Cough, choryza
- HA, photophobia
- N/D/V
- Abdo pain
- Joint symptoms
What signs are suggestive of an unwell child?
- Lethargic
- Poor interaction
- Inconsolability
- Tachycardia
- Tachypnoea
- Cyanosis
- Poor peripheral perfusion
PEx components febrile child?
- General aspects to indicate likelihood of serious infection
- Well or unwell i.e. signs of unwell child
- Localising signs
Localising signs to examine for in febrile child?
- ENT exam
- Neck stiffness
- Work of breathing
- Abdo signs
- Skin rash
- Joint swelling
Full sepsis work up in febrile child - components?
-FBE / film
-Blood culture
-Urine culture
+/- CXR if resp Sx / signs
When should you not perform an LP in a child?
-Impaired LoC
-Focal near signs
-Haemodynamically unstable
Empirically treat, LP later
When should a child be admitted / paediatric team be consulted?
- Unwell child
- Septic shock
- High risk pts (immunosuppressed, chronic lung disease, congenital heart disease)
- Advice needed regarding empirical Mx
When should a febrile child be transferred to a tertiary centre?
- Haemodynamic or respiratory instability
- Encephalopathy
- High risk patients
- Child requiring care above level of comfort of local hospital
When can a child less than 1 month with a fever be discharged?
All infants less than 1 month with a fever should be admitted
When can children older than 3 months be discharged?
- child is well
- follow up has been arranged
Child well and afebrile with S. pneumo +ve blood culture?
- If on ABx, a 7 day course should be completed.
- If not received ABx, they do not need Ix or Rx as have cleared infection themselves.
- Review if clinical deterioration occurs.
Child unwell or febrile with S. pneumo +ve blood cultures?
Sepsis workup and admission for IVABx
Child with non S.pneumo positive blood cultures?
Sepsis work up and admission for IVABx
Discuss with consultant if ?contaminant
High risk activity cues for febrile child?
- No response to social cues
- Appears ill to Dr
- Doesn’t wake if aroused or doesn’t stay awake
- Weak, high-piched or continuous cry
Respiratory high risk cues for febrile child?
- Grunting
- tachypnoea: RR>60
- moderate or severe chest indrawing
Hydration mod/high risk cues?
- Reduced skin turgor
- Dry mucous membranes
- reduced urine output
- poor feeding
Miscellaneous high risk signs febrile child?
- Non blanching rash
- Bulging fontanelle
- Neck stiffness
- Status epilepticus
- Focal neuro signs
- Focal seizures
- Bile stained vomit
Mod risk miscellaneous signs in febrile child?
- Fever >5 days
- Swelling of a joint or limb
- NWB / not using extremity
- New lump >2cm
When can an infant 1-3 months be discharged?
- child is well
- investigations are normal
- the child has been reviewed by a senior registrar / constultant
- follow up has been arranged within 12h
What are the key factors to keep in mind when assessing the febrile child?
- Child’s age
- presence of signs of toxicity
- presence of infectious focus
What are the signs of toxicity in a febrile child?
ABCD:
- Alertness, arousal or activity decreased
- Breathing difficulties (tachypnoea, increased WOB)
- Colour (pale or mottled), circulation (cool peripheries), or cry (weak, high pitched)
- Decreased fluid intake or decreased urine output
What is preferred method of temperature measurement in 0-5 age group?
Axillary. Oral and rectal not recommended due to safety concerns; TM may be inaccurate
What are important causes of fever and rash which must be considered?
- Meningococcal
- Kawasaki
What are the clinical features of Kawasaki disease?
- high fever 5+ days
- conjunctival infection
- polymorphous rash
- changes in mucous membranes
- changes in extremities
- cervical lymphadenopathy
What are Ix results found in Kawasaki disease?
- Neutrophilia
- Thrombocytosis
- Raised acute phase reactants
- Elevated transaminases
- Low serum albumin
Approach to urine culture in febrile child?
- All feb less than 3months, all toxic children
- Clean catch appropriate but difficult
- Bag urine inappropriate
- Catheter recommended invasive technique
What is recommended regarding febrile neonates? (0-4w)
All should have full septic workup and be admitted for parental antibiotics
What is Kawasaki disease?
Acute, self limited systemic vasculitis of unknown aetiology. Mainly affects infants and young children. Coronary artery aneurysms may develop if untreated.
What features are most useful for identifying UTI in febrile infants?
- Previous UTI
- Temp 40C+
- Suprapubic tenderness
