The Febrile Child

Question 1

How to test a child < 4 weeks olds temperature?

Answer 1

Electronic axilla thermometer

Question 2

How to test a child between 4 weeks - 5 years temperature?

Answer 2

Infra red tympanic thermometer

Electronic axilla thermometer

Question 3

What are you looking for in the examination of the febrile child?

Answer 3

ABCDE
Obvs
Perfusion / CRT / Colour
Resp effort / added sounds
Abdo tenderness / distention 
Play / interaction 
Posture
Fontanel 
Rash / nodes / ear / throat

Question 4

Signs of septicaemia shock

Answer 4

Early
- tachycardia
- tachypnoea
- CRT > 4s 
- cool peripheries 
- urine output < 1ml/kg/hr in hosp
Progressive 
- base excess < -5
- increasing tachycardia / tachypnoea 
Late
- agitation 
- drowsiness
- hypotension

Question 5

Potential causes of fever

Answer 5

URTIs
- otitis media
- tonsillitis/pharyngitis
GE
Non specific viral illness
LRTIs
UTI
Meningitis
Septicaemia
Septic arthritis / osteomyelitis 
Non infectious diseases

Question 6

What must be identified in a child with a fever?

Answer 6

Infection source

Systemic complications

Question 7

What is involved in a full septic screen?

Answer 7

FBC / Filml / Coag / cross match 
CRP / U and Es / LFTs / glucose/ Ca / Mg
Blood culture
Urine culture
Throat culture 
Stool culture
CSF culture 
CVBG
CXR
AUSS
Limb Xray

Question 8

Effect of stress on BG

Answer 8

Increased

Question 9

Effect of poor feeding on BG

Answer 9

Decreased

Question 10

What is CRP?

Answer 10

An inflammatory marker

Question 11

Management of the febrile child

Answer 11

1. Antipyretics - paracetomal / ibruprofen
2. Anti microbials may be appropriate
3. Sepsis 6
   - O2
   - 20ml/kg bolus (usually saline) if shock
   - Early IV Ax (cefotaxime or ceftrixazone)
   - Add IV amox if < 1 month to cover Listeria
   Consider inotropic support if need

Question 12

Special situations that need considering with a febrile child

Answer 12

Babies < 3 months 
Immunocompromised 
Fever > 5 days 
Absence of clinical focus 
Non infectious cause of fever

Question 13

Features of babies < 3 months immunity

Answer 13

Immature immune system
Maternal transfer of IgG provides some protection 
- mirrors maternal immunity
- lasts around 3 months 
Increased susceptibility

Question 14

Common causes of fever in babies < 3 months

Answer 14

Bacterial more common
- GBS
- Ecoli
Viral (HSV/VZV) high morbidity and mortality

Question 15

Treatment of fever in babies < 3 months

Answer 15

IV broad spec Ax (cefotaxime and Amox)

+/- IV acyclovir

Question 16

Causes of the immunocompromised child

Answer 16

Post chemo neutropenia
High dose steroids / tacrolimus
Congenital

Question 17

What may be the only symptom in an infected immunocompromised child?

Answer 17

Fever

Question 18

Tx of fever in immunocompromised child

Answer 18

IV tazocin

Question 19

Non infectious causes of fever in a child

Answer 19

Systemic onet JIA
SLE
Kawasaki disease 
Lymphoma / leukaemia 
Neuroblastoma 
Antibiotic fever 
Ectasy / new psychoactive substances

Question 20

Diagnostic criteria for Kawasaki disease

Answer 20

Fever > 5 days
4 out of 
- cervical lymphadenopathy 
- polymorphous rash 
- cracked lips / strawberry tongue 
- bilateral conjunctivitis 
- erythematous / peeling extremities