Pediatric Annals

CME Article 

Management of Infants and Young Children with Fever without Source

Larry J. Baraff, MD

Abstract

Febrile infants and children frequently present to pediatricians and emergency room physicians. The majority of these children are less than 3 years of age. Fever is defined as a rectal temperature 38.0° C. An infant or child with a recent history of a documented fever who is afebrile in the office or emergency department should be considered a febrile child. Temperatures in infants and young children should be measured rectally. Axillary and tympanic membrane temperatures are unreliable and have a sensitivity of approximately 50% to 65%. Although some infants with serious bacterial infections may be afebrile, most of these will appear seriously ill.

ABOUT THE AUTHOR

Larry J. Baraff, MD, is Professor of Pediatrics and Emergency Medicine, UCLA Emergency Medicine Center, David Geffen School of Medicine at UCLA.

Address correspondence to: Larry J. Baraff, MD, Professor of Pediatrics and Emergency Medicine, UCLA Emergency Medicine Center, David Geffen School of Medicine at UCLA, 924 Westwood Boulevard, Suite 300, Los Angeles, CA 90024; fax 310-794-0599; e-mail lbaraff@mednet.ucla.edu.

Dr. Baraff has disclosed no relevant financial relationships.

EDUCATIONAL OBJECTIVES

  1. Review the current evidence upon which rational decision making for the management of infants and children with fever without source should be based.
  2. Discuss an evidence-based framework for the evaluation of infants and children with fever without source.
  3. Determine the most logical management scheme for infants and children with fever without source based upon their age and immunization status.

Abstract

Febrile infants and children frequently present to pediatricians and emergency room physicians. The majority of these children are less than 3 years of age. Fever is defined as a rectal temperature 38.0° C. An infant or child with a recent history of a documented fever who is afebrile in the office or emergency department should be considered a febrile child. Temperatures in infants and young children should be measured rectally. Axillary and tympanic membrane temperatures are unreliable and have a sensitivity of approximately 50% to 65%. Although some infants with serious bacterial infections may be afebrile, most of these will appear seriously ill.

ABOUT THE AUTHOR

Larry J. Baraff, MD, is Professor of Pediatrics and Emergency Medicine, UCLA Emergency Medicine Center, David Geffen School of Medicine at UCLA.

Address correspondence to: Larry J. Baraff, MD, Professor of Pediatrics and Emergency Medicine, UCLA Emergency Medicine Center, David Geffen School of Medicine at UCLA, 924 Westwood Boulevard, Suite 300, Los Angeles, CA 90024; fax 310-794-0599; e-mail lbaraff@mednet.ucla.edu.

Dr. Baraff has disclosed no relevant financial relationships.

EDUCATIONAL OBJECTIVES

  1. Review the current evidence upon which rational decision making for the management of infants and children with fever without source should be based.
  2. Discuss an evidence-based framework for the evaluation of infants and children with fever without source.
  3. Determine the most logical management scheme for infants and children with fever without source based upon their age and immunization status.

Febrile infants and children frequently present to pediatricians and emergency room physicians. The majority of these children are less than 3 years of age. Fever is defined as a rectal temperature 38.0° C. An infant or child with a recent history of a documented fever who is afebrile in the office or emergency department should be considered a febrile child. Temperatures in infants and young children should be measured rectally. Axillary and tympanic membrane temperatures are unreliable and have a sensitivity of approximately 50% to 65%. Although some infants with serious bacterial infections may be afebrile, most of these will appear seriously ill.

ABOUT THE AUTHOR

Larry J. Baraff, MD, is Professor of Pediatrics and Emergency Medicine, UCLA Emergency Medicine Center, David Geffen School of Medicine at UCLA.

Address correspondence to: Larry J. Baraff, MD, Professor of Pediatrics and Emergency Medicine, UCLA Emergency Medicine Center, David Geffen School of Medicine at UCLA, 924 Westwood Boulevard, Suite 300, Los Angeles, CA 90024; fax 310-794-0599; e-mail lbaraff@mednet.ucla.edu.

Dr. Baraff has disclosed no relevant financial relationships.

EDUCATIONAL OBJECTIVES

  1. Review the current evidence upon which rational decision making for the management of infants and children with fever without source should be based.
  2. Discuss an evidence-based framework for the evaluation of infants and children with fever without source.
  3. Determine the most logical management scheme for infants and children with fever without source based upon their age and immunization status.

10.3928/00904481-20081001-01

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