Fever in Children

Fever in Children

·        Most fevers caused by respiratory tract viral infection, are self-limiting, and require only symptomatic treatment.

·        Kids have 6 – 8 viral infections each year ® they are common

·        Role of doctor:

o   Identify source of infection

o   Counsel caregivers and child

o   Manage the illness

o   Identify and refer those with potentially serious illness

·        If no focus found:

o   Consider UTI, occult pneumococcal bacteraemia, meningitis 

o   Consider non-infectious causes: rheumatic fever, poisoning, drug fever, more rarely leukaemia and other autoimmune diseases (eg Kawasaki‟s Disease)

o   On exam, pay attention to:

§  General appearance: activity, perfusion, colour

§  Vital signs: pulse, respiration, blood pressure 

§  Exclude: fontanelle, neck stiffness, respiratory distress, abnormal chest signs, ears, throat, lymphadenopathy, hepatosplenomegaly, abdominal distension, bone or joint tenderness/swelling, skin rashes 

o   At greater risk: neonates, immunocompromised, congenital abnormalities, toxic appearance, epidemiological ­ risk (eg Maori)

o   WBC are unreliable for detection serious infection

o   Review within 24 hours and parent education

·        Advice for parents:

o   Light clothing

o   Small, frequent drinks of water or fruit juice diluted 1:4, 5 – 7 mls/kg/hr

o   Paracetamol, 15 mg/kg/6 hourly, max of 90 mg/kg/day for 2 days 

o   Return to doctor if refusing drink, pale or floppy, difficulty breathing, headache/neck stiffness/photophobia, doesn‟t improve in 48 hours

·        Clues for predicting serious illness (even over the phone):

o   Responsiveness and activity

o   Feeding

o   Urine output

o   Breathing

o   Colour