Paediatrics: Fever: management (red or amber features)

Fever: management (red or amber features)

Children with red/amber features need admission. Those with red fea-tures have life-threatening illness and need urgent treatment.

• In hypoxic children or those in shock.

• If there is no apparent source of infection, despite fever, then the investigations should include the following:

•   Blood—culture, FBC, CRP, electrolytes;

•   Urine—test for UTI;

•   lumbar puncture—consider if the clinical assessment dictates and there are no contraindications;

•   CXR—consider if high white blood cell count.

Antibiotics

Immediate treatment

Maximum dose third-generation cephalosporins (cefotaxime or ceftriax-one) should be given to children with fever and:

•   signs of shock or coma

•   signs of meningococcal disease

Consider giving high dose IV aciclovir if suspect herpes simplex encepha-litis or disseminated neonatal disease.

Consider giving IV corticosteroid if confirmed bacterial meningitis (but not in infants younger than 3mths

Treatment for suspected bacterial infection

Give third-generation cephalosporin if any of the following are sus-pected

•   Neisseria meningitidis

•   Streptococcus pneumoniae

•   Escherichia coli

•   Staphylococcus aureus

•   Haemophilus influenzae type b

Special cases

Consider choice of antibiotics or route of administration carefully in the following instances:

•   Child <3mths: add antibiotic against listeria (e.g. ampicillin)

•   Child with decreased level of consciousness: give parenteral antibiotics.

•   Significant rates of antibiotic resistance: follow local guidelines

Antipyretics

Fever should be treated if the child is unwell with it:

• Do not use tepid sponging.

• Do not over- or underdress the child.

•   Only use paracetamol or ibuprofen if the child is distressed with fever.