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Current challenges in the diagnosis and management of fever

Joshua M Sherman1, Sunil K Sood

  • 1Department of Pediatric Emergency Medicine, Cohen Children's Medical Center of New York, USA.

Current Opinion in Pediatrics
|April 25, 2012
PubMed
Abstract

Insights

Fever management in children requires updated guidance. Pediatricians should educate parents on antipyretic use and utilize low-risk criteria for febrile infants to reduce unnecessary testing and antibiotic exposure.

Area of Science:

  • Pediatrics
  • Clinical Medicine
  • Evidence-Based Practice

Background:

  • Public anxiety regarding fever persists, alongside growing concerns about antipyretic toxicity.
  • The American Academy of Pediatrics (AAP) highlights risks of antipyretic overdosing, particularly with alternating medication schedules.

Purpose of the Study:

  • To review current recommendations on fever management with antipyretics.
  • To discuss the classification and diagnosis of fevers of unknown origin (FUO).
  • To evaluate fever management in infants under 90 days old.

Main Methods:

  • Systematic review of recent publications.
  • Analysis of clinical guidelines and expert recommendations.
  • Evaluation of diagnostic criteria for FUO and febrile infants.

Main Results:

  • Alternating acetaminophen and ibuprofen offers limited clinical benefit.
  • Nonclassic and pseudo-fevers of unknown origin (FUO) warrant consideration alongside true FUO.
  • Low-risk criteria effectively identify febrile infants with low risk for serious bacterial infection (SBI).

Conclusions:

  • Enhanced parental education on fever and antipyretics is crucial.
  • Targeted diagnostic testing based on clinical condition is recommended, as not all persistent fevers are FUO.
  • Utilizing established low-risk criteria for infants can safely reduce extensive work-ups and antibiotic use, improving outcomes.

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