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Evaluation and Management of Febrile Children: A Review

Leigh-Anne Cioffredi1, Ravi Jhaveri2

  • 1Division of General Pediatrics and Adolescent Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill.

JAMA Pediatrics
|June 21, 2016
PubMed

Insights

Febrile children require careful management, with advances in diagnostics and vaccines improving risk stratification for serious bacterial infections. Urinary tract infections remain a key concern in infants of all ages.

Area of Science:

  • Pediatric emergency medicine
  • Infectious disease management

Background:

  • Febrile children constitute 15% of emergency department visits, with varied outcomes.
  • Management of febrile infants (<90 days) has evolved due to rising E. coli UTIs, ampicillin resistance, and viral diagnostics.
  • Vaccinations against H. influenzae and S. pneumoniae have reduced bacterial infection concerns in children aged 3-36 months.

Purpose of the Study:

  • To review the evolution of febrile infant and child management over 30 years.
  • To highlight current approaches to risk stratification and diagnostic testing.
  • To identify persistent concerns such as urinary tract infections.

Main Methods:

  • Review of studies from 1979 to 2015 on febrile infants and children.
  • Analysis of changes in diagnostic and treatment strategies.
  • Assessment of the impact of vaccination and antimicrobial resistance.

Main Results:

  • Improved risk stratification for serious bacterial infections in infants <90 days is now possible.
  • Targeted testing can reduce diagnostic workup and empirical treatment for this age group.
  • Urinary tract infections remain a significant concern across all febrile infant age groups.

Conclusions:

  • Modern advances enable precise risk assessment for serious bacterial infections in febrile infants.
  • Appropriate initial testing can minimize unnecessary diagnostics and treatments.
  • Urinary tract infections are the primary bacterial concern in vaccinated children (3-36 months) and all febrile infants.
Abstract

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