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Fever in young children can indicate serious illness. Pediatricians use clinical signs and lab tests like white blood cell counts to identify children needing immediate care for potential bacterial infections.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Decision-Making
Background:
- Fever is a common pediatric complaint, accounting for 20% of clinic visits.
- Distinguishing benign fever from serious bacterial infections is crucial for timely treatment.
Purpose of the Study:
- To outline the approach for evaluating fever in young children.
- To identify key indicators of serious illness in febrile children.
Main Methods:
- Physicians assess clinical signs (e.g., tachypnea, stiff neck) and observational clues of illness severity.
- Laboratory tests, including white blood cell count, band count, and urinalysis, are used to refine risk assessment.
Main Results:
- High fever (over 40°C) in children under 2 increases the risk of bacteremia (6-10%), primarily from S. pneumoniae and H. influenzae.
- Abnormal white blood cell counts (>15,000) and elevated sedimentation rates (>30 mm/hour) are useful indicators.
Conclusions:
- Clinical examination and targeted laboratory tests help differentiate serious from inconsequential febrile illnesses in children.
- Early identification of bacteremia is vital for initiating appropriate antimicrobial therapy.
Abstract:
Fever is one of the most common complaints presented to the child's pediatrician or health provider. Some 20% of children seen in the office or clinic are there because of fever. The first decision the physician faces is over the phone: who should be seen immediately and who can be managed over the phone. The purpose of the consultation and the visit is to separate those with inconsequential febrile illness from those who have serious illnesses, bacterial illnesses in particular, since these could be life-threatening and are amenable to antimicrobial therapy. Many studies performed over the past 10 years are essentially in agreement that high fever in children younger than 2 years includes a subset of about 6 to 10% with bacteremia caused principally by S. pneumoniae and H. influenzae. The higher the fever (particularly over 40%) the higher the risk of bacteremia. Examination of the young child elicits two sets of findings. These are traditional physical clues to a specific diagnosis, such as tachypnea, crepitant rales, stiff neck, swollen joints and others. Additionally there are general observational clues dealing with how sick the child really is. The physician then needs to decide which of several possible laboratory tests need to be done in order to further refine a subset of children at high risk. The white count (less than 5000 or greater than 15,000), the band count (greater than 1500) and the sedimentation rate (greater than 30 mm/hour) have proved useful in various studies, as has examination of the urine.(ABSTRACT TRUNCATED AT 250 WORDS)