The febrile child: diagnosis and treatment.

Abstract

BACKGROUND: Fever accounts for 70% of all consultations with pediatricians and family physicians. Fever without an identifiable cause (<7 days' duration) and fever of unknown origin (FUO, ≥ 7 days' duration) are particularly challenging clinical situations. METHOD: This article is based on a selective literature search for publications containing the term "pediatric fever management," with special attention to meta-analyses and systematic reviews. RESULTS: The mainstay of diagnosis is physical examination by a physician who is experienced in the care of children and adolescents. The frequency of severe bacterial infection (SBI) is about 10% in neonates, 5% in babies aged up to 3 months, and 0.5% to 1% in older infants and toddlers. The mortality of SBI in neonates is about 10%. Both the degree of the parents' and the physician's concern are important warning signs for SBI. Clinical signs of SBI include cyanosis, tachypnea, poor peripheral perfusion, petechiae, and a rectal temperature above 40°C. Antipyretic drugs should only be used in special, selected situations. More than 40% of cases of FUO are due to infection; in more than 30% of cases, the cause is never determined. CONCLUSION: Aspects of central importance include the repeated physical examination of the patient, and parent counseling and education of medical and nursing staff pertaining to the warning signs for SBI. Research is needed in the areas of diagnostic testing and the development of new vaccines.