is a frequent medical symptom that describes an
increase in internal body temperature to levels
that are above normal
◦ Common oral measurement of normal human body
36.8±0.7°C or 98.2±1.3°F
Fever isn't an illness, but a sign of other problems
in the body that trigger the immune system to
release chemicals that cause temperature to rise.
Plastic forehead strips - not accurate
Glass Mercury thermometers
Only if your child is cooperative, and is 5
years of age or older
Younger children may bite and break the
Wait at least 10 minutes after your child
drinks hot or cold liquids before taking
Put the tip of the thermometer under your
Tell your child to close his lips tightly but not
to bite the thermometer
Keep the thermometer in place for 2 to 3
Never leave your child alone with the
thermometer in his mouth
Hold tip of thermometer in the
middle of the armpit with one
Use your other hand to hold
your child's arm snugly against
Hold the thermometer in place
3 to 4 minutes
Indicate if oral or rectal
equivalent with a switch near top
of the thermometer
Put tip of thermometer gently into
your child's ear canal
Press the start button
After one second, a digital
reading appears in the small
Pros - very fast reading, easier to
use with a fussy child
Cons -most expensive
needs to be placed in the ear
canal correctly for an accurate
Coat the tip of the
thermometer with petroleum
Insert it half an inch into the
Hold the thermometer still for
Never let go of the
Pros – Accurate, core temp.
Cons –Social acceptance poor
1. Infant appears generally well
2. Infant has been previously healthy:
Born at term (>/=37 weeks of gestation)
No perinatal antimicrobial therapy
No treatment for unexplained hyperbilirubinemia
No previous antimicrobial therapy
No previous hospitalization
No chronic or underlying illness
Not hospitalized longer than mother
White blood cell count of 5,000 to 15,000 per mm3 (5 to 15 109 per L)
Absolute band cell count of ≤ 1,500 per mm3 (≤ 1.5 109 per L)
Ten or fewer white blood cells per high-power field on microscopic examination of
Five or fewer white blood cells per high-power field on microscopic examination of
stool in infant with diarrhea
1. Infant has no evidence of skin, soft tissue, bone, joint or ear infection
2. Infant has these laboratory values:
3. Infant has these laboratory values:
◦ Clinical presentation characterized by lethargy,
evidence of poor perfusion, cyanosis, hypoventilation
◦ Poor or absent eye contact; failure of child to
recognize parents or to interact with persons or objects
in the environment
May not require admission if they meet the
Patient was healthy prior to onset of fever.
Patient has no significant risk factors.
Patient appears nontoxic and otherwise healthy.
Patient's laboratory results are within reference ranges defined as
Patient's parents (or caregivers) appear reliable and have access to
transportation if the child's symptoms should worsen
Careful physical examination to identify potential focal
infection (e.g., pneumonia, abscess, cellulitis, sinusitis,
otitis media, osteomyelitis,
impetigo, lymphadenitis, strep. pharyngitis)
Consider no antibiotics
No tests or antibiotics if infant or young child looks well and
no possible bacterial source is identified
Schedule a follow-up appointment within 24-48 hours and
instruct parents to return with the child sooner if the
Hospital admission is indicated for children whose
conditions worsen or whose evaluation findings suggest a
Urine culture in all infants and children < 2 years of
age who are prescribed empiric antibiotics10
Consider radiograph if infant or child is asymptomatic
and has a WBC count >20,000 per mm3
Stool culture if blood and mucus are in the stool, or
there are >5 WBCs per high-power field on
microscopic examination of stool
Empiric antibiotic therapy e.g., ceftriaxone 50 mg per
kg IM or IV
Follow-up: within 24 to 48 hours
Admit child for further treatment;
pending culture results, administer parenteral
Initially administer ceftriaxone, cefotaxime, or
ampicillin/sulbactam (50 mg/kg/dose).
Child has a fever yet is content, eating, drinking,
or playing, they may not need medication.
Dress them in lightweight clothing or remove
clothing to allow heat loss through the skin.
Use a lightweight blanket if they feel cold or are
Try to keep your child quiet - activity increases
Give your child extra fluids to prevent dehydration
or extra loss of water.
Make sure your child's room is a comfortable
temperature - not too hot or too cold
Medication is only needed to make child comfortable.
If your child is sleeping, don't wake them up to give medicines. If the fever is high enough
to need medication, your child will waken.
Always give your child medication for fever if he has had febrile seizure (seizures when
your child has a fever)
Give your child a sponge bath with lukewarm
water only if fever is higher than 104° F and fever
is not decreased 30-60 minutes after medication
is given-- NEVER LEAVE HIM ALONE IN THE
Stop the sponge bath if your child starts to shiver
Never use rubbing alcohol for baths or sponging
Trial with chloroquine (considering epidemiology)
Trial with broad spectrum antibiotics should not be considered
without relevant investigations to rule out serious infections such as
UTI, Meningitis, Typhoid or Pneumonia.
If the response to the first antibiotic is poor, another drug may be
If two drugs have failed, it is logical to reconsider the diagnosis
rather than change the antibiotic.
Do not try empirical treatment for tuberculosis except in lifethreatening situations, wherein treatment must be completed for full
conventional period, unless another cause for fever is found out
during the trial period.
Steroids should never be used for undiagnosed fever
Do not prescribe an antibiotic without presumptive diagnosis.
Routine investigations must be carried out to support the diagnosis.
As clinical diagnosis of Bacterial infection in office practice is rarely
possible within the first 2-3 days of fever, (except in case of
Tonsillitis or otitis) prescribing antibiotic is not recommended during
If antibiotic is justified then, for most community infections, oral
amoxycillin, or cotrimoxazole is sufficient (first line drugs).
Injectable antibiotics are almost never needed in office practice.
Newer antibiotics are not recommended for routine community
Clinical picture might have been modified by prior therapy.
If etiologic evidence is based on reasonable evidence,
dosage & compliance of drug is checked.
In case of suspected drug resistance, change of therapy is
If the disease has never been diagnosed and the therapy is
empirical, failure of response may be due to wrong
diagnosis. It is best to continue empirical therapy while
investigations are repeated to arrive at the right diagnosis.
Lab tests need to be repeated in patients who continue to be febrile
even after few days of therapy
Some tests may be modified by therapy. E.g. WBC counts, peripheral
smear for malarial parasites, urinalysis and bacterial culture.
Persistence of high ESR in spite of treatment suggests uncontrolled
active disease. So is persistent eosinopenia, hence change in therapy
may be indicated.
Change from neutrophilic response to lymphocytic response in
peripheral smear indicates recovering bacterial infection, hence to
continue the same antibiotic.
Improving laboratory tests with no clinical response should alert the
physician to the possibility of complications.
Clinical improvement with persistent abnormal tests warrants close
observation without change in the antibiotic
Paracetamol (Acetamniophen):15 mg/kg /dose q 4 h
Ibuprofen : 12 mg/kg /dose q 8 h
Mefanamic acid – 2.5 mg/kg/ dose q 8 h
Nimesulide – 4 mg/kg/dose q 8 h
Do not use Aspirin for fever (it has been related to a
serious illness, Reye's Syndrome)
Irish Medicines Board (IMB) suspends Nimesulide
Singapore Health Science Authority suspends Nimesulide
On September 21, 2007 the EMEA has concluded that
the benefits of these medicines outweigh their risks, but
that there is a need to limit the duration of use to ensure
that the risk of patients developing liver problems is kept to
Therefore the EMEA has limited the use of systemic
formulations (tablets, solutions, suppositories) of
nimesulide to 15 days.
Changes in behaviour
Constant vomiting or diarrhea
Sore throat that doesn't improve
Earache that doesn't improve
Stiff neck Fever comes and goes over several
Swelling on the soft spot on the head
Unresponsive or limp
Wheezing or problems breathing
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