FEVER IN

PEDIATRICS
 Outline
Definition
Assessment
Initial workup
Differential diagnoses
Subsequent management
Definition of a fever
A fever is a temperature of 38 °C or higher.
Keep in mind: infants aged < 3 months might
present with low temperature isntead
BEFORE WE KICK OFF
PARENTAL PERCEPTIONS OF FEVER ARE USUALLY
ACCURATE AND MUST BE TAKEN SERIOUSLY
 Assessment
A three step process:
1. Look for life threatening features
2. Risk stratify using the traffic light system
3. Narrow down your differential
Life threatening
features
GET YOUR PRIORITIES STRAIGHT!

CHECK YOUR ABCDEs

The traffic light system
For children > 3 months of age
 Observations
Things to report in every febrile pediatric
patient
Temperature (Duh!!). But what's the best way
to do so?
Respiratory rate, heart rate, capillary refill time
Dehydration signs :
Skin turgor
Respiratory pattern
Weak pulse
Cool extremities
Travel history
 RE-ASSESS IN 1 - 2H

If the child exhibits amber or red features

Initial Workup
< 3 months of age
> 3 months of age
 Now what?
What should we do immediately?
Temperature: to lower or not to
lower? and how??
Temperature: to lower or not to
lower? and how??
Tepid sponging is OUT! (not recommended)
Temperature: to lower or not to
lower? and how??
Tepid sponging is OUT! (not recommended)
Cool fluids are IN!
Temperature: to lower or not to
lower? and how??
Tepid sponging is OUT! (not recommended)
Cool fluids are IN!
Dress child normally (or opt for loose-fitting
clothes)
Temperature: to lower or not to
lower? and how??
Tepid sponging is OUT! (not recommended)
Cool fluids are IN!
Dress child normally (or opt for loose-fitting
clothes)
Antipyretics don't lower the risk of seizures
Temperature: to lower or not to
lower? and how??
Tepid sponging is OUT! (not recommended)
Cool fluids are IN!
Dress child normally (or opt for loose-fitting
clothes)
Antipyretics don't lower the risk of seizures
Combining them doesn't either!!
Temperature: to lower or not to
lower? and how??
Tepid sponging is OUT! (not recommended)
Cool fluids are IN!
Dress child normally (or opt for loose-fitting
clothes)
Antipyretics don't lower the risk of seizures
Combining them doesn't either!!
Give antipyretics to make the patient more
comfortable
What's the deal with febrile
seizures anyway?
Read about it here!
 What about antibiotics?

DON'T TAKE THE EASY WAY OUT

WE'RE WHITNESSING A SHORTAGE OF BASIC

ANTIBIOTICS IN REAL TIME
 What about antibiotics?

DON'T TAKE THE EASY WAY OUT

WE'RE WHITNESSING A SHORTAGE OF BASIC

ANTIBIOTICS IN REAL TIME

No oral ATB for fever without an apparent

source
DID YOU JUST CALL ME BASIC!
What to do if you suspect
shock?
What to do if you suspect
shock?
IV fluid bolus of normal saline (0.9%) at 20
ml/kg
What to do if you suspect
shock?
IV fluid bolus of normal saline (0.9%) at 20
ml/kg
Supplement if necessary
What to do if you suspect
shock?
IV fluid bolus of normal saline (0.9%) at 20
ml/kg
Supplement if necessary
Ask for senior support
When to give oxygen?
When to give oxygen?
If SpO2 < 92%, or clinically
indicated.
DDX
Fever
Non-blanching rash, particularly with ≥1 of the
following:
Ill-looking child
lesions >2 mm in diameter (purpura)
CRT >3 sec
Neck stiffness
What's the most likely diagnosis ?
Meningococcal disease
 Neck stiffness
Bulging fontanelle
Decreased level of consciousness
Convulsive status epilepticus
What's the most likely diagnosis?
Meningitis
 Focal neurological signs
Focal seizures
Decreased level of consciousness
What's the most likely diagnosis?
Herpes simplex encephalitis
 Tachypnoea
Crackles in the chest
Nasal flaring
Chest indrawing
Cyanosis
SpO2 ≤95%
What's the most likely diagnosis?
Pneumonia
 Poor feeding
Lethargy
Irritability
Abdominal pain or tenderness
Urinary frequency or dysuria
Offensive urine or haematuria
What's the most likely diagnosis?
Urinary tract infection
 Swelling of a limb or joint
Not using an extremity
Non weight bearing
What's the most likely diagnosis?
Septic arthritis / osteomyelitis
Fever lasting > 5 days and 4 or more of the
following:
bilateral conjunctival injection
change in upper respiratory tract mucous
membranes
injected pharynx
dry cracked lips or strawberry tongue
change in peripheral extremities (oedema,
erythema, desquamation)
polymorphous rash
cervical lymphadenopathy
What's the most likely diagnosis?
Kawasaki disease
Subsequent
management
Serious bacterial infection
suspected
Cefotaxime 50 mg/kg slow IV bolus every 6h
When patient is stable, change to once daily
ceftriaxone.
Refer to your local guidelines
for management of specific
illnesses
 FINALLY
EMPOWER PARENTS

Instruct them to return if anything changes

Advise them on how to manage their child at
home Fever Advice Sheet
 References
CAT devant une fièvre chez l'enfant (Pr.
Boutrid)
Bedside Paediatric Guidelines 2022-24
Pediatric emergency playbook (pediatrics
podcast)
 THANK YOU
&

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