← Diagnosis and Management Guides
Fever in Young Child
Key considerations: Meningitis, Bacteremia, UTI
Cannot miss
- Meningitis
- Bacteremia
- UTI
- Kawasaki disease
- Septic arthritis
Likely diagnoses
- Viral illness
- Otitis media
- Pharyngitis
- UTI
- Pneumonia
Red flags
- Age <28 days with fever
- Ill-appearing
- Petechial rash
- Bulging fontanelle
- Altered mental status
Workup
- history: Duration, associated symptoms, ill contacts, immunization status, urine output; exam: Source identification, fontanelle, ear exam, rash, joint exam; labs: Age <28 days: CBC, blood culture, UA/UCx, LP, CXR if respiratory symptoms; 28-90 days: Rochester/Philadelphia/Boston criteria or Step-by-Step approach; Procalcitonin, CRP, ANC for risk stratification; imaging: CXR if respiratory symptoms or WBC elevated; bedside: Urinalysis by catheter specimen in non-toilet-trained children
Management
- immediate: Neonates <28 days: empiric ampicillin + gentamicin (or cefotaxime) after full sepsis workup; general: 29-90 days well-appearing: based on risk stratification — low risk may be observed or given ceftriaxone IM with close follow-up; Identify and treat source; Antipyretics for comfort
Disposition
- admit: All febrile neonates <28 days; Ill-appearing at any age; Positive bacterial cultures; discharge: Well-appearing >28 days meeting low-risk criteria with reliable follow-up in 24 hours; consults: Pediatric ID for complex febrile illness
Clinical pearls
- All febrile neonates <28 days get full sepsis workup and empiric antibiotics regardless of appearance
- Procalcitonin <0.5 has high NPV for serious bacterial infection in young febrile infants
Source and review
- AAP Febrile Infant Guidelines 2021. Last reviewed: 2024-11-01