Why is emergent management of pediatric patients with fever challenging?

Updated: Jul 23, 2019
  • Author: Hina Z Ghory, MD; Chief Editor: Russell W Steele, MD  more...
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Emergent management of pediatric patients with fever is a common challenge. Children with fever account for as many as 20% of pediatric emergency department (ED) visits, [1] and the underlying disorders in these cases range from mild conditions to the most serious of bacterial and viral illnesses. [2, 3]

Infants younger than 2 months have unique risks for serious bacterial infections; as such, their management is discussed separately from that of older children.

Clinical guidelines have been studied, reported, and scrutinized in major journals for the past 2 decades, yet definitive conclusions are sometimes still elusive and the application to each individual case in the ED is sometimes even more frustrating for the clinician. [4] Inconsistent treatment approaches exist even in the most experienced pediatric EDs. [5, 6]

Some of the fears and anxiety exhibited by parents are shared by ED staff as well. Myths and misperceptions about children with temperature elevations are reported. Fever phobia is well described as existing with both caregivers as well as medical providers. [8, 9, 10, 11]

Because pediatric fever is both a high-impact and a high-frequency chief complaint, the clinician should be knowledgeable about febrile conditions that occur in a variety of age groups of pediatric patients. ED guidelines for treating children with febrile illness are used in order to standardize the approach to care.

This article discusses the appropriate ED management of young febrile children, particularly those younger than 2 years. Neonates (< 28 days) and young infants (28-60 days) are discussed as subsets of this group of pediatric febrile patients.

For more information, see the Medscape Reference articles Fever in the Infant and Toddler and Fever Without a Focus.

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