What should be the focus of history in the emergent management of pediatric patients with fever?

Updated: Jul 23, 2019
  • Author: Hina Z Ghory, MD; Chief Editor: Russell W Steele, MD  more...
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Answer

Answer

The clinician should ask the patient's parents or caretakers about the following items when they bring in a febrile or ill-appearing child:

  • Immunization history, such as recent vaccination or a history of inadequate immunizations

  • History of exposure to sick contacts and treatments, such as antibiotics

  • Recent travel history

  • History of previous hospitalization, prolonged ICU stay, prematurity, or immunocompromised diseases

  • History of change in mental status, change in eating and/or behavioral patterns such as irritability, lethargy, or apnea

  • History of neglect or abuse

  • Documented fever at home, the duration of any fever, and the last treatment (if any) for the fever

Environmental factors, such as being in the heat for a long time during the summer and being overdressed during the winter, may indicate a risk for hyperthermia.

The neonate (birth to 28 days)

The history of the neonate is explored for possible symptoms of poor feeding, vomiting, poor social interaction, changes in the quality of crying, and possible apneic episodes. Any of these findings are reasons to consider serious bacterial infection and may warrant further investigation and laboratory evaluation.

The birth history is explored to ascertain risk factors for underlying pathology, such as prematurity, maternal infections (eg, group B Streptococcus, sexually transmitted diseases such as genital herpes simplex), and congenital or chronic disease states. Neonates at risk for congenital herpes are those born to mothers with a history of recent genital infection and high-risk sexual activity; delivery-related risk factors include rupture of membranes for longer than 6 hours and use of a scalp electrode.

Neonates who present with irritability, seizures, respiratory distress, jaundice, or a characteristic vesicular rash should be considered at risk for neonatal herpes. Note that 10-50% will not develop skin lesions during the course of their illness. [21]

The history is also explored for previous diagnostic studies and their results.


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