What should be the focus of history for the emergent management of older children 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 following questions might be helpful:

  • What is the timing of the current illness?

  • When did the fever start?

  • How long has the fever been present? Are there any related symptoms?

  • What is the patient's medical history? The history may not be applicable in all cases, but it must be explored to reveal potential high risk or complicating factors.

  • Has the child's activity significantly changed during the illness?

  • Is the child tolerating fluids at home? Has the child been less interested in eating?

  • Have the stool patterns changed in consistency or frequency?

  • Has there been recent antibiotic use?

  • Has there been exposure to illness through babysitters, day care contacts, or other caregivers? Are others at home sick?

  • Have the sleep patterns changed? Has the patient been snoring more at night than usual?

  • Has there been any recent travel that might have exposed the child to illnesses?

It can also be helpful to ask what has been done at home to help control the fever. Was an antipyretic given at home? If so, what dose was given?

In some cases, the clinician finds that child received an inadequate does of antipyretic medication. Over-the-counter medications may not clearly list the correct weight-based dose for children younger than 2 years. Some product instructions simply state "call physician" or "seek medical care." Parents should be educated that the steadily changing weight of their child will result in a need to periodically update the correct dose of medication. [22, 23]

According to the 2003 clinical policy of the American College of Emergency Physicians (ACEP), response to antipyretic medication does not change the likelihood of a child having a serious bacterial infection and should not be used for clinical decision making. [24]


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