What is included in follow-up care for 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

Follow-up necessitates reliable parents with a telephone at home, with transportation readily available to them, and with follow-up care arranged with the primary physician the next day. If next-day follow-up with the primary physician cannot be arranged, the patient should return to the ED. Diagnosis-specific information sheets can enhance parental understanding of ED discharge instructions. [121]

Older children with a low-grade fever, no risk factors, no localized signs of infection, a good appearance, and no irritability may require only symptomatic treatment and close follow-up care. These patients do not routinely need laboratory evaluation, radiography, or empiric antibiotics.

For patients discharged from the ED, close follow-up with the primary care physicians should be arranged, and an ED protocol for notification of positive cultures is needed. Primary care physicians or ED physicians should notify caretakers if an outpatient has a positive blood culture. Such children, if they remain febrile, may require collection of CSF, a repeat blood culture, and hospitalization.

Primary care physicians or ED physicians should notify caretakers if a child has a positive urine culture. Older children with pyelonephritis may continue outpatient treatment if they appear well and can tolerate oral antibiotics. Clinicians should have a low threshold for hospitalizing those who are younger than 6 months with pyelonephritis.

The child should return either to the ED or to the primary care physician's office if his or her clinical presentation worsens after discharge.


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