Pediatric Fever

The bulk of this episode is based on the UK NICE guideline: Feverish illness in children under 5, published in 2013.

The guideline covers:

The Traffic Light System in assessing risk for serious infection

This assessment tool takes into consideration color/appearance, activity, respiratory, circulation and hydration, and “other” parameters. For each parameter, their associated signs and symptoms are assigned a color code: “green” (low risk), “amber” (intermediate risk) and “red” (high risk). The table can be found here.

Age-appropriate investigations for pediatric fever

Once the risk for serious infection is determined, the following investigation should be performed:

Age CBC diff BC CRP UA/UC LP CXR Stool culture
<1mo yes yes yes yes yes if indicated if indicated
1-3mo yes yes yes yes if unwell, or WBC >15 or <5M/mL if indicated if indicated
>=3mo, RED yes yes yes yes yes yes if indicated
>=3mo, AMBER yes yes yes yes if <1yr if fever >39 and WBC >20 if indicated
>=3mo, GREEN no no no yes no no if indicated

And at the same time, empiric parenteral antibiotic coverage for meningitis (3rd generation cephalosporin plus ampicillin/amoxicillin) should be started if LP is indicated.