The advent of pneumococcal and Haemophilus influenzae vaccines has substantially reduced the risk for occult (unsuspected) serious bacterial infection or invasive bacterial infection in the febrile child. The challenge for emergency clinicians is to identify and treat children with serious illness while avoiding overtreatment.
Our recent issue Fever in Children Aged 3 to 36 Months: Management in the Emergency Department reviews the epidemiology and management of fever in children aged 3 to 36 months, focusing primarily on previously healthy, well-appearing children without a source of fever whose evaluation and management are more ambiguous.
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Here are a few key points:
- Fever of concern in a well child is ≥39°C.
- In general, fever measured at home may be evaluated as fever in the ED even if the child is afebrile at presentation.
- A meta-analysis found that all peripheral methods of thermometry have poor limits of agreement with central methods such as rectal thermometry.
- When a temperature measured by means other than rectal is necessary, the best alternatives are oral, then tympanic measurements.