Overview
Definition:
Fever is a temporary increase in body temperature above the normal range of 37°C (98.6°F)
In children, a rectal temperature of 38°C (100.4°F) or higher is generally considered a fever
Fever is a symptom, not an illness itself, and is often a sign that the body is fighting an infection or illness.
Epidemiology:
Fever is one of the most common reasons parents seek medical attention for their children
It is estimated that over 30% of children under 3 years of age will have at least one episode of fever annually
The likelihood of serious bacterial infection decreases significantly with age.
Clinical Significance:
Understanding when to seek medical care for a febrile child is crucial for timely diagnosis and management of potentially serious conditions
It helps differentiate between self-limiting viral illnesses and conditions requiring urgent medical intervention, impacting patient outcomes and reducing healthcare burden.
Age Considerations
Infants Under 3 Months:
Fever in infants younger than 3 months (12 weeks) is always a cause for concern and requires immediate medical evaluation
Their immune systems are immature, and serious bacterial infections can progress rapidly.
Infants 3 To 6 Months:
Fever in this age group warrants prompt medical attention, especially if the temperature is high or the infant appears unwell
While less critical than younger infants, the risk of serious infection remains.
Older Infants And Children:
For older infants and children, the approach to fever is more nuanced, focusing on the child's overall well-being, behavior, and associated symptoms rather than just the temperature reading.
Clinical Presentation
Symptoms:
Elevated body temperature
Irritability or lethargy
Decreased activity and playfulness
Poor feeding or decreased fluid intake
Vomiting or diarrhea
Cough, runny nose, or sore throat
Rash
Seizures (febrile seizures)
Difficulty breathing.
Signs:
High temperature on thermometer
Warm skin
Red cheeks
Flushed appearance
Increased heart rate and respiratory rate
Signs of dehydration (dry mouth, sunken eyes, reduced urination)
Lethargy or unresponsiveness.
Red Flags For Immediate Care:
Fever in an infant less than 3 months old
Temperature of 104°F (40°C) or higher
Fever lasting more than 3 days
Child appears very ill, lethargic, or difficult to wake
Stiff neck or severe headache
Difficulty breathing or shortness of breath
Persistent vomiting or diarrhea
Signs of dehydration
Rash that doesn't fade when pressed
Seizure
Complains of severe pain.
Diagnostic Approach
History Taking:
Duration and pattern of fever
Associated symptoms (cough, vomiting, rash, etc.)
Child's activity level and behavior
Fluid intake and urine output
Recent exposures to illness
Vaccination status
Any chronic medical conditions or medications
History of febrile seizures.
Physical Examination:
General appearance (alertness, comfort level, activity)
Vital signs (temperature, heart rate, respiratory rate, blood pressure)
Examination of ears, nose, throat, and lungs
Assessment for rash
Palpation of abdomen and lymph nodes
Neurological assessment (mental status, neck stiffness).
Investigations:
Complete blood count (CBC) to assess for infection and inflammation
Blood cultures to identify bacteria in the bloodstream
Urine culture to detect urinary tract infection
Chest X-ray if pneumonia is suspected
Lumbar puncture (spinal tap) to rule out meningitis
Viral testing (e.g., influenza, RSV) may be considered based on symptoms and local epidemiology
Swabs for strep throat or other rapid antigen detection tests.
Differential Diagnosis:
Viral infections (common cold, influenza, gastroenteritis)
Bacterial infections (otitis media, pneumonia, urinary tract infection, meningitis, sepsis)
Kawasaki disease
Other inflammatory conditions.
Management
Home Care For Mild Fever:
Encourage fluid intake to prevent dehydration
Dress the child in light clothing and keep the room at a comfortable temperature
Do not over-bundle
Administer antipyretics as recommended by a healthcare provider (e.g., acetaminophen or ibuprofen for children over 6 months)
Monitor temperature and symptoms closely
Provide rest.
When To Seek Medical Care:
Refer to the "Red Flags for Immediate Care" section
Always consult a pediatrician if you are concerned about your child's fever or overall condition
Infants under 3 months with any fever need immediate evaluation
Fever above 104°F (40°C) or fever lasting more than 3 days warrants a doctor's visit.
Medical Management:
Treatment of the underlying cause
Antipyretics (acetaminophen, ibuprofen) for symptom relief
Antibiotics if a bacterial infection is diagnosed
Antiviral medications for specific viral infections like influenza
Hospitalization for severe illness, dehydration, or suspected sepsis/meningitis.
Supportive Care:
Adequate hydration is paramount
Rest is important for recovery
Close monitoring of vital signs and symptoms by parents and healthcare providers
Education for parents on fever management and warning signs.
Complications
Early Complications:
Dehydration
Febrile seizures (usually benign and self-limiting, but can be frightening)
Worsening of underlying condition.
Late Complications:
Rarely, untreated or inadequately treated serious infections can lead to long-term sequelae such as neurological damage, organ damage, or chronic illness
Delayed diagnosis of conditions like meningitis or sepsis can be life-threatening.
Prevention Strategies:
Promote good hygiene practices (handwashing)
Ensure children are up-to-date on vaccinations
Promptly address symptoms of illness
Seek timely medical care for concerning fever presentations to prevent complications from serious infections.
Key Points
Exam Focus:
Fever in neonates (< 28 days) is a medical emergency
always admit and investigate
Differentiating viral from bacterial causes is crucial
Red flag symptoms for immediate evaluation are key for DNB/NEET SS scenarios
Age-appropriate antipyretic dosing and indications are important.
Clinical Pearls:
Trust your parental instinct
A child's behavior and overall appearance are often more important than the exact temperature reading
For infants under 3 months, any fever requires urgent medical attention regardless of other symptoms
Avoid aspirin in children due to the risk of Reye's syndrome.
Common Mistakes:
Over-reliance on temperature alone without assessing the child's overall well-being
Underestimating the significance of fever in young infants
Inappropriate use of antibiotics for viral infections
Delaying medical evaluation for red flag symptoms.