Management of Prolonged Pediatric Fever in the Emergency Department (Infectious Disease CME)

Publication Date: February 2026 (Volume 23, Number 2)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-B Credits. CME expires 02/01/2029.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 3 Infectious Disease CME credits, subject to your state and institutional approval.

Authors

Anneka Hooft, MD, MPH, FAAP

University of California San Francisco, Departments of Emergency Medicine and Pediatrics, Oakland, CA

Morgan Leighton, MD, MPH

Pediatric Emergency Medicine Fellow, UCSF Benioff Children’s Hospitals, San Francisco and Oakland, CA

Peer Reviewers

Kendall S. Luyt, MD, FAAP, FACEP

Clinical Assistant Professor, Pediatric Emergency Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK

James Naprawa, MD

Clinical Professor, Emergency Medicine, University of California San Francisco School of Medicine; Attending Physician, Pediatric Emergency Department, UCSF Benioff Children’s Hospital, Oakland, CA

Abstract

Prolonged pediatric fever is most often due to a self-limiting infectious illness, but can sometimes be a sign of much more serious disease. The care of children with prolonged fever can be challenging, since there is significant variation in the definition of prolonged pediatric fever, and evidence-based decision support tools to guide evaluation and management of children with prolonged fever are limited. This issue constructs a framework for initial emergency department evaluation and management of children with fever lasting ≥5 days and fever of unknown origin lasting ≥8 days.

Case Presentations

CASE 1

An 18-month-old boy presents with 14 days of fever...

The child’s parents tell you he has been sick with cough, congestion, and rhinorrhea for at least 2 weeks, and he has had tactile fevers “every night.”
He is fully vaccinated, well hydrated, and playful in the examination room, with clear nasal rhinorrhea and an occasional cough.
Your leading diagnosis is viral illness, but you wonder whether you should investigate further, due to the family’s report of fever for 2 weeks...

CASE 2

A 3-year-old girl presents with 6 days of fever, red eyes, and rash...

Her mother says she has had daily fevers to a maximum temperature of 103.8°F, with low energy, red eyes without discharge, and a rash of small red bumps on her chest and back.
The family thought it was “just a cold” and have been treating her with antipyretics, rest, and fluids, but tell you her symptoms are not getting better.
You consider that this could still be a viral infection, but also wonder whether you should investigate for bacterial infection or other conditions, since the girl has had a fever for more than 5 days...

CASE 3

An 8-year-old boy with autism presents for 10 days of true fever and no localizing symptoms…

The boy’s parents report that he has had fever to at least 101°F each day for 10 days and that he seems less active than usual, with poor appetite and not wanting to run and play as he normally does. The boy‘s parents say he speaks only a few words and does not often express pain, so they have a hard time knowing whether anything specific has been bothering him.
The boy is febrile and tired-appearing, with a nonfocal examination.
You consider what further workup you should pursue or if he needs further monitoring, given his difficulty communicating and his inability to clearly indicate pain.

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.