Fever in Children Aged 3 to 36 Months: Management in the Emergency Department (Pharmacology CME) -
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Publication Date: October 2022 (Volume 19, Number 10)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 10/01/2025.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 1 Pharmacology CME credit, subject to your state and institutional approval.

Authors

Nader Badri, MD

Emergency Department, Riverside, CA

Lucas Friedman, MD

Associate Professor, University of California Riverside School of Medicine, Riverside, CA

Peer Reviewers

Jeffrey R. Avner, MD, FAAP

Chairman, Department of Pediatrics, Professor of Clinical Pediatrics, Maimonides Children’s Hospital of Brooklyn, Brooklyn, NY

Jo-Ann O. Nesiama, MD, MS

Associate Professor, Department of Pediatrics, Program Director, Pediatric Emergency Medicine Fellowship Program, Division of Emergency Medicine, UT Southwestern/Children’s Medical Center, Dallas, TX

Abstract

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. This issue 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.

Case Presentations

CASE 1

A 3-month-old boy presents with cough, congestion, and fever…

The boy’s mother tells you she measured the boy’s temperature at home, and it was 104.2°F (40.1°C). She says he has been sick for the past 3 days.
The history reveals that the infant has received all his recommended vaccinations, is uncircumcised, and was born at term without any complications. The prenatal course was unremarkable. On examination, he is fussy but consolable. He is congested, with no respiratory distress.
The diagnosis of a viral infection, such as bronchiolitis, is possible, but you also consider the possibility of a concurrent bacterial infection. Is the height of the fever concerning enough to warrant further testing?

CASE 2

An 18-month-old unvaccinated girl presents with the primary concern of fever…

The mother says her daughter has felt “hot to the touch” for the past 4 days, but the girl is afebrile in the ED, without any antipyretics given at home. The girl is otherwise asymptomatic.
On examination, the girl is well-appearing with normal vital signs. No focal bacterial infection is found.
Should you consider this patient febrile if there are no documented fevers at home or in the ED? Does this patient need a workup for fever without a source?

CASE 3

A previously healthy 3-month-old boy presents with fever for the past 2 days…

The boy is circumcised and unvaccinated. He has been febrile to 39.8°C for the past 2 days but looks well.
What is the likelihood that this patient has an invasive bacterial infection or a serious bacterial infection? If discharged home, should antibiotics be started and how soon should they follow up?

Accreditation:

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