Fever (Pediatric)

“Treat the patient, not the numbers.” At least once a shift I’m handed a chart that says something like “pediatric fever.” It’s usually assessed and solved by the triage nurse long before I arrive and my whole job then is to determine sick vs. not sick, and to offer reassurance. To mom who’s been up all night wrestling junior, “of course the kid’s sick!”

Red Flags:

• Dehydrated (not urinating, dry lips, no tears)
• No interest in drinking (BTW We don’t really care about eating. But if junior’s eating McNuggets, we’re just about done.)
• Fever not controlled by properly dosed acetaminophen (15mg/kg) or ibuprofen (10mg/kg)
• Immunocompromised (cancer, HIV, asplenic, chronic steroids, post transplant etc.)
• Neck stiffness +/- rash
• Short of breath
• Painful urination +/- back pain
• Unusual or painful rash (cellulitis, abscess, blisters, etc.)
• Listless and lethargic

Happy Words

• Eating, drinking, peeing, pooping, playing normally
• All siblings have the same cold
• Short 1-2 week duration
• Sniffles
• No past hospitalizations
• Vaccinations up to date
• Full term, and more than 3 months old

(Totally different recommendations for neonates. For one month olds with fever, expect the full “septic workup.” Usually viral. Usually resolves. But occasionally not, so we go the distance and hate it every time.)

Back to the title… Don’t go crazy checking temps every 30 minutes if all happy words apply. The large majority of kids I see in any ER leave with the diagnosis “viral syndrome,” and live on to sniffle another day. Fevers in kids are frequent and expected, but there are some lethal causes out there. So beware of red flags and realize that childhood is immunity boot camp.

Also, have a look here to properly dose acetaminophen and ibuprofen. Give us a call with questions or for your house call requests. Seeing kids in their own beds is way more pleasant for everyone involved.

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