Fever

Overview

Meningitis and septicaemia (from any source) are the two most serious conditions to consider in the febrile child
Children (particularly neonates) can deteriorate rapidly from sepsis
Unappreciated or inadequately treated circulatory compromise (shock) increases mortality
All neonates (< 3mo) should be admitted regardless of how well they appear
If you have limited paediatric experience, it is better to err on the side of caution and perform all components of a septic screen i.e. MSU, BC, LP and administer broad-spectrum antibiotics to unwell looking infants/children
Experienced clinicians may omit lumbar puncture or withhold antibiotics (and adopt a 'watch and see' attitude)

Resuscitation (see Assessing severity of Illness)

Evidence of circulatory should be specifically assessed for and managed
Administer 10ml/kg crystalloid or colloid (type of fluid has minimal important) over 10 min
Observe for improvement in ANY abnormal sign hypotension, tachycardia or delayed capillary refill
Repeat bolus every 10min until abnormal signs resolve

A search for the focus should be made

For pre-schoolers onward (see Assessing focus of infection)

For neonates to pre-schoolers, inquire into

Investigation (neonates generally require complete septic screen)

WCC (normal WCC can occur in sepsis, elevated WCC/neutrophila/bands can occur in viral illness)
BC
CXR
MSU (mandatory prior to commencing antibiotics) - confirmed paediatric UTIs generally need further investigation
LP - do not perform if drowsy, seizures or focal signs

Treat obvious bacterial sources (refer to Antibiotic Guidelines) with antibiotics
Ensure adequate fluid resuscitation

Admit

Discharge with GP review in 24 hrs only if: