The Febrile Child

Ed and Shiv talk about the febrile child. Probably the most important topic in paeds.

 

Lecture by

Video Duration: 23 minutes

  • The Febrile Child
    Created by Matthew Simkiss
    General
    Epidemiology
    • Normal body temp
      • 37C
    • Pyrexia
      • > 38C
    • Hypothermia:
      • Axillary temp <35C
      • Oral/rectal temp <35.5C
    • Fever/pyrexia of unknown origin:
      • ≤ 38.3oC for 1-3 weeks
      • ≤ 1 week of hospital investigation
    Pathology

    Variable but most common differentials:

    • URTI /LRTI
    • Gastroenteritis
    • UTI
    • Meningitis/encephalitis
    • Abdomen – surgical?
    • Superficial skin infections

    Less common differentials:

    • Septic arthritis/osteomyelitis
    • Tropical diseases – don't forget TB, malaria
    • Scalded skin syndrome, Toxic Shock
    • Fungal
    • Abscesses
    • Endocarditis
    Top three causes
    • URTI /LRTI
    • UTI
    • Gastroenteritis
    Clinical Features
    Symptoms

    Vary depending on cause but important to think about:

    • Duration & pattern of fever
    • Associated pain
      • Earache, sore throat, headache, abdominal pain, bone pain, dysuria, urinary frequency
    • Associated features
      • Coryza, cough, anorexia, vomiting, diarrhoea
    • Contact with infectious cases
    • Recent travel
    • Recent vaccination / immunisation status
    • Past medical history / family history
    • Any medication given already
    • If chronic:
      • What investigations already?
      • Any relevant family history?
    Signs

    Again vary with cause but think about:

    • General observations give most information
      • Vital signs really important!
        • Can tell you how sick a child is
        • What do they look like?
        • Can they be distracted or consoled?
    • Systems
      • Think about differential diagnosis
    • Examination of:
      • Bones/joints
      • Skin
      • CNS
      • ENT
      • CVS
      • Respiratory system
      • Abdomen
      • Lymphadenopathy
    Investigations
    Cultures
    • Blood culture
    • Urine dipstick, MC&S
    • Throat swab
    • NPA
    • Sputum culture
    • Discharge/pus culture +/- viral PCR
    • Stool MC&S
    • Viral serology/PCR
    • Lumbar puncture
    Bloods
    • FBC & blood film
    • ESR/CRP
    Imaging

    Consider:

    • CXR
    • USS
    • CT/MRI
    Scopic/Biopsy
    • Bone marrow aspirate
    • FNA
    Functional

    None

    Treatment
    Conservative

    Keep child as comfortable as possible

    Simple cooling methods

    Medical

    ABCDE!

    • Tailor to cause (try to be specific!)
    • If viral infection:
      • No treatment for cause
      • Use antipyretics +/- bronchodilators
      • Explain and reassure
    • If localised:
      • Use appropriate treatment for that infection
      • e.g. Penicillin V for bacterial tonsillitis
    • If systemic:
      • Broad spectrum antibiotics
      • Change antibiotics once sensitivities are known
      • Follow local trust guidelines
    Surgical

    Consider surgical intervention for some conditions e.g. arthrotomy with joint washout