Fever in children

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Zaida Obeidat, M.D.

Synonyms and Keywords: Fever in kids

Overview

Fever can be defined as any elevation of body temperature above 38°C, it is a normal physiological response as a result of the encounter of an infectious agent producing exogenous and endogenous pyrogenes affecting the central set point of body temperature. It is mostly caused by a benign viral infection, but it can be an indicator of a serious sickness such as meningitis, septicaemia, pneumonia. The risk for severe change depends on the clinical condition and the age of the infant. Most predictive for serious sickness are situations in which infants are younger than 3 months with body temperature > or = 38°C, infants between 3 and 6 months with body temperature > or = 39°C, and children of any ages with critical clinical signs. Uncomplicated fever is benign and should not be treated.

Historical Perspective

Classification

Body temperature °C °F
Normal 37-38°C 98.6-100.4°F
Mild/low grade fever 38.1-39°C 100.5-102.2°F
Moderate grade fever 39.1-40°C 102.2-104.0°F
High grade fever 40.1-41.1°C 104.1-106°F
Hyperpyrexia >41.1°C >106.0°F

Pathophysiology

The role of pyrogens and cryogens

Pryogens

Cryogens


The pathophysiological mechanisms for the injurious effects of a fever, classified as follows:[3]

Causes

Common conditions that can cause fevers include:

Fever in children can sometimes associated with more serious signs and symptoms, such as:

Serious bacterial infections include:

Causes of undiagnosed fever in children include:[4]

Differential diagnoses for fever in children

Cause Differential Diagnosis
Infectious; Bacterial or mycobacterial Brucellosis, dental abscess, endocarditis, non-tuberculous mycobacteria (eg, Mycobacterium chelonae), occult bacterial infection, recurrent bacterial infections, relapsing fever (Borrelia spp other than Borrelia burgdorferi), Yersinia enterocolitica
Parasitic Malaria (eg, Plasmodium vivax, Plasmodium ovale)
Inflammatory or Immunologic Behçet syndrome, inflammatory bowel disease (eg, Crohn disease), hereditary fever syndromes (eg, FMF), juvenile dermatomyositis, PFAPA syndrome, sarcoidosis, systemic lupus erythematous, systemic juvenile idiopathic arthritis (Still disease), vasculitis (eg, polyarteritis nodosa)
Malignant Leukemia, lymphoma
Other Benign giant lymph node hyperplasia (Castleman disease), CNS abnormalities (eg, hypothalamic dysfunction), drug fever, factitious fever, IgG4-related disease, immunodeficiency syndromes with recurrent infections


Epidemiology and Demographics

Age

Prognosis

Diagnosis

Symptoms

Physical Examination

Laboratory Findings

Urinalysis and urine culture

  • Urinalysis is a key factor in the evaluation of fever in infancy and early childhood because UTI is a common cause of serious bacterial infection.
  • Urine sample should be obtained for all children younger than 24 months with unexplained fever. It may be obtained by catheterization or suprapubic aspiration.
  • In children with voluntary urine control, a clean catch method (urination into a specimen container after cleaning the area around the urethra) may be used.
  • Cultures of specimens collected in a urine bag may have an 85 percent false-positive rate, and urine dipstick testing has a 12 percent false-negative rate.
  • All specimens should be sent for formal urinalysis and culture.
  • UTI rates vary with patient sex and age.
  • In the first three months of life, UTIs are more common in boys than in girls, and much more common in uncircumcised boys. After three months of age, UTIs are more common in girls.

Blood cell counts and blood culture

Stool testing

Inflammatory markers

Lumbar puncture

Electrocardiogram

There are no ECG findings associated with fever in children.

X-ray

  • Chest X ray is recommended in all neonates with unexplained fever.
  • Chest X ray is also recommended for young children older than one month revealing respiratory symptoms and for patients with a fever of more than 102.2°F (39°C) and a WBC count of more than 20,000 per mm3 (20 × 109 per L).

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with fever in children.

CT scan

There are no CT scan findings associated with fever in children.

MRI

There are no MRI findings associated with fever in children.

Treatment

Medical Therapy

References

  1. Stein MT (1991). "Historical perspective on fever and thermometry". Clin Pediatr (Phila). 30 (4 Suppl): 5–7. doi:10.1177/0009922891030004S02. PMID 2029820.
  2. 2.0 2.1 2.2 Ogoina D (2011). "Fever, fever patterns and diseases called 'fever'--a review". J Infect Public Health. 4 (3): 108–24. doi:10.1016/j.jiph.2011.05.002. PMID 21843857.
  3. Walter EJ, Hanna-Jumma S, Carraretto M, Forni L (2016). "The pathophysiological basis and consequences of fever". Crit Care. 20 (1): 200. doi:10.1186/s13054-016-1375-5. PMC 4944485. PMID 27411542.
  4. BREWIS EG (1965). "CHILD CARE IN GENERAL PRACTICE. UNDIAGNOSED FEVER". Br Med J. 1 (5427): 107–9. PMC 2165027. PMID 14218464.
  5. Soon GS, Laxer RM (2017). "Approach to recurrent fever in childhood". Can Fam Physician. 63 (10): 756–762. PMC 5638471. PMID 29025800.
  6. Van den Bruel A, Haj-Hassan T, Thompson M, Buntinx F, Mant D, European Research Network on Recognising Serious Infection investigators (2010). "Diagnostic value of clinical features at presentation to identify serious infection in children in developed countries: a systematic review". Lancet. 375 (9717): 834–45. doi:10.1016/S0140-6736(09)62000-6. PMID 20132979.
  7. Barbi E, Marzuillo P, Neri E, Naviglio S, Krauss BS (2017). "Fever in Children: Pearls and Pitfalls". Children (Basel). 4 (9). doi:10.3390/children4090081. PMC 5615271. PMID 28862659.