children s health issues
Fever in Infants and Children
Evaluation of Fever in Infants and Children
Detecting a fever is not difficult, but determining its cause can be. Certain symptoms are cause for concern. They include Any fever in infants less than 3 months old Lethargy or listlessness Ill appearance Difficulty breathing Bleeding in the skin, appearing as tiny reddish purple dots (petechiae) or splotches (purpura) Continuous crying in an infant or toddler (inconsolability) Headache, neck stiffness, confusion, or a combination in an older child Children with fever should be evaluated by a doctor right away if they have any warning signs or are less than 3 months old. Children without warning signs who are between 3 months and 3 years of age should be seen by the doctor if the fever is 102.2° F (39° C) or higher, if there is no obvious upper respiratory infection (that is, children are sneezing and/or have a runny nose and nasal congestion), or if the fever has continued more than 5 days. For children without warning signs who are over 3 years of age, the need for and timing of a doctor's evaluation depend on the child's symptoms. Children who have upper respiratory symptoms but otherwise appear well may not need further evaluation. Children over 3 years of age with fever lasting more than 5 days should be seen by the doctor. Doctors first ask questions about the child's symptoms and medical history. Doctors then do a physical examination. A description of the child's symptoms and a thorough examination usually enable doctors to identify the fever’s cause (see table). Doctors take the child’s temperature. It is measured rectally in infants and young children for accuracy. The breathing rate is noted. If children appear ill, blood pressure is measured. If children have a cough or breathing problems, a sensor is clipped on a finger or an earlobe to measure the oxygen concentration in blood ( Pulse oximetry ). As doctors examine children, they look for warning signs (such as an ill appearance, lethargy, listlessness, and inconsolability), noting particularly how children respond to being examined—for example, whether children are listless and passive or extremely irritable. Occasionally, the fever itself can cause children to have some of the warning signs including lethargy, listlessness, and ill appearance. Doctors may give children fever-reducing drugs (such asibuprofen) and reevaluate them once the fever is reduced. It is reassuring when lethargic children become active and playful once the fever is reduced. On the other hand, it is worrisome when ill-appearing children remain ill-appearing despite a normal temperature. The need for testing depends on the child's age, overall appearance, vaccination status, and whether the fever is Testing for Acute Fever or 