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August 2016

Evaluation and Management of Febrile Children: A Review

Author Affiliations
  • 1Division of General Pediatrics and Adolescent Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
  • 2Division of Infectious Diseases, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
JAMA Pediatr. 2016;170(8):794-800. doi:10.1001/jamapediatrics.2016.0596

Importance  Management of febrile children is an intrinsic aspect of pediatric practice. Febrile children account for 15% of emergency department visits and outcomes range from the presence of serious bacterial infection to benign self-limited illness.

Observations  Studies from 1979 to 2015 examining febrile infants and children were included in this review. Management of febrile infants younger than 90 days has evolved considerably in the last 30 years. Increased rates of Escherichia coli urinary tract infections, increasing resistance to ampicillin, and advances in viral diagnostics have had an effect on the approach to caring for these patients. Widespread vaccination with conjugate vaccines against Haemophilus influenzae and Streptococcus pneumoniae has virtually eliminated the concern for bacterial infections in children aged 3 to 36 months. Urinary tract infections still remain a concern in febrile infants of all ages.

Conclusions and Relevance  Advances over the last 30 years allow for more precise risk stratification for infants at high risk of serious bacterial infection. With appropriate testing at the initial visit, much of the diagnostic testing and empirical treatment can be avoided for infants younger than 90 days. In the vaccinated child aged 3 to 36 months, the only bacterial infection of concern is urinary tract infection.

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    1 Comment for this article
    Meningitis due to S. pneumoniae
    Valeriy Chorny | Kings County Hospital/ SUNY Downstate, Brooklyn, NY
    Thank you for the comprehensive and up to date article. I would like to clarify the statement made in reference to the study by Olarte et al (Reference 16, Olarte L, Barson WJ, Barson RM, et al. Impact of the 13-valent pneumococcal conjugate vaccine on pneumococcal meningitis in US children. Clin Infect Dis. 2015;61(5):767-775.)<br/>As far as I could infer, among the findings in the above study was that there was no significant change in the incidence of S. pneumo meningitis, in contrary to the statement made by Drs. Cioffredi and Jhavedi in this review.​