Febrile Child

Question 1

What are frequently isolated organisms causing bacteriaemia in children?

Answer 1

E. Coli and Staph

Question 2

What are not good predictors of serious illness in a febrile child?

Answer 2

• Degree of fever
• Its rapidity of onset
• Its response to antipyretics
• Febrile convulsions

Question 3

Hx features in febrile child?

Answer 3

• Localising symptoms
• Travel Hx
• Sick contacts
• Immunisation Hx

Question 4

Localising symtoms to assess on Hx?

Answer 4

• Cough, choryza
• HA, photophobia
• N/D/V
• Abdo pain
• Joint symptoms

Question 5

What signs are suggestive of an unwell child?

Answer 5

• Lethargic
• Poor interaction
• Inconsolability
• Tachycardia
• Tachypnoea
• Cyanosis
• Poor peripheral perfusion

Question 6

PEx components febrile child?

Answer 6

• General aspects to indicate likelihood of serious infection
• Well or unwell i.e. signs of unwell child
• Localising signs

Question 7

Localising signs to examine for in febrile child?

Answer 7

• ENT exam
• Neck stiffness
• Work of breathing
• Abdo signs
• Skin rash
• Joint swelling

Question 8

Full sepsis work up in febrile child - components?

Answer 8

-FBE / film
-Blood culture
-Urine culture
+/- CXR if resp Sx / signs

Question 9

When should you not perform an LP in a child?

Answer 9

-Impaired LoC
-Focal near signs
-Haemodynamically unstable
Empirically treat, LP later

Question 10

When should a child be admitted / paediatric team be consulted?

Answer 10

• Unwell child
• Septic shock
• High risk pts (immunosuppressed, chronic lung disease, congenital heart disease)
• Advice needed regarding empirical Mx

Question 11

When should a febrile child be transferred to a tertiary centre?

Answer 11

• Haemodynamic or respiratory instability
• Encephalopathy
• High risk patients
• Child requiring care above level of comfort of local hospital

Question 12

When can a child less than 1 month with a fever be discharged?

Answer 12

All infants less than 1 month with a fever should be admitted

Question 13

When can children older than 3 months be discharged?

Answer 13

• child is well

- follow up has been arranged

Question 14

Child well and afebrile with S. pneumo +ve blood culture?

Answer 14

1. If on ABx, a 7 day course should be completed.
2. If not received ABx, they do not need Ix or Rx as have cleared infection themselves.
3. Review if clinical deterioration occurs.

Question 15

Child unwell or febrile with S. pneumo +ve blood cultures?

Answer 15

Sepsis workup and admission for IVABx

Question 16

Child with non S.pneumo positive blood cultures?

Answer 16

Sepsis work up and admission for IVABx

Discuss with consultant if ?contaminant

Question 17

High risk activity cues for febrile child?

Answer 17

• No response to social cues
• Appears ill to Dr
• Doesn’t wake if aroused or doesn’t stay awake
• Weak, high-piched or continuous cry

Question 18

Respiratory high risk cues for febrile child?

Answer 18

• Grunting
• tachypnoea: RR>60
• moderate or severe chest indrawing

Question 19

Hydration mod/high risk cues?

Answer 19

• Reduced skin turgor
• Dry mucous membranes
• reduced urine output
• poor feeding

Question 20

Miscellaneous high risk signs febrile child?

Answer 20

• Non blanching rash
• Bulging fontanelle
• Neck stiffness
• Status epilepticus
• Focal neuro signs
• Focal seizures
• Bile stained vomit

Question 21

Mod risk miscellaneous signs in febrile child?

Answer 21

• Fever >5 days
• Swelling of a joint or limb
• NWB / not using extremity
• New lump >2cm

Question 22

When can an infant 1-3 months be discharged?

Answer 22

• child is well
• investigations are normal
• the child has been reviewed by a senior registrar / constultant
• follow up has been arranged within 12h

Question 23

What are the key factors to keep in mind when assessing the febrile child?

Answer 23

• Child’s age
• presence of signs of toxicity
• presence of infectious focus

Question 24

What are the signs of toxicity in a febrile child?

Answer 24

ABCD:

• Alertness, arousal or activity decreased
• Breathing difficulties (tachypnoea, increased WOB)
• Colour (pale or mottled), circulation (cool peripheries), or cry (weak, high pitched)
• Decreased fluid intake or decreased urine output

Question 25

What is preferred method of temperature measurement in 0-5 age group?

Answer 25

Axillary. Oral and rectal not recommended due to safety concerns; TM may be inaccurate

Question 26

What are important causes of fever and rash which must be considered?

Answer 26

- Meningococcal | - Kawasaki

Question 27

What are the clinical features of Kawasaki disease?

Answer 27

- high fever 5+ days - conjunctival infection - polymorphous rash - changes in mucous membranes - changes in extremities - cervical lymphadenopathy

Question 28

What are Ix results found in Kawasaki disease?

Answer 28

- Neutrophilia - Thrombocytosis - Raised acute phase reactants - Elevated transaminases - Low serum albumin

Question 29

Approach to urine culture in febrile child?

Answer 29

- All feb less than 3months, all toxic children - Clean catch appropriate but difficult - Bag urine inappropriate - Catheter recommended invasive technique

Question 30

What is recommended regarding febrile neonates? (0-4w)

Answer 30

All should have full septic workup and be admitted for parental antibiotics

Question 31

What is Kawasaki disease?

Answer 31

Acute, self limited systemic vasculitis of unknown aetiology. Mainly affects infants and young children. Coronary artery aneurysms may develop if untreated.

Question 32

What features are most useful for identifying UTI in febrile infants?

Answer 32

- Previous UTI - Temp 40C+ - Suprapubic tenderness