Paediatric Emergencies 363FEBRILE CHILDMANAGEMENT
1 Treat the toxic, unwell child symptomatically with oxygen via a face mask,
an i.v. f luid bolus 10–20 mL/kg for hypotension and paracetamol 15 mg/kg
orally or p.r. for pain or distress. Involve the senior doctor early.
2 Febrile child with no focus of infection
(i) Admit the following who may need empirical antibiotics:
(a) any febrile neonate <28 days old
(b) any systemically unwell child <36 months old with no
discernable focus of infection
(c) infants and young children with any non-blanching rash,
signs of meningism or irritability.
(ii) Infants and young children who display no overt toxic symptoms
or signs:
(a) most infants and small children <36 months of age who
appear well, have no systemic toxic findings and have normal
lab results have a viral illness
(b) discharge these patients with appropriate advice, and review
after 24 h back in the ED
(c) up to 10% of these patients will turn out to have an occult
bacteraemia, that is they return a positive blood culture, but
negative urine and cerebrospinal fluid (CSF) culture:
- most patients with Streptococcus pneumoniae remain non-
toxic and afebrile, will clear the organism themselves and
require no further treatment. Advise parents to return if
fever recurs within the first 7 days - admit patients with Neisseria meningitidis on blood culture
for i.v. antibiotics.
3 Febrile child with a focus of infection
(i) Manage children with an identified focus of infection according
to the individual condition and its severity based on the presence
of systemic toxic signs.
(ii) Admit under the paediatric team for management of the specific
condition, if the child looks unwell.
(iii) Discharge home if the child looks well with no toxic signs. Give
symptomatic treatment and antibiotic therapy as indicated
clinically
(a) advise regular fluid intake ‘little but often’
(b) give paracetamol 15 mg/kg orally 4–6-hourly and/or
ibuprofen 10 mg/kg orally 8-hourly
(c) arrange review within 24–48 h in the ED or by the GP.