Fever in Well-Appearing Children Younger Than Two Years: A Clinical Policy from the ACEP
Am Fam Physician. 2017 Apr 15;95(8):524-525.
Author disclosure: No relevant financial affiliations.
Key Points for Practice
• Lumbar puncture can be delayed in well-appearing infants 29 to 90 days of age with fever and suspected virus provided they are followed closely or hospitalized.
• Chest radiography should not be performed in well-appearing children two months to two years of age with fever of at least 100.4°F and wheezing or a high chance of bronchiolitis.
• Urinalysis and urine cultures to diagnose urinary tract infection should be considered in well-appearing children two months to two years of age who have a fever of at least 100.4°F, especially if they are at higher risk.
From the AFP Editors
In one year, 15% of visits to the emergency department by persons younger than 15 years are children with fever, usually attributed to a benign, self-limited viral infection. Some fevers, however, can be a sign of serious infection, especially in infants younger than three months. Although treating those who appear ill is clear cut, it can be difficult to distinguish between a benign condition and a serious bacterial infection in those who appear well. The American College of Emergency Physicians (ACEP) has released a clinical policy addressing issues in children younger than two years who visit the emergency department with fever, but who appear well.
INFANTS ONE TO THREE MONTHS OF AGE
Laboratory studies, including a lumbar puncture to evaluate for meningitis, are commonly performed in the emergency department when an infant presents with fever. Routinely performing a lumbar puncture, which is invasive and has associated risks, is controversial. On the other hand, initiating antibiotic treatment without performing a lumbar puncture can lead to incomplete treatment or late identification of meningitis. Being able to predict which infants presenting with fever would benefit from a lumbar puncture could help lessen parent anxiety, as well as decrease costs, the use of invasive testing, exposure to antibiotics, and admissions to the hospital.
Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.
This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.
A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.
Copyright © 2017 by the American Academy of Family Physicians.
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