APPROACH TO A CHILD

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APPROACH TO A CHILD WITH FEVER
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FEVER THE FIRST SEVEN DAYS

• Fever is defined as an elevation of body
  temperature above normal and represents an
  important defense mechanism of our body
• Needs to have been reliably documented
• Diurnal Variation / circadian rhythm

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Mechanism of fever
ENDOGENOUS PYROGENS IL-1 / IL-6 /TNFa/IFN
EXOGENOUS PYROGENS
PG
HYPOTHALAMUS
PG-E2
ELEVATED THERMOSTAT
FEVER
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TYPES OF FEVER

• CONTINUOUS / SUSTAINED
• INTERMITTENT
• REMITTENT
• TERTIAN
• QUARTAN
• BIPHASIC

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Red Flags

• Change in behavior
• Irritability
• Drowsiness or reduced alertness
• Tachypnea, chest retractions or grunting
• Signs of Shock
• Disproportionate tachycardia or tachypnea
• Delayed capillary refill
• Reduced urine output
• Core-Skin temperature difference

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Red Flags

• Membrane over the tonsils
• Fever in a neonate
• Hyper-pyrexia Temperature exceeding 106º C
• Purpura, Petechie and Ecchymoses
• Known predisposing condition or illness VP
  shunt, cardiac disease, immunodeficiency state,
  rheumatologic conditions e.g. Lupus

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Most Common Causes

• Upper airway infection - Viral / Bacterial
• Gastroenteritis
• Malaria
• Viral exanthems
• Viral hepatitis
• Pneumonia
• Typhoid

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Less Common Causes

• Urinary Tract infection
• Tuberculosis
• Meningitis
• Dengue
• Leptospirosis
• Diphtheria

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Non-infectious Conditions

• Kawasaki Disease
• Acute leukemia

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EVALUATION
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Ask

• Age
• Onset
• Duration
• Progress
• Inter-febrile state
• Response to antipyretic
• Accompanying (localizing) symptoms
• Contact with similar illness or past history of
  infective focus

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Look

• Sick or ill-looking
• Alertness
• Core-skin temperature difference, capillary
  refill time
• Heart rate, respiratory rate
• Chest retraction, grunt, stridor

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Look

• Meningeal signs
• ENT
• Abdominal distension
• Spleen, liver
• No abnormality detected on clinical examination
  or history

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Perform

• Perform relevant tests if there is clinical
  localization of symptoms and signs
• When no localizing manifestations are present,
  the following investigations may be useful
• Infants Hemogram, urinalysis, chest
  radiograph
• Older children Hemogram, blood culture

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FEVER THE FIRST SEVEN DAYS
No localizing manifestations
Non-toxic
Toxic
Viral Fever Malaria
Typhoid Urinary Tract infection
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FEVER THE FIRST SEVEN DAYS
With Localizing Manifestations
Nasal discharge Tonsillar Follicles Palatal
petichiae
Tachypnea Chest signs
Loose stools
Urinary cts.
URTI
PNEUMONIA
ACUTE G.E
UTI
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