Fever in Children. Dr Shane George Staff Specialist - Emergency Medicine & Children s Critical Care Gold Coast University Hospital

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Hugh Hicks
5 years ago
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1 Fever in Children Dr Shane George Staff Specialist - Emergency Medicine & Children s Critical Care Gold Coast University Hospital

2 Update on Children s GCUH Dedicated Children s Pod in the Emergency Department at GCUH Number of children presenting to ED has doubled since opening ~2000 children per month at GCUH ED AND ~1000 at Robina ED Children s Intensive Care opened February /7 Children s Surgical capability now available Neonatal intensive care fully operational

3 What comes to the ED? Top 10 discharge diagnoses May 2015: 1. Viral Infection 2. Minor Head Injury 3. Croup 4. URTI 5. Asthma / Reactive Airways Disease 6. Bronchiolitis 7. Fever (No Focus) 8. Ankle Sprain/Strain 9. Viral Gastroenteritis 10.# Radius

4 Humanity has but three great enemies: fever, famine and war; of these by far the greatest, by far the most terrible, is fever Sir William Osler

5 Fever is our most common presenting complaint

6 Why????

7 It worries me when my child has a fever... 50% gave a score of 10 All scored 7 or above! I worry that she is sick We worry about the severity of the illness Something serious might be wrong Seizures Irrepairable damage

8 Do you measure the temperature? How often? 90% said yes Every 1-2 hours Every 30 minutes When they look sick or hot

9 What constitutes a fever? Ranged from over 36 to 39 degrees Around half said over 38 One said when it feels high to me

10 I always give medication to bring the temperature down... Again, 50% gave a score of 10/10 40% gave a score of 8 or 9 One said only if the temperature was >39 Half wake their sleeping child to give medication 60% sleep in the same room All feel better when the temperature is coming down

11 Has advertising got anything to do with it?

12 Fever Phobia Barton Schmitt identified FEVER PHOBIA in 1980 Have parents feelings changed since then? Fever Phobia Revisited: Have Parental Misconceptions About Fever Changed in 20 Years? Crocetti M, Moghbeli N & Serwint J; Pediatrics June % thought fever could cause harmful effects 21% listed brain damage and 14% listed death Fever phobia hasn t gone away

13 Fever Facts Any temperature > 38 is a fever Height of fever does not correlate with seriousness of illness Expect 10 BPM increase in heart rate for every 0.5 degrees above 37.5 Teething will not cause a fever > 38.5 The following are NOT good predictors of serious illness: - Height of fever - Rapidity of onset - Response to antipyretics - Febrile convulsion

14 Epidemiology 80% of children presenting with fever will have an identifiable source Of the remaining 20% most have a self limiting viral infection Approximately 7% of febrile children aged <5 years, presenting to hospital have a bacterial infection % = UTI % = pneumonia - 0.4% = occult bacteremia - 0.1% = meningitis

15 Risk stratification

18 UTI Common infection in children <5 years old 6.5% girls and 3.3% of boys will have a UTI in the first year of life Often present with non-specific symptoms (beware isolated vomiting in febrile children) Urine dip-sticks unreliable in children <3 years old ALWAYS SEND for Urine M/C/S If systemically well can be treated with oral Bactrim No harm in waiting for urine M/C/S prior to commencing treatment if systemically well and not obviously UTI

19 Pneumonia Most commonly viral aetiology but difficult to distinguish on CXR and clinically CXR only indicated if clinical signs consistent with pneumonia S. pneumoniae remains most common organism (even in immunised children) If systemically well, with minimal respiratory distress can be treated with oral amoxycillin

20 Bacteraemia Incidence has fallen from ~10% to <0.5% of febrile children aged 3 months 3 years as a result of HiB and pneumooccus vaccination Rates remain between 2-10% for unvaccinated children Common organisms in immunised children are: - E. coli with associated UTI - Salmonella (especially <6 months) with associated diarrhoea

21 Who needs to come to ED?? 1. All unwell looking children 2. All infants <2 months old with documented core temperature >38 degrees 3. Infants <4 months old with fever without clear respiratory source 4. Infants <6 months old with fevers and bloody diarrhoea 5. Unimmunised children with fever >38 degrees without clear focus of infection 6. Children with fevers >5 days and signs of Kawasaki s disease 7. Immunocompromised children, or children with chronic underlying disease 8. Any child you are concerned about

22 Summary Fevers are a normal part of infection Parents worry about fevers and need intensive education Most infections of childhood are self limiting viral infections and do not require any treatment Algorithms of risk stratification are available for use Avoid empiric use of antibiotics without first sending at least a urine off for M/C/S Respiratory virus PCR testing can be useful to reassure parents that antibiotics are not required

4/14/2010. Theoretical purpose of fever? Andrea Marmor, MD, MSEd Assistant Clinical Professor, Pediatrics UCSF April 13, 2010

4/14/2010. Theoretical purpose of fever? Andrea Marmor, MD, MSEd Assistant Clinical Professor, Pediatrics UCSF April 13, 2010 Andrea Marmor, MD, MSEd Assistant Clinical Professor, Pediatrics UCSF April 13, 2010 Parental touch? Absence of fever more reliable than presence. Axillary and tympanic Vulnerable to environmental and