Fever 101
What are some ways to measure body temperature?
rectal
oral
axillary
temporal
tympanic
tactile (subjective)
What is the first-line antipyretic recommended for a child with a fever?
Acetaminophen (Tylenol)
Source: UpToDate, 2023
What common viral infection is associated with a rash and high fever in toddlers, often appearing after the fever breaks?
Roseola
- followed by the appearance of a rash once the fever breaks, characterized by a few discrete popular erythematous lesions confined to the anterior chest and abdomen
Source: El-Radhi, 2018
Assess for signs of hyperthermia.
flushed face, weakness, rash, respiratory distress, tachycardia, malaise, headache, and irritability, monitor for sweating, hot and dry skin
What is considered "normal temperature"? (give a range)
97F (36.1C) and 99.3F (37.4C)
AAP considers a temperature above 100.4F (38C) as a sign of a fever.
Source: American Academy of Pediatrics, 2022
List some ways to treat fever at home
Provide your child with fluids
Dress your child lightly to help keep them cool
Sponge with lukewarm water
Check temperature every 4 hours in the day
The Pt has a low-grade fever, runny nose, and minimal rhinorrhea. What common viral infection primarily affects the upper respiratory tract?
viral rhinitis or the common cold
Source: Thomas, 2023
State some questions you would ask for in a fever visit.
OLDCARTS, duh! (HPI)
ROS
PMH, FHx, PSH
How and when fever is being measured.
Impact on functioning/ADLs.
Medications and allergies.
What is the recommended method to measure temperature in our 2yo Pt?
Rectal (rec for under 4 years of age)
Source: American Academy of Pediatrics, 2022
What NOT to do at home when treating for fever?
1. Do not use aspirin to treat (Reye syndrome is a serious illness that affects the liver and brain).
2. Do not use cold water (can cause shivering and increase your child's temperature).
3. Never apply rubbing alcohol (rubbing alcohol can be absorbed into the skin or inhaled, causing serious conditions such as a coma).
Source: El-Radhi, 2018
What is the potential complication of untreated urinary tract infection (UTI) in toddlers?
Kidney damage
Untreated UTIs in toddlers can potentially lead to kidney damage. The infection may ascend from the lower urinary tract to the kidneys, causing pyelonephritis.
Source: El-Radhi, 2018
How would you address the parent's concern about the rash on our Pt's chest?
Explain that rashes are common with viral infections, and it may resolve as the illness improves.
Name the 3 different fever categories and its duration
1. acute: less than 7 days
2. sub-acute: up to 2 weeks
3. chronic or persistent: greater than 2 weeks
Source: Netmeds, 2020
High fevers in young children can cause ____ and what to worry about
Seizures.
- Occurs in children btwn 6mo and 5yrs w/ a temp >100.4F (38C).
- A FHx of febrile seizures increases risk.
- Having one episode increases the risk of having another febrile seizure.
Source: Leung, 2018
Koplik (tiny-whitish spots in the buccal mucosa) can be found with what diagnosis?
Measles (prodromal phase)
Symptoms like abrupt high fever, sneezing, dry cough, and conjunctivitis, align with the initial pre-exanthem stage of measles, resembling a common cold. As measles progresses, the characteristic rash appears.
Source: El-Radhi, 2018
If the child develops respiratory distress during the visit, what immediate actions would you take?
Assess airway, breathing, and circulation (ABCs)
Consider oxygen support and prompt referral to emergency services
Describe some behavioral responses to fever
Cognitive changes (ranging from mild difficulty concentrating to delirium).
Wearing or covering w/ additional layers to keep warm d/t chills.
Decreased activity.
Fatigue/malaise.
Decreased oral intake.
In the case of our 2 yo Pt with fever, what role does parent education play in preventing OTC medication errors?
Parents should be educated on proper dosing based on the child's weight, understanding the difference between formulations (ex. infant vs. children's), and avoiding double-dosing by combining multiple medications with similar ingredients.
Source: American Academy of Pediatrics, 2022
What respiratory syncytial virus (RSV) precautionary measures would you recommend for a 2 yo with fever and respiratory symptoms?
Isolation precautions to prevent the spread of the virus.
RSV is highly contagious, especially in young children. Isolation precautions, including proper hand hygiene, wearing masks, and maintaining distance from other individuals, are essential to prevent the spread of RSV.
Name some red flags (concerns) for a fever exam
rigors
very high temp
hypotension
oliguria
CNS abnormalities (change from baseline)
cardiorespiratory compromise
new, significant cardiac murmurs
petechial eruption
significant leukocytosis or leukopenia