Jennifer L. Hamilton, MD, PhD, FAAFP, Drexel University College of Medicine Sony P. John, MD, Chester County Hospital

In children less then 36 months of age has the potential for serious consequences

Important! Higher incidences of Urinary Tract Infections are occuring in children UTI’s are the most common source of infection in children less than 3 months old UTI’s are the second most common source of infection in children 3-36 months old (pneumonia is the first)

Cyanosis Poor peripheral circulation Petechial rash Inconsolability

A clinically significant fever in children younger than 36 months old is a rectal temperature of F or greater Axillary, tympanic and temporal artery measurements have been shown to be unreliable.

When parents report a clinically significant fever they may have a serious bacterial infection, even if they do not have a fever at the time of their initial medical evaluation

Teething is rarely associated with a fever of more than F

The history and physical exam cannot identify all children with serious bacterial infection Judicious use of imaging and laboratory testing is valuable

Urine cultures taken from a urinary bag have an 85% false positive rate

WBC counts and absolute neutrophil counts have been used to identify serious bacterial infection, including occult bacteremia

Complete blood count with differential and blood cultures for infants 3 months or younger with a fever

In neonates and young infants, diarrhea with a fever suggest a systemic illness Stool culture and fecal WBC counts are recommended

LP’s are recommended for all febrile neonates Infants and children WITH clinical signs of meningitis should also have an LP

Children who test positive for influenza are unlikely to have a coexistent serious bacterial infection They still have significant risk for UTI Patients who test positive for influenza do not need more invasive testing