From the Guidelines
Seek emergency care for a child with fever if they are under 3 months with any fever (100.4°F/38°C or higher), appear very ill, have a fever above 104°F (40°C), show signs of dehydration, have a rash with fever, experience seizures, have difficulty breathing, show extreme irritability or lethargy, have a stiff neck, or if the fever persists beyond 2-3 days. While waiting for medical attention, you can administer appropriate doses of acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (10 mg/kg every 6-8 hours, only for children over 6 months) 1. Keep the child hydrated with frequent small amounts of clear fluids and dress them in light clothing. Avoid cold baths or alcohol rubs as these can cause shivering and actually increase body temperature. Fever itself is not dangerous but rather a sign that the body is fighting infection; however, in young children, high fevers can sometimes indicate serious infections requiring prompt medical evaluation. The emergency department has resources to quickly assess and treat potentially serious conditions that might be causing the fever.
Some key considerations for pediatric ER precautions for fever include:
- The risk of serious bacterial infections (SBI) in febrile infants and children, particularly those under 3 months, is a concern 1.
- The definition of fever and the criteria for fever without a source are important in determining the need for further evaluation and treatment 1.
- Antipyretic therapy may be used to optimize patient comfort and reduce metabolic demand in certain clinical scenarios, but its use should be guided by the clinical context and the latest evidence 1.
- The decision to include a chest radiograph in the evaluation of an infant or child with fever without a source should be based on clinical judgment and the presence of specific risk factors 1.
It is essential to prioritize the child's comfort, hydration, and overall clinical condition while awaiting medical attention. The emergency department is equipped to quickly assess and treat potentially serious conditions that might be causing the fever, and prompt medical evaluation is crucial in young children with high fevers or other concerning symptoms. By following these guidelines and considering the latest evidence, healthcare providers can provide optimal care for children with fever and minimize the risk of morbidity, mortality, and decreased quality of life.
From the Research
Pediatric ER Precautions for Fever
- Fever management in children is crucial, and various studies have investigated the effectiveness of different treatment regimens 2, 3, 4, 5.
- Combination treatment with ibuprofen and acetaminophen has been shown to be beneficial for sustained fever reduction in children older than 6 months 2.
- Both acetaminophen and ibuprofen are effective in fever reduction by inhibiting prostaglandin synthesis, and their metabolic pathways have been compared in relation to fever control 3.
- For children with mild gastroenteritis, oral rehydration therapy is the mainstay of treatment, and ondansetron may be prescribed to prevent vomiting and improve tolerance of oral rehydration solutions 6.
- Combined paracetamol and ibuprofen therapy can result in a lower mean temperature at one hour after treatment and fewer children remaining or becoming febrile for at least four hours after treatment 4.
- Alternating paracetamol and ibuprofen therapy may also be effective in reducing temperatures and improving child discomfort, although the evidence for improvements in child discomfort remains inconclusive 4.
- A network meta-analysis found that combined and alternating therapies may be superior to acetaminophen alone in terms of proportion of afebrile children at the fourth hour, with no differences in adverse events between treatment regimens 5.