Is there concern for a 5-month-old infant with a recent history of fever, now presenting with hoarseness, who has received multiple doses of Tylenol (acetaminophen) and is currently afebrile with normal feeding and elimination patterns?

From the Guidelines

There is concern for a 5-month-old infant with a recent history of fever, now presenting with hoarseness, despite being afebrile with normal feeding and elimination patterns, and warrants medical attention. The infant's symptoms, including hoarseness, could indicate a possible respiratory infection, such as croup or laryngitis, which requires evaluation by a healthcare provider 1. Although the infant has received multiple doses of Tylenol (acetaminophen) and is currently afebrile, the underlying cause of the fever and hoarseness needs to be medically evaluated.

Key considerations in this case include:

• The infant's age and immature immune system, which can lead to rapid deterioration 1
• The potential for serious bacterial infections (SBIs), such as bacteremia, bacterial meningitis, or urinary tract infections, which can occur in febrile infants younger than 2 years 1
• The importance of monitoring the infant's temperature, as antipyretic use can result in a normal or lower temperature, masking a potential infection 1
• The need for a thorough history and physical examination to determine the accuracy or validity of the temperature obtained and to identify any localizing signs of infection 1

Given the potential risks and complications associated with febrile infants, it is essential to prioritize caution and seek medical attention promptly. The infant's healthcare provider should be contacted today, or an urgent care facility should be visited to have the baby examined.

From the FDA Drug Label

Do not use • with any other drugs containing acetaminophen (prescription or nonprescription). If you are not sure whether a drug contains acetaminophen, ask a doctor or pharmacist. • if you are allergic to acetaminophen or any of the inactive ingredients in this product. The FDA drug label does not answer the question.

From the Research

Clinical Presentation

The 5-month-old infant presents with hoarseness, a recent history of fever, and has received multiple doses of Tylenol (acetaminophen). The infant is currently afebrile with normal feeding and elimination patterns.

Differential Diagnosis

• Upper respiratory tract infections (URTIs) are a common cause of fever and hoarseness in infants, as noted in 2, 3.
• Fever without a focus of infection is also a possibility, as discussed in 4, 5.
• The infant's age and clinical presentation should be considered when evaluating the risk of serious bacterial infection, as recommended in 4, 6, 5.

Management

• The use of acetaminophen for symptom management is appropriate, as noted in 2, 3.
• The decision to prescribe antibiotics should be based on the presence of bacterial infection, as discussed in 2, 4, 3.
• Close follow-up and monitoring of the infant's condition are essential, as recommended in 4, 5.

Considerations

• The infant's age and vaccination status should be considered when evaluating the risk of serious bacterial infection, as noted in 6, 5.
• The presence of hoarseness and recent history of fever should be further evaluated to determine the underlying cause, as discussed in 2, 3.