Management of Fever and Influenza in a 4-Year-Old Child
For a 4-year-old with fever and influenza, management should include appropriate antipyretics, hydration, antiviral therapy if within 48 hours of symptom onset, and antibiotics only if bacterial co-infection is suspected. 1
Initial Assessment
- Assess for signs of respiratory distress including markedly raised respiratory rate, grunting, intercostal recession, and breathlessness with chest signs 1
- Check for cyanosis, severe dehydration, altered conscious level, complicated or prolonged seizure, and signs of septicemia 1
- Perform pulse oximetry to evaluate oxygen saturation; values ≤92% indicate need for oxygen therapy 1
- Monitor vital signs including heart rate, respiratory rate, and temperature 1
Home Management for Mild Cases
Fever Management
- Administer appropriate weight-based doses of antipyretics (acetaminophen or ibuprofen) to control fever and reduce discomfort 1, 2
- Encourage adequate fluid intake to prevent dehydration 2
- Avoid tepid sponging as it causes discomfort without lasting temperature reduction 2
- Dress the child in lightweight clothing and maintain comfortable room temperature 2
Supportive Care
- Ensure rest to support the body's physiological responses 2
- Monitor for signs of worsening illness including difficulty breathing, severe earache, vomiting >24 hours, or drowsiness 1
- Maintain adequate hydration with preferred liquids 2, 3
Antiviral Therapy
- Consider oseltamivir (the antiviral agent of choice) if the child:
- Has an acute influenza-like illness
- Has fever >38.5°C
- Has been symptomatic for two days or less 1
- For severely ill children, oseltamivir may be used if symptoms have been present for <6 days, though evidence for benefit is limited 1
- Treatment with antivirals can decrease illness duration by about 24 hours and may reduce risk of serious complications 4
Antibiotic Therapy
- Antibiotics should only be prescribed if:
- The child is at risk of complications of influenza, OR
- The disease is severe enough to merit hospital admission 1
- For children under 12 years, co-amoxiclav is the drug of choice to cover S. pneumoniae, S. aureus, and H. influenzae 1
- For penicillin-allergic children, clarithromycin or cefuroxime should be used 1
- Oral antibiotics are appropriate if the child can tolerate oral fluids 1
Criteria for Hospital Admission
Hospital admission should be considered if the child has:
- Signs of respiratory distress
- Oxygen saturation ≤92% while breathing air
- Inability to maintain oral intake
- Signs of severe dehydration
- Altered level of consciousness 1
Hospital Management
- Provide oxygen therapy via nasal cannulae, head box, or face mask to maintain oxygen saturation above 92% 1
- Administer intravenous fluids at 80% basal levels if the child cannot maintain oral intake 1
- Perform appropriate investigations:
- For severely ill children with pneumonia complicating influenza, add a second antibiotic agent (e.g., clarithromycin or cefuroxime) administered intravenously 1
Discharge Criteria
Children can be safely discharged from hospital when they:
- Are clearly improving
- Are physiologically stable
- Can tolerate oral feeds
- Have a respiratory rate <40/min (<50/min in infants)
- Have an awake oxygen saturation of >92% in air 1
Follow-up
- Most children will make an uneventful recovery and do not require follow-up 1
- Children with prolonged illness may be followed up by their primary care provider 1
- Only children with severe disease and/or at high risk of sequelae need hospital follow-up 1