---
title: Pediatric Fever Management
description: A comprehensive clinical reference on the assessment and treatment of fever in children.
keywords: [pediatrics, fever, antipyretics, sepsis, meningitis]
category: clinical
---

## Introduction

Fever is one of the most common presenting symptoms in pediatric patients, with a wide range of potential underlying etiologies. Appropriate management of fever in children is essential to ensure timely diagnosis and treatment of serious bacterial infections while avoiding unnecessary interventions. This clinical reference provides an evidence-based approach to the assessment and management of fever in the pediatric population.

## Fever Evaluation

### History and Physical Examination
The initial evaluation of a febrile child should focus on a thorough history and physical examination. Key elements include:
- Onset and duration of fever
- Associated symptoms (e.g. rash, respiratory, gastrointestinal, neurologic)
- Immunization history
- Recent travel or sick contacts
- Physical exam findings such as vital signs, appearance, and focus of infection

### Diagnostic Testing
Based on the clinical presentation, further diagnostic testing may be warranted, which may include:
- Complete blood count with differential
- Blood culture
- Urinalysis and urine culture
- Chest radiograph
- Cerebrospinal fluid analysis

The decision to pursue specific tests should be guided by the child's age, clinical appearance, and risk factors for serious bacterial infection.

## Fever Management

### Antipyretic Therapy
The mainstay of fever management in children is the use of antipyretic medications. The two most commonly used antipyretics are:
- Acetaminophen: Dosage of 10-15 mg/kg/dose every 4-6 hours, maximum 75 mg/kg/day
- Ibuprofen: Dosage of 5-10 mg/kg/dose every 6-8 hours, maximum 40 mg/kg/day

These medications should be used judiciously, as excessive use can lead to adverse effects such as hepatotoxicity (acetaminophen) or gastrointestinal bleeding (ibuprofen).

### Fever Reduction Techniques
In addition to pharmacologic interventions, non-pharmacologic fever reduction techniques may be employed, such as:
- Tepid sponge baths
- Removing excess clothing
- Increasing fluid intake

These methods should be used cautiously, as aggressive cooling can lead to shivering and discomfort.

## Evaluation of Serious Bacterial Infection

### Febrile Infant (0-90 days)
Infants younger than 90 days with fever are at high risk for serious bacterial infections, such as urinary tract infection, bacteremia, and meningitis. The Serious Bacterial Infection (SBI) risk assessment should be performed, which may include:
- Complete blood count with differential
- Blood culture
- Urinalysis and urine culture
- Lumbar puncture for cerebrospinal fluid analysis

Empiric antibiotic therapy should be initiated while awaiting culture results, as per the American Academy of Pediatrics (AAP) guidelines.

### Febrile Child (3-36 months)
Children aged 3-36 months with fever present a more heterogeneous risk for serious bacterial infections. The Pediatric Emergency Care Applied Research Network (PECARN) clinical prediction rule can be utilized to stratify risk and guide management.

## Fever of Unknown Origin

Fever of unknown origin (FUO) is defined as a temperature greater than 38.3°C (101°F) on several occasions without an identified cause after initial evaluation. In these cases, a more extensive workup may be warranted, which may include:
- Infectious disease panel
- Autoimmune and rheumatologic studies
- Imaging studies (e.g., CT, MRI)
- Bone marrow aspiration or biopsy

The diagnostic approach should be guided by the patient's clinical presentation and risk factors.

## Fever and Specific Conditions

### Febrile Neutropenia
Febrile neutropenia is a medical emergency in pediatric oncology patients, as it can rapidly progress to life-threatening sepsis. These patients should be promptly evaluated and treated with broad-spectrum intravenous antibiotics, as per the Infectious Diseases Society of America (IDSA) guidelines.

### Kawasaki Disease
Kawasaki disease is an acute, self-limited vasculitis of unknown etiology that primarily affects young children. Diagnostic criteria include fever lasting at least 5 days, along with at least 4 of the following:
- Bilateral conjunctival injection
- Oral mucosa changes
- Polymorphous rash
- Cervical lymphadenopathy
- Edema or erythema of the hands or feet

Prompt recognition and treatment with intravenous immunoglobulin (IVIG) and aspirin are crucial to prevent life-threatening coronary artery aneurysms.

## Conclusion

Fever in pediatric patients is a common and often benign presentation, but it can also be a harbinger of serious underlying conditions. A systematic approach to fever evaluation and management, guided by evidence-based clinical guidelines, is essential to ensure timely diagnosis and appropriate treatment. Clinicians should be vigilant for signs of severe bacterial infections, while also recognizing and managing fever-related syndromes, such as Kawasaki disease and febrile neutropenia.