📊 Definitions
• Fever: rectal temperature ≥38°C (100.4°F)
• Fever without source (FWS): acute fever (<1 week) in previously well child with no obvious cause after H&P
• Serious bacterial infection (SBI): meningitis, sepsis, bacteremia, UTI, pneumonia, osteomyelitis, septic arthritis, bacterial enteritis
👶 Infants <28 Days (Neonates)
• HIGH risk for SBI (meningitis, sepsis, HSV)
• Must be hospitalized; full sepsis workup: CBC, blood culture, UA/UC, LP, +/- CXR
• Empiric antibiotics: ampicillin + cefotaxime or gentamicin; add acyclovir if HSV suspected
• Lumbar puncture mandatory before antibiotics if safe
🍼 Infants 29-90 Days (Well-appearing)
• Risk of occult bacteremia significantly reduced post-Hib/pneumococcal vaccines
• Low-risk criteria: WBC 5,000-15,000, UA negative, well-appearing, reliable follow-up
• Options: observation without labs (if low-risk), or CBC, UA, blood culture (if moderate-risk)
• LP and antibiotics if high-risk or abnormal labs
👧 Children >3 Months (Well-appearing)
• Most fevers viral, self-limited
• Urinalysis for girls <24 months, uncircumcised boys <12 months (UTI risk)
• CXR if respiratory symptoms or high fever without source
• Observation for 2-3 days reasonable; antibiotics not indicated unless bacterial source found
📌 Decision strategy: Ill-appearing child → hospitalize, full sepsis workup, empiric antibiotics. Well-appearing infant <28 days → hospitalize. 29-90 days → risk stratify. >3 months → UA, observation. Hib/pneumococcal vaccines have reduced occult bacteremia rates.