Approach to Short Duration Fever in Children in Office Practice

Abstract

Fever is the second most common symptom after respiratory complaints in pediatric practice, often causing parental anxiety despite usually resulting from self-limiting viral infections. Without localized symptoms, diagnosing hidden bacterial infections is challenging. Tropical regions like India present additional diagnostic challenges due to endemic diseases like malaria, dengue, and typhoid. This review provides an algorithmic approach to evaluate and manage short-duration fever in children, tailored to the Indian epidemiological context. The approach requires careful clinical assessment and consideration of bacterial and tropical etiologies. While most cases are self-limited viral infections, early identification of serious bacterial infections (SBI) is crucial in reducing morbidity and mortality. A structured approach is outlined, based on clinical symptoms, signs, age, and vaccination status. Children are divided into three groups: neonates (0-28 d), young infants (29-90 d), and older infants/toddlers (3-36 mo). Neonates and sick/toxic-appearing children with fever warrant immediate hospital admission for empirical antibiotics and diagnostic work-up. Management of young infants is stratified according to risk factors for SBI such as bacteremia, urinary tract infections (UTI), and pneumonia. Well-appearing older infants/toddlers are often managed as outpatients, with investigations tailored to specific clinical and epidemiological contexts.

Keywords: Children; Febrile neonate; Fever without focus; Pediatric fever management; Serious bacterial infection; Short-duration fever; Tropical fevers.