Diagnostic Approach for Pediatric Patients with Recurrent Fevers
Initial Assessment and Risk Stratification
- The American College of Rheumatology suggests assessing for accompanying symptoms that may suggest specific diagnoses, including mucocutaneous findings, lymphadenopathy, or neurologic symptoms, in pediatric patients with recurrent fevers 1
- The American Academy of Emergency Medicine recommends considering respiratory symptoms, such as cough or respiratory distress, in the initial assessment of pediatric patients with recurrent fevers 2, 3
Laboratory Evaluation
- The American College of Rheumatology recommends first-tier testing, including complete blood count with manual differential, complete metabolic panel, and inflammatory markers, such as C-reactive protein and erythrocyte sedimentation rate, for all pediatric patients with recurrent fevers 1, 4, 5
- Blood cultures during febrile episodes are recommended by the Journal of Clinical Oncology for pediatric patients with recurrent fevers 6, 7
Imaging Studies
- The American College of Emergency Physicians suggests obtaining a chest radiograph in febrile children less than 3 months with evidence of acute respiratory illness, with a Level B recommendation 2, 3
- The American College of Radiology recommends against MRI in the workup of a child with simple febrile seizures 8
Specific Clinical Scenarios
- The Journal of Clinical Oncology recommends risk stratification into low-risk and high-risk categories for pediatric patients with recurrent fevers and neutropenia, and initiating empiric broad-spectrum antibiotics for neutropenic patients with fever 6, 7, 10
Treatment Approaches
- The Journal of Clinical Oncology suggests considering outpatient management for low-risk patients with neutropenic fever if infrastructure exists for careful monitoring, and considering oral antibiotic administration if the child can tolerate it reliably 6
- The American College of Rheumatology recommends avoiding cognitive bias of anchoring on specific diagnoses without thorough evaluation in pediatric patients with recurrent fevers 1, 4