Child with Fever — Age Considerations — Clinical Pathway: All Settings

Fever Clinical Pathway — All Settings

Age Considerations

Younger children are more at risk for bacterial infection. Consider the possibility of occult infections, especially UTI and pneumonia. Symptoms may be more non-specific and physical exams more challenging.

> 56 days to 24 mos
  • Consider UTI Pathway
  • Consider occult pneumonia
    • if > 3-4 days of fever in setting of respiratory symptoms, hypoxia, tachypnea, abdominal pain, chest pain
  • Consider occult bacteremia and obtaining a blood culture and/or CBC with differential
    • if unimmunized or not fully immunized, especially those under 6 months of age
  • Consider Sinusitis
    • if ≥ 1 year of age, fever ≥ 39°C for at least 3 days and purulent nasal discharge
  • Consider Kawasaki, including incomplete Kawasaki Pathway
    • if fever ≥ 3 days (including fever alone if < 6 months of age)
  • Consider Fever of Unknown Origin
    • if ≥ 8 days of fever without a source
  • Consider seasonal or locally endemic infection
> 24 mos
  • Evaluation directed by H&P
  • Consider risk factors for UTI in the child who is not toilet trained — UTI Pathway
  • Consider occult pneumonia
    • especially if URI symptoms precede an abrupt onset of persistent high fever
  • Consider Sinusitis
    • if ≥ 1 year of age, fever ≥ 39°C for at least 3 days and purulent nasal discharge
    • if persistent and not improving, nasal discharge ≥ 10 days
  • Consider Kawasaki, including incomplete Kawasaki Pathway
    • if fever ≥ 3 days
  • Consider Fever of Unknown Origin
    • if ≥ 8 days of fever without a source
  • Consider seasonal or locally endemic infection

CDC Immunization Schedule

Immunization Schedule  

Clinical Practice Guideline for the Diagnosis and Management of Acute Sinusitis in Children 1-18 years of Age. Wald, E, Applebee K, Bordley C et al. Pediatr 2013  

Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months Subcommittee on Urinary Tract Infection, Steering Committee On Quality Improvement And Management, 2011  

Management of Community-Acquired Pneumonia (CAP) in Infants and Children Older than 3 Months of Age AAP, 2011