Child with Fever — Discharge — Clinical Pathway: All Settings

Fever Clinical Pathway — All Settings

ED Plan, Discharge Considerations, Discharge Instructions

ED Plan
  • Consider the following during the ED visit as clinically indicated by the child’s H&PE:
    • PO challenge
    • Antipyretic medications
    • Repeat VS as clinically indicated
    • Testing as indicated
Discharge Considerations
  • Nontoxic appearance
  • VS consistent with illness, fever
  • Tolerating PO, able to keep up with losses
  • Parental understanding of follow-up instructions and reasons to return to the ED
  • Access to outpatient follow-up
Discharge Instructions
  • Take the time to review discharge instructions with family, including:
  • Fever Guidelines for the Healthy Child over 3 Months of Age
  • What is fever?
    • Fever is a body temperate of 100.4°F (38.0°C) or greater.
    • Fever helps the body fight infection.
  • How to understand fever:
    • How your child looks is what is most important, not the number on the thermometer.
    • Fever itself does not cause brain damage or any other body harm.
    • Fevers come and go and typically last several days.
    • Your child may also have body aches with fever.
    • The goal of treating fever should be to keep your child comfortable.
  • How to manage fevers at home:
    • You do not need to use fever-reducing medication such as acetaminophen (Tylenol®) or ibuprofen (Motrin® and Advil®) unless your child is uncomfortable.
    • You do not need to alternate these medications.
    • Pick one and stay with that schedule (see table below).
    • Make sure you know the correct dose for your child’s age and weight.
    • Never give aspirin (even baby aspirin) to your child.
    Fever Medication Age Restrictions Dosing
    Acetaminophen (Tylenol) Can be used for ANY age May be given every 4-6 hours for a maximum of 4 doses per day
    Ibuprofen (Motrin/Advil) Can ONLY be used for children 6 months of age and older May be given every 6-8 hours with a maximum of 4 doses per day
    • Fever may or may not come down with fever-reducing medication.
    • It is normal for fever to return in a few hours.
    • Dress your child in light clothing.
    • Encourage fluids all day long.
    • Keep your child home from school/daycare so he/she can rest and not spread infection until they are 24 hours fever-free.
  • Call your doctor if you are concerned about your child, or if your child:
    • Does not smile or have periods of playfulness.
    • Is becoming more sick or develops new problems
    • Drinking very little or not at all, has no urine for 8-12 hours and has dry lips
    • Has stiff neck or has purple spots on the skin
    • Is under 3 months of age
    • Has fevers that last for more than 3 days or develops new symptoms that cause concern
    • Pain, redness or swelling localized in one area (like a bad sore throat or a red, swollen knee)
    • Go to the Emergency Room if your child is working hard to breathe or is difficult to awaken