Child with Fever — Signs of Severe Infection — Clinical Pathway: All Settings

Fever Clinical Pathway — All Settings

Some Signs that May Be Suggestive of Severe Infection

Consider the following list of examples of signs in ill-appearing children with a concern for infection during initial assessment. Proceed with timely intervention as clinically indicated.

Diagnosis Some Possible Associated Signs
Meningitis/Encephalitis
Altered sensorium Irritability, lethargy, obtundation, coma
Neurologic signs Seizures (prolonged, focal), meningismus, focal neurologic deficits
Signs of elevated ICP Vomiting, bulging fontanel, lateralizing neurologic signs
Note: Infants < 1 year with CNS infection may not have meningismus

Meningitis Pathway
Epiglottitis Excessive drooling, neck extension, sniffing or tripod positioning, anxious
Severe Croup
  • Stridor with suprasternal > intercostal retractions, anxious
  • Croup Pathway
Severe Retropharyngeal Abscess
Severe Pneumonia
Myocarditis
Sepsis Syndrome
Meningococcemia, Rocky Mountain Spotted Fever, Other Sepsis Syndrome (or Toxic Shock Syndrome)
  • Anxious or altered MS, or irritability
  • Petechial, purpuric rash or Erythroderma
  • Evanescent erythematous papular rash
  • Tachycardia with poor perfusion
Necrotizing Fasciitis
  • Severe muscle tenderness/pain (often out of proportion)
  • Overlying skin changes, signs of sepsis
  • Rapidly progressive

Please note this is not a complete list of signs associated with severe infection.

Considerations for interventions as clinically indicated

  • Provide emergent stabilization of airway, breathing and circulation (address ABCDE’S)
  • Anticipate need for airway subspecialist or operating room airway placement
  • Assess need for rapid initiation of vascular access and fluids, laboratory studies, radiographic testing, and empiric antibiotics
  • Seizure control as indicated Status Epilepticus Pathway
  • Surgical subspecialty consultation as required by condition
  • Refer to ED, Inpatient and PICU Sepsis Pathway for guidance
  • Consider ID consultation for specific antimicrobial recommendations as needed
  • Consider meningitis dosing of antimicrobials if concern for CNS infection Meningitis Pathway