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Controversies in Pediatrics: What Tests Are Indicated for the Child Under 2 with Fever

Most articles in PEDIATRICS IN REVIEW are presented in a didactic manner, sometimes more so than the authors would like. But other topics are still so controversial that to present only one side or one view would do disservice to authors and readers. From time-to-time we will present such controversies in pediatrics in this section. Such an instance is "fever in young children." Since the studies a few years ago that demonstrated bacteremia in more of these children than most of us previously suspected, all of us are more anxious than before about such children. Can we trust our clinical judgment as to who requires blood cultures and antimicrobial therapy? What tests are useful in making this difficult decision? McCarthy has done a series of studies over the years which he summaries below. But the experts do not always agree. Smith has added his view of the problem. Unfortunately, some things in medicine are still not so clear. But the reader will know that experts share his uncertainties.

R.J.H

One of the common reasons that a child visits the pediatrician is for the evaluation of a febrile illness. In our emergency room, 20% of children evaluated have a fever. Therefore, a well thought out approach to the febrile child is essential in pediatric practice.

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				S. Press Association of Hyperpyrexia with Serious Disease in Children Clinical Pediatrics, January 1, 1994; 33(1): 19 - 25. [Abstract] [PDF]

				R. H. Pantell, M. Naber, R. Lamar, and J. K. Dias Fever in the First Six Months of Life: Risks of Underlying Serious Infection Clinical Pediatrics, February 1, 1980; 19(2): 77 - 82. [Abstract] [PDF]