Pediatric Fever By Age 2 to 24 MonthsAPPROACH

PEDIATRICS · 19 SECTIONS

⚲

367 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Fever In The Neonate And Young Infant Pediatric Fever By Age 0 To 28 Days Pediatric Fever By Age 29 To 60 Days Pediatric Fever By Age 2 To 24 Months Pediatric Respiratory Distress Croup And Stridor In Children Pediatric Dehydration Pediatric Abdominal Pain Febrile Seizure Rash In The Child Poor Feeding And Lethargy In The Infant Vomiting In The Child Diarrhea In The Child Pediatric Trauma Evaluation Brief Resolved Unexplained Event In The Infant And Apparent Life Threatening Event Concern Lethargy And Altered Mental Status In The Child

Environmental and Exposure4▾

01History/hx29

Fever characterization

›Fever details

›Maximum temperature measured

›Measurement method

›Antipyretic response pattern

›Duration of fever

›Fever pattern

Source clues and exposures

›Context

›Sick contacts

›Daycare exposure

›Recent travel

›Recent antibiotics

›Recent vaccinations

›Animal exposures

Hydration and intake

›Intake and output

›Oral intake change

›Wet diapers count trend

›Vomiting episodes

›Diarrhea episodes

Urinary symptoms and UTI risk cues

›UTI risk history

›Dysuria cues

›Malodorous urine

›New urinary frequency

›Prior UTI history

›Known urinary tract abnormality

Baseline and trajectory

›Course

›Baseline activity level

›Current interaction and play

›Sleepiness beyond baseline

›Prior similar episodes

02Alarm Features/alarm28

Immediate escalation triggers

›Resuscitation triggers

›Toxic appearance

›Altered mental status

›Cyanosis

›Apnea

›Seizure

›Persistent inconsolability

High risk vitals and perfusion

›High risk physiology

›Hypotension for age

›Delayed capillary refill

›Marked tachycardia for age

›Marked tachypnea for age

›Hypoxia

›Hypothermia

High risk exam findings

›High risk findings

›Neck stiffness

›Bulging fontanelle

›Petechiae

›Purpura

›Respiratory distress

›Signs of dehydration

Time sensitive syndromes

›Fever syndromes needing urgent action

›Suspected sepsis

›Suspected meningitis

›Suspected pneumonia with hypoxia

›Suspected septic arthritis

›Suspected osteomyelitis

›Suspected Kawasaki disease with 5 days of fever

03Medications/meds14

Antipyretics and recent treatments

›Recent meds

›Acetaminophen use pattern

›Ibuprofen use pattern

›Dosing accuracy concerns

›Recent antibiotics

Chronic medications and immunosuppression

›Medication risks

›Systemic corticosteroids

›Chemotherapy agents

›Biologics

›Transplant immunosuppression

Allergies and contraindications

›Allergy profile

›Beta lactam allergy history

›Sulfa allergy history

›Prior severe drug reaction history

04Diet/diet8

Recent intake patterns

›Nutrition and hydration

›Breastmilk or formula intake change

›Solids intake change

›Water intake pattern

Dehydration risk exposures

›Fluid loss risks

›Vomiting frequency

›Diarrhea frequency

›Reduced intake duration

05Review of Systems/ros30

General and constitutional

›General

›Lethargy

›Irritability

›Poor feeding

›Decreased urine output

Respiratory

›Respiratory

›Cough

›Rhinorrhea

›Work of breathing

›Wheeze

Gastrointestinal

›Gastrointestinal

›Vomiting

›Diarrhea

›Abdominal pain cues

›Poor oral tolerance

Genitourinary

›Genitourinary

›Dysuria cues

›Malodorous urine

›Frequency change

›Hematuria

Skin and mucous membranes

›Skin

›Rash

›Petechiae

›Purpura

›Conjunctival injection

Neurologic

›Neurologic

›Seizure

›Neck stiffness

›Bulging fontanelle cues

›Persistent altered behavior

06Collateral History and Family History/chafh12

Collateral source and reliability

›Historian

›Primary caregiver source

›Reliability concerns

›Time course consistency

Family history relevant to risk

›Family history

›Immunodeficiency history

›Sickle cell disease (D57.1)

›Early severe infections

Household and social context

›Environment

›Household sick contacts

›Daycare attendance

›Ability to return for reassessment

07Risk Factors/rf17

Serious bacterial infection risk

›SBI risks

›Age 2 to 24 months with fever without source

›Under immunized status

›Prematurity history

›Indwelling devices

›Immunocompromised state

UTI risk factors

›UTI risks

›Female sex

›Uncircumcised male

›Prior UTI

›Known urinary tract anomaly

›Fever without source

Exposure and outbreak risks

›Exposures

›Influenza season exposure

›SARS CoV 2 exposure

›Pertussis exposure

›Recent travel

08Differential Diagnosis/ddx23

Life threatening

›Cannot miss

›Sepsis (A41.9)

›Meningitis (G03.9)

›Pneumonia with hypoxia (J18.9)

›Bacteremia (R78.81)

›Septic arthritis (M00.9)

›Osteomyelitis (M86.9)

Common

›Common causes

›Viral upper respiratory infection (J06.9)

›Acute otitis media (H66.9)

›Urinary tract infection (N39.0)

›Viral gastroenteritis (A08.4)

›Roseola (B08.2)

Less common

›Less common causes

›Kawasaki disease (M30.3)

›Occult pneumonia without focal findings (J18.9)

›Enteritis with bacteremia risk in immunocompromised

›Intraabdominal infection

›Serious skin and soft tissue infection (L03.90)

Diagnostic clues and pitfalls

›Clues and pitfalls

›Viral symptoms do not exclude UTI

›Fever 5 days needs Kawasaki disease screen

›Early sepsis may have normal initial labs

09Past Medical History/pmh13

Birth and neonatal history

›Birth history

›Prematurity

›NICU stay history

›Perinatal infections

Medical history and devices

›Medical background

›Congenital heart disease (Q24.9)

›Chronic lung disease

›Immunodeficiency

›Indwelling catheter history

Immunization status

›Immunizations

›Up to date status

›Missing conjugate vaccines history

›Recent vaccinations within 48 hours

10Physical Exam/exam45

General appearance and perfusion

›General

›Toxic appearance

›Consolability

›Interaction with caregiver

›Hydration status

›Capillary refill

Vital sign interpretation

›Vitals patterns

›Temperature trend

›Heart rate relative to fever

›Respiratory rate relative to fever

›Oxygen saturation

HEENT

›HEENT

›Otitis media findings

›Oropharyngeal lesions

›Conjunctivitis

›Mucous membrane dryness

Respiratory

›Lungs

›Retractions

›Nasal flaring

›Focal crackles

›Wheeze

Cardiovascular

›Circulation

›Murmur

›Peripheral pulses

›Cool extremities

›Hepatomegaly

Abdomen

›Abdomen

›Tenderness

›Distension

›Guarding

›Costovertebral angle tenderness cues

Skin

›Skin

›Rash morphology

›Petechiae

›Purpura

›Cellulitis focus

Neurologic

›Neuro

›Mental status

›Neck stiffness

›Focal deficit

›Fontanelle assessment when applicable

Musculoskeletal

›MSK

›Refusal to bear weight

›Joint swelling

›Bone point tenderness

11Lab Studies/labs26

Urine testing

›Urine evaluation

›Urinalysis

›Leukocyte esterase

›Nitrite

›Pyuria on microscopy

›Urine culture

›Collection method documentation

›Catheter or suprapubic aspirate preferred for culture when high suspicion

Blood testing when indicated

›Blood evaluation

›CBC with differential

›Extreme leukocytosis concern

›Neutrophil predominance concern

›Blood culture

›Ill appearance

›Under immunized status

›CRP or procalcitonin

›Local protocol dependent

›Trend and context dependent

Metabolic and dehydration evaluation

›Metabolic

›Electrolytes

›Glucose

›Venous blood gas if shock concern

Viral testing

›Viral testing

›Influenza testing when community circulation

›SARS CoV 2 testing when community circulation

›RSV testing when bronchiolitis phenotype

12Imaging/img20

Scoring Systems

›Risk stratification tools

›NICE traffic light system

›Green low risk features

›Amber intermediate risk features

›Red high risk features

›UTICalc

›Pretest probability estimate for UTI in febrile children 2 to 23 months

›Supports urine testing targeting

MRI

›MRI indications

›Suspected osteomyelitis with persistent fever and localized pain

›Suspected epidural abscess with neurologic findings

›Persistent fever with limp and nondiagnostic initial imaging

›CT indications

›Complicated sinusitis concern with orbital or neurologic findings

›Intracranial complication concern with altered mental status

›Intraabdominal emergency when ultrasound nondiagnostic and high concern

Ultrasound

›Ultrasound applications

›Renal and bladder ultrasound after febrile UTI

›Appendicitis ultrasound when abdominal tenderness pattern

›Hip ultrasound when septic arthritis concern in appropriate age and exam

13Special Tests/spec11

Lumbar puncture decision points

›CSF evaluation

›Ill appearance with concern for meningitis

›Petechiae or purpura with systemic illness

›Seizure with persistent altered mental status

›Neck stiffness or bulging fontanelle

Respiratory testing beyond basic viral assays

›Respiratory diagnostics

›Chest radiograph when focal lung findings or hypoxia

›Pertussis PCR when paroxysmal cough phenotype

Inflammatory and vasculitis evaluation

›Kawasaki disease evaluation

›Fever 5 days or more with compatible features

›CRP and ESR supportive but nonspecific

14ECG/ecg8

When ECG is relevant

›ECG indications

›Significant dehydration with tachycardia out of proportion to fever

›Suspected myocarditis

›Electrolyte abnormality concern

ECG red flags

›High risk patterns

›Diffuse ST segment changes with myocarditis concern

›High grade AV block

›Wide complex tachycardia

15Assessment/ax16

Problem representation

›Fever in child age 2 to 24 months

›Well appearing versus ill appearing stratification

›Source identified versus fever without source (R50.9)

Risk stratification

›SBI risk assessment

›Immunization status contribution

›Duration and trajectory contribution

›Exam based traffic light category contribution

Working diagnoses

›Most likely diagnoses

›Viral syndrome (B34.9)

›UTI (N39.0)

›Acute otitis media (H66.9)

›Pneumonia (J18.9)

Complications to exclude

›Key complications

›Sepsis (A41.9)

›Meningitis (G03.9)

›Dehydration (E86.0)

16Plan/plan24

First 5 minutes workflow

›Immediate priorities

›Continuous pulse oximetry if respiratory symptoms or ill appearance

›IV or IO access if poor perfusion or toxic appearance

›Point of care glucose if altered mental status

›Fluid bolus if shock concern per local protocol

Diagnostic sequencing by appearance

›Diagnostic pathway

›If ill appearing

›Blood culture

›CBC with differential

›Urinalysis and urine culture

›Lumbar puncture if meningitis concern and no contraindication

›If well appearing

›Focused exam guided testing for source

›Urine testing when UTI risk not low

Therapeutics

›Symptom control

›Acetaminophen oral per weight based dosing

›Ibuprofen oral per weight based dosing if age 6 months or more and no contraindication

›Antimicrobials when indicated

›Empiric antibiotics for ill appearing child after cultures as feasible

›UTI treatment based on urinalysis and clinical status

Reassessment loop

›Reassessment

›Vitals repeat after antipyretic

›Hydration reassessment after oral or IV fluids

›Clinical appearance reassessment within 30 to 60 minutes in ED

17Disposition/dispo16

Admission and higher level of care

›Admit criteria

›Toxic appearance or sepsis concern

›Hypoxia or significant respiratory distress

›Inability to maintain hydration

›Suspected meningitis

›Reliable follow up not possible

Observation pathway

›Observation criteria

›Well appearing but pending cultures with concerning urinalysis

›Persistent tachycardia after fever control

›Social concerns requiring monitoring

Discharge criteria

›Discharge requirements

›Well appearing after period of observation

›Hydrating adequately

›No alarm features on exam

›Clear follow up plan within 24 to 48 hours when fever without source

›Return precautions understood

18Discharge Instructions/di17

Copy discharge instructions

›Discharge text

›Diagnosis:

›Fever in a young child

›No dangerous cause identified today based on exam and testing

›Home care:

›Encourage fluids

›Use fever medicine only as directed by your clinician

›Follow up:

›See your primary care clinician within 24 to 48 hours if fever continues

›Review urine culture results if obtained

›Return to emergency:

›Trouble breathing

›Blue lips or severe sleepiness

›New rash with purple spots

›Seizure

›Signs of dehydration

›Not drinking or very few wet diapers

19References/r10

Key guidelines and tools

›Evidence sources

›NICE guideline NG143 Fever in under 5s assessment and initial management 2019

›NICE NG143 traffic light table educational resource 2019

›Canadian Paediatric Society Urinary tract infection in infants and children diagnosis and management 2014

›American Academy of Pediatrics Urinary tract infection clinical practice guideline 2011

›American Academy of Pediatrics reaffirmation and retirement notice for UTI guideline 2016 and retired 2021

›Canadian Paediatric Society Guidelines for suspected and confirmed bacterial meningitis in children older than 2 months 2020 reaffirmed 2026

›WHO guidelines on meningitis diagnosis treatment and care 2025

›UTICalc development and validation Shaikh et al 2018

›Source file

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.

Pediatric Fever By Age 2 to 24 MonthsAPPROACH

PEDIATRICS · 19 SECTIONS

⚲

367 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx29

Fever characterization

›Fever details

›Maximum temperature measured

›Measurement method

›Antipyretic response pattern

›Duration of fever

›Fever pattern

Source clues and exposures

›Context

›Sick contacts

›Daycare exposure

›Recent travel

›Recent antibiotics

›Recent vaccinations

›Animal exposures

Hydration and intake

›Intake and output

›Oral intake change

›Wet diapers count trend

›Vomiting episodes

›Diarrhea episodes

Urinary symptoms and UTI risk cues

›UTI risk history

›Dysuria cues

›Malodorous urine

›New urinary frequency

›Prior UTI history

›Known urinary tract abnormality

Baseline and trajectory

›Course

›Baseline activity level

›Current interaction and play

›Sleepiness beyond baseline

›Prior similar episodes

02Alarm Features/alarm28

Immediate escalation triggers

›Resuscitation triggers

›Toxic appearance

›Altered mental status

›Cyanosis

›Apnea

›Seizure

›Persistent inconsolability

High risk vitals and perfusion

›High risk physiology

›Hypotension for age

›Delayed capillary refill

›Marked tachycardia for age

›Marked tachypnea for age

›Hypoxia

›Hypothermia

High risk exam findings

›High risk findings

›Neck stiffness

›Bulging fontanelle

›Petechiae

›Purpura

›Respiratory distress

›Signs of dehydration

Time sensitive syndromes

›Fever syndromes needing urgent action

›Suspected sepsis

›Suspected meningitis

›Suspected pneumonia with hypoxia

›Suspected septic arthritis

›Suspected osteomyelitis

›Suspected Kawasaki disease with 5 days of fever

03Medications/meds14

Antipyretics and recent treatments

›Recent meds

›Acetaminophen use pattern

›Ibuprofen use pattern

›Dosing accuracy concerns

›Recent antibiotics

Chronic medications and immunosuppression

›Medication risks

›Systemic corticosteroids

›Chemotherapy agents

›Biologics

›Transplant immunosuppression

Allergies and contraindications

›Allergy profile

›Beta lactam allergy history

›Sulfa allergy history

›Prior severe drug reaction history

04Diet/diet8

Recent intake patterns

›Nutrition and hydration

›Breastmilk or formula intake change

›Solids intake change

›Water intake pattern

Dehydration risk exposures

›Fluid loss risks

›Vomiting frequency

›Diarrhea frequency

›Reduced intake duration

05Review of Systems/ros30

General and constitutional

›General

›Lethargy

›Irritability

›Poor feeding

›Decreased urine output

Respiratory

›Respiratory

›Cough

›Rhinorrhea

›Work of breathing

›Wheeze

Gastrointestinal

›Gastrointestinal

›Vomiting

›Diarrhea

›Abdominal pain cues

›Poor oral tolerance

Genitourinary

›Genitourinary

›Dysuria cues

›Malodorous urine

›Frequency change

›Hematuria

Skin and mucous membranes

›Skin

›Rash

›Petechiae

›Purpura

›Conjunctival injection

Neurologic

›Neurologic

›Seizure

›Neck stiffness

›Bulging fontanelle cues

›Persistent altered behavior

06Collateral History and Family History/chafh12

Collateral source and reliability

›Historian

›Primary caregiver source

›Reliability concerns

›Time course consistency

Family history relevant to risk

›Family history

›Immunodeficiency history

›Sickle cell disease (D57.1)

›Early severe infections

Household and social context

›Environment

›Household sick contacts

›Daycare attendance

›Ability to return for reassessment

07Risk Factors/rf17

Serious bacterial infection risk

›SBI risks

›Age 2 to 24 months with fever without source

›Under immunized status

›Prematurity history

›Indwelling devices

›Immunocompromised state

UTI risk factors

›UTI risks

›Female sex

›Uncircumcised male

›Prior UTI

›Known urinary tract anomaly

›Fever without source

Exposure and outbreak risks

›Exposures

›Influenza season exposure

›SARS CoV 2 exposure

›Pertussis exposure

›Recent travel

08Differential Diagnosis/ddx23

Life threatening

›Cannot miss

›Sepsis (A41.9)

›Meningitis (G03.9)

›Pneumonia with hypoxia (J18.9)

›Bacteremia (R78.81)

›Septic arthritis (M00.9)

›Osteomyelitis (M86.9)

Common

›Common causes

›Viral upper respiratory infection (J06.9)

›Acute otitis media (H66.9)

›Urinary tract infection (N39.0)

›Viral gastroenteritis (A08.4)

›Roseola (B08.2)

Less common

›Less common causes

›Kawasaki disease (M30.3)

›Occult pneumonia without focal findings (J18.9)

›Enteritis with bacteremia risk in immunocompromised

›Intraabdominal infection

›Serious skin and soft tissue infection (L03.90)

Diagnostic clues and pitfalls

›Clues and pitfalls

›Viral symptoms do not exclude UTI

›Fever 5 days needs Kawasaki disease screen

›Early sepsis may have normal initial labs

09Past Medical History/pmh13

Birth and neonatal history

›Birth history

›Prematurity

›NICU stay history

›Perinatal infections

Medical history and devices

›Medical background

›Congenital heart disease (Q24.9)

›Chronic lung disease

›Immunodeficiency

›Indwelling catheter history

Immunization status

›Immunizations

›Up to date status

›Missing conjugate vaccines history

›Recent vaccinations within 48 hours

10Physical Exam/exam45

General appearance and perfusion

›General

›Toxic appearance

›Consolability

›Interaction with caregiver

›Hydration status

›Capillary refill

Vital sign interpretation

›Vitals patterns

›Temperature trend

›Heart rate relative to fever

›Respiratory rate relative to fever

›Oxygen saturation

HEENT

›HEENT

›Otitis media findings

›Oropharyngeal lesions

›Conjunctivitis

›Mucous membrane dryness

Respiratory

›Lungs

›Retractions

›Nasal flaring

›Focal crackles

›Wheeze

Cardiovascular

›Circulation

›Murmur

›Peripheral pulses

›Cool extremities

›Hepatomegaly

Abdomen

›Abdomen

›Tenderness

›Distension

›Guarding

›Costovertebral angle tenderness cues

Skin

›Skin

›Rash morphology

›Petechiae

›Purpura

›Cellulitis focus

Neurologic

›Neuro

›Mental status

›Neck stiffness

›Focal deficit

›Fontanelle assessment when applicable

Musculoskeletal

›MSK

›Refusal to bear weight

›Joint swelling

›Bone point tenderness

11Lab Studies/labs26

Urine testing

›Urine evaluation

›Urinalysis

›Leukocyte esterase

›Nitrite

›Pyuria on microscopy

›Urine culture

›Collection method documentation

›Catheter or suprapubic aspirate preferred for culture when high suspicion

Blood testing when indicated

›Blood evaluation

›CBC with differential

›Extreme leukocytosis concern

›Neutrophil predominance concern

›Blood culture

›Ill appearance

›Under immunized status

›CRP or procalcitonin

›Local protocol dependent

›Trend and context dependent

Metabolic and dehydration evaluation

›Metabolic

›Electrolytes

›Glucose

›Venous blood gas if shock concern

Viral testing

›Viral testing

›Influenza testing when community circulation

›SARS CoV 2 testing when community circulation

›RSV testing when bronchiolitis phenotype

12Imaging/img20

Scoring Systems

›Risk stratification tools

›NICE traffic light system

›Green low risk features

›Amber intermediate risk features

›Red high risk features

›UTICalc

›Pretest probability estimate for UTI in febrile children 2 to 23 months

›Supports urine testing targeting

MRI

›MRI indications

›Suspected osteomyelitis with persistent fever and localized pain

›Suspected epidural abscess with neurologic findings

›Persistent fever with limp and nondiagnostic initial imaging

›CT indications

›Complicated sinusitis concern with orbital or neurologic findings

›Intracranial complication concern with altered mental status

›Intraabdominal emergency when ultrasound nondiagnostic and high concern

Ultrasound

›Ultrasound applications

›Renal and bladder ultrasound after febrile UTI

›Appendicitis ultrasound when abdominal tenderness pattern

›Hip ultrasound when septic arthritis concern in appropriate age and exam

13Special Tests/spec11

Lumbar puncture decision points

›CSF evaluation

›Ill appearance with concern for meningitis

›Petechiae or purpura with systemic illness

›Seizure with persistent altered mental status

›Neck stiffness or bulging fontanelle

Respiratory testing beyond basic viral assays

›Respiratory diagnostics

›Chest radiograph when focal lung findings or hypoxia

›Pertussis PCR when paroxysmal cough phenotype

Inflammatory and vasculitis evaluation

›Kawasaki disease evaluation

›Fever 5 days or more with compatible features

›CRP and ESR supportive but nonspecific

14ECG/ecg8

When ECG is relevant

›ECG indications

›Significant dehydration with tachycardia out of proportion to fever

›Suspected myocarditis

›Electrolyte abnormality concern

ECG red flags

›High risk patterns

›Diffuse ST segment changes with myocarditis concern

›High grade AV block

›Wide complex tachycardia

15Assessment/ax16

Problem representation

›Fever in child age 2 to 24 months

›Well appearing versus ill appearing stratification

›Source identified versus fever without source (R50.9)

Risk stratification

›SBI risk assessment

›Immunization status contribution

›Duration and trajectory contribution

›Exam based traffic light category contribution

Working diagnoses

›Most likely diagnoses

›Viral syndrome (B34.9)

›UTI (N39.0)

›Acute otitis media (H66.9)

›Pneumonia (J18.9)

Complications to exclude

›Key complications

›Sepsis (A41.9)

›Meningitis (G03.9)

›Dehydration (E86.0)

16Plan/plan24

First 5 minutes workflow

›Immediate priorities

›Continuous pulse oximetry if respiratory symptoms or ill appearance

›IV or IO access if poor perfusion or toxic appearance

›Point of care glucose if altered mental status

›Fluid bolus if shock concern per local protocol

Diagnostic sequencing by appearance

›Diagnostic pathway

›If ill appearing

›Blood culture

›CBC with differential

›Urinalysis and urine culture

›Lumbar puncture if meningitis concern and no contraindication

›If well appearing

›Focused exam guided testing for source

›Urine testing when UTI risk not low

Therapeutics

›Symptom control

›Acetaminophen oral per weight based dosing

›Ibuprofen oral per weight based dosing if age 6 months or more and no contraindication

›Antimicrobials when indicated

›Empiric antibiotics for ill appearing child after cultures as feasible

›UTI treatment based on urinalysis and clinical status

Reassessment loop

›Reassessment

›Vitals repeat after antipyretic

›Hydration reassessment after oral or IV fluids

›Clinical appearance reassessment within 30 to 60 minutes in ED

17Disposition/dispo16

Admission and higher level of care

›Admit criteria

›Toxic appearance or sepsis concern

›Hypoxia or significant respiratory distress

›Inability to maintain hydration

›Suspected meningitis

›Reliable follow up not possible

Observation pathway

›Observation criteria

›Well appearing but pending cultures with concerning urinalysis

›Persistent tachycardia after fever control

›Social concerns requiring monitoring

Discharge criteria

›Discharge requirements

›Well appearing after period of observation

›Hydrating adequately

›No alarm features on exam

›Clear follow up plan within 24 to 48 hours when fever without source

›Return precautions understood

18Discharge Instructions/di17

Copy discharge instructions

›Discharge text

›Diagnosis:

›Fever in a young child

›No dangerous cause identified today based on exam and testing

›Home care:

›Encourage fluids

›Use fever medicine only as directed by your clinician

›Follow up:

›See your primary care clinician within 24 to 48 hours if fever continues

›Review urine culture results if obtained

›Return to emergency:

›Trouble breathing

›Blue lips or severe sleepiness

›New rash with purple spots

›Seizure

›Signs of dehydration

›Not drinking or very few wet diapers

19References/r10

Key guidelines and tools

›Evidence sources

›NICE guideline NG143 Fever in under 5s assessment and initial management 2019

›NICE NG143 traffic light table educational resource 2019

›Canadian Paediatric Society Urinary tract infection in infants and children diagnosis and management 2014

›American Academy of Pediatrics Urinary tract infection clinical practice guideline 2011

›American Academy of Pediatrics reaffirmation and retirement notice for UTI guideline 2016 and retired 2021

›Canadian Paediatric Society Guidelines for suspected and confirmed bacterial meningitis in children older than 2 months 2020 reaffirmed 2026

›WHO guidelines on meningitis diagnosis treatment and care 2025

›UTICalc development and validation Shaikh et al 2018

›Source file

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.