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Infectious diseases are a major cause of disease in children. The widespread use of antibiotics has greatly reduced morbidity and mortality, but infections are still one of the most common types of problems encountered by physicians who care for children.

General Considerations

Fever is the primary sign that indicates an infectious process in children of all ages. Other than fever, however, many children do not display signs or symptoms indicative of the underlying disease. Twenty percent of febrile children, after history and physical examination, have fever without a source of infection. The physician's dilemma is to separate children with a serious bacterial illness from those with a viral or nonserious bacterial illness. A serious bacterial illness is defined variably, but generally includes growth of a known bacterial pathogen from cerebrospinal fluid, blood, urine, or stool, as well as abscess or cellulitis and pneumonia with positive blood cultures. Children are generally divided into three groups for evaluation purposes: young children aged 3 months to 3 years, young infants aged 2-3 months, and neonates (≤1 month of age). There is no absolute demarcation between these ages. Rather, one age group fades into the next, and the physician is left to make a judgment about how to treat each child in the border ages.

Young children are much more likely to show outward signs of illness, and their evaluation is much easier than that of younger infants. Neonates are a separate diagnostic group, more likely to have infections with organisms seen in the newborn period and less likely to show overt clinical signs of infection.

No officially adopted, evidence-based guidelines have been published to guide physicians in the workup and management of febrile illnesses, although several papers have been written detailing suggested guidelines based on expert opinion, group consensus, and locally performed research studies. Baraff and colleagues published a set of useful practice guidelines that are summarized in Table 5-1.

Table 5-1. Evaluation and Treatment of Febrile Children.

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