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Pediatrics : Fever in Infants Under 2 Years
Infants under 2 years of age often manifest a fever as the first sign of a viral or bacterial infection. Temperatures (rectal) over 100.4 Fahrenheit are considered by most physicians as indicative for the presence of fever. Higher temperatures (103, or greater) have a greater incidence of serious bacterial infection. The physician's approach to the febrile (feverish) infant focuses on determining the source of the infection. A diagnosis will be possible only after a medical history, physical examination, and diagnostic testing (if necessary) are completed. The age and general appearance of the child are key factors in the evaluation of the febrile infant. Fever in the infant under 1 year of age is potentially more serious than fever in an older child (over the age of two years).
COMMON CAUSES OF FEVER IN INFANTS INCLUDE
1. UPPER RESPIRATORY INFECTION, "COLDS" (viral causes)
2. PNEUMONIA
3. TONSILLITIS
4. EAR INFECTION
5. URINARY TRACT INFECTION
6. Gastroenteritis
7. CROUP
8. EPIGLOTTITIS
9. BRONCHIOLITIS
10. MENINGITIS
11. SEPSIS (an important bacterial agent is Hemophilus influenza type B and currently a recommeded vaccine (HIB) in the U.S.
The medical history and the findings upon physical examination will help the physician arrive at the appropriate diagnosis. Laboratory tests commonly performed on the febrile infant include:
1. CHEST X-RAY
2. URINALYSIS AND URINE CULTURE
3. BLOOD CULTURES
4. COMPLETE BLOOD COUNT
Younger infants (less than 3 months), or those with signs and symptoms of meningitis (sicker infants with no obvious cause for high fever) will require a spinal tap to rule out the presence of this SERIOUS disease. Infants UNDER 3 months of age, who present with high fever, are commonly admitted to the hospital for observation, regardless of lab test results. Studies show this group has a much higher rate of the serious bloodstream (bacterial) infection, known as sepsis. Infants 3 months to 1 year may be admitted to the hospital for more serious conditions such as pneumonia, urinary tract infection, sepsis, or dehydration. Infants 1-2 years are commonly treated on an outpatient basis for uncomplicated pneumonia, gastroenteritis, urinary tract infection, or bronchiolitis. All cases of epiglottitis and meningitis will be admitted to the hospital, regardless of the patients age. Fever, in the infant UNDER 2 years, should always be evaluated by a physician to exclude the presence of serious bacterial illness.
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