George H . McCracken , Jr and Keith R . Powell

Study objective. To develop guidelines for the care of infants and children from birth to 36 months of age with fever without source. Participants and setting. An expert panel of senior academic faculty with expertise in pediatrics and infectious diseases or emergency medicine. Design and intervention. A comprehensive literature search was used to identify all publications pertinent to the management of the febrile child. When appropriate, meta-analysis was used to combine the results of multiple studies. One or more specific management strategies was proposed for each of decision nodes in draft management algorithms. The draft algorithms, selected publications, and the meta-analyses were provided to the panel, which determined the final guidelines using the modified Delphi technique. Results. All toxic-appearing infants and children and all febrile infants less than 28 days of age should be hospitalized for parenteral antibiotic therapy. Febrile infants 28 to 90 days of age defined at low risk by specific clinical and laboratory criteria may be managed as outpatients if close follow-up is assured. Older children with fever less than 39.0#{176}Cwithout source need no laboratory tests or antibiotics. Qtildren 3 to 36 months of age with fever of 39.0#{176}C or more and whose white blood cell count is 15 000/mm3 or more should have a blood culture These Guidelines are those proposed by the authors and do not constitute Practice Guidelines of the American Academy of Pediatrics. This article is being published simultaneously in the Annals of Emergency