Management of the non-toxic-appearing acutely febrile child: a 21st century approach.

From the Division of Infectious Diseases, Department of Pediatrics, Duke University A lthough most febrile children aged <36 months have a self-limited viral infection that will resolve without treatment, a small proportion who are not obviously toxic will develop a serious bacterial infection (SBI), including bacteremia, meningitis, and urinary tract infection (UTI). How to best assess and manage such children has long been amatter of debate. Identifying non–toxic-appearing febrile children with an SBI is a persistent challenge for pediatric practitioners. Management of febrile children is further complicated by the fact that parents and physicians value the risks and costs differently. Most physicians find errors of omission (ie, missing a child with SBI) intolerable, and parents give more consideration to procedures involving pain and discomfort for their children, such as diagnostic testing and false-positive test results and their consequences.