Definitions of Terms in the 1993 Practice Guideline on the Management of Fever in Infants

and Young Children

Term Definition
Fever Rectal temperature of 38C (100.4F)*
Fever without Acute febrile illness in which the etiology of the fever is not apparent after a
source careful history and physical examination
Serious bacterial Meningitis, sepsis, bone and joint infections, urinary tract infections,
infection pneumonia, enteritis
Toxic appearance Clinical presentation characterized by lethargy, evidence of poor perfusion,
cyanosis, hypoventilation or hyperventilation
Lethargy Poor or absent eye contact; failure of child to recognize parents or to interact
with persons or objects in the environment

Clinical approach to a child with fever

A good clinical history and a thorough physical examination should form the basis of making
a provisional diagnosis. Laboratory tests should only be supportive and not an alternative to
clinical diagnosis.

Fever in infants < 3 months of age should be considered as evidence of serious bacterial infection
until proven otherwise.

In this article,
infant describes a child <1 years old younger
Neonates describes a child 0-28 days old
Young infant refers to a child <3 months.
older infant describes a child <12 months.
Young child refers to a child 1-3 years of age.

Approximately 10 percent of well-appearing young infants with a temperature higher than 38C
(100.4F) harbor a serious bacterial infection or meningitis. In contrast, fewer than 2 percent of well-
appearing older infants and young children with a temperature higher than 39C (102.2F) manifest
bacteremia

*In infants older than 28 days, low risk criteria are well defined. The reference range white blood cell
(WBC) count is 5,000-15,000 cells/L. The band count should be less than 1500 cells/L. ANC (absolute
Neutrofil count) 1000-10000
Rochester Criteria for Identifying Febrile Infants at Low Risk for Serious Bacterial
Infection

Infant appears generally well

Infant has been previously healthy:
-Born at term (37 weeks of gestation)
-No perinatal antimicrobial therapy
-No treatment for unexplained hyperbilirubinemia
-No previous antimicrobial therapy
-No previous hospitalization
-No chronic or underlying illness
-Not hospitalized longer than mother
Infant has no evidence of skin, soft tissue, bone, joint or ear infection
Infant has these laboratory values:
-White blood cell count of 5,000 to 15,000 per mm3 (5 to 15 109 per L)
-Absolute band cell count of 1,500 per mm3 (1.5 109 per L)
-Ten or fewer white blood cells per high-power field on microscopic examination of urine
-Five or fewer white blood cells per high-power field on microscopic examination of stool in
infant with diarrhea